Toxic shock syndrome

Toxic shock syndrome (TSS) represents a heterogeneous group of disorders th at results in hypotension, multiorgan system involvement, and a characteris tic rash or soft tissue infection caused by staphylococcal or streptococcal exotoxins and enterotoxins. Staphylococcal TSS emerged in the late 1970s a s an illness associated with highly absorbent tampons; subsequently it has been described with postoperative infections, burns, and various viral illn esses. Although the morbidity rate associated with staphylococcal TSS may b e high, the mortality rate approximates 5%. Streptococcal TSS has emerged i n the 1980s and into the 1990s as a disorder that results in rapid progress ion of soft tissue infection in the form of cellulitis, myositis, or necrot izing fasciitis due to pyogenic streptococcal group A exotoxin. The rapidit y of progression of local infection to hypotension and multiorgan failure r esults in a mortality rate of 30-70%. In both forms of TSS, staphylococcal and streptococcal exotoxins function as superantigens, a unique mechanism o f immune activation that results in an exuberant T-cell response and profou nd cytokine expression. The role of antibiotics is reviewed. The use of cli ndamycin in streptococcal TSS and the potential therapeutic role of intrave nous immunoglobulin in both forms of this disorder are discussed as well.