General Comments: role in treatment is unclear, but likely beneficial to reduce organism carriage and inhibit toxin synthesis
Nafcillin or Oxacillin + Clindamycin (see Nafcillin, Oxacillin, [[Oxacillin]]), and Clindamycin): if only methicillin-susceptible Staphylococcus Aureus (MSSA) is suspected
Clindamycin is a protein synthesis inhibitor which decreases in vitro toxin synthesis
Vancomycin + Clindamycin (see Vancomycin and Clindamycin, [[Clindamycin]]): if methicillin-resistant Staphylococcus Aureus (MRSA) is suspected
Clindamycin is a protein synthesis inhibitor which decreases in vitro toxin synthesis
Linezolid (Zyvox) (see Linezolid): also decreases in vitro toxin synthesis
Mortality: usually due to ARDS, hypotension, and/or DIC
Menstrual-Associated TSS: 5% mortality
Non-Menstrual-Associated TSS: 10-15% mortality
Streptococcal TSS: 30-70% mortality
Recurrence: up to 30% of affected menstruating females may have recurrence (although milder) with future menses
Recurrence only occurs in those with lack the anti-TSST-1 antibody
References
General
Case definitions for public health surveillance. MMWR Recomm Rep. 1990 Oct 19;39(RR-13):1-43 [MEDLINE]
Toxic shock syndrome: broadening the differential diagnosis. J Am Board Fam Pract. 2001 Mar-Apr;14(2):131-6 [MEDLINE]
Staphylococcal toxic shock syndrome. Suspicion and prevention are keys to control. Postgrad Med. 2001 Oct;110(4):55-6, 59-62 [MEDLINE]
Diagnosis
XXXX
Clinical
Defining the group A streptococcal toxic shock syndrome. Rationale and consensus definition. The Working Group on Severe Streptococcal Infections. JAMA. 1993;269(3):390 [MEDLINE]
Treatment
Intravenous immunoglobulin for treating sepsis and septic shock. Cochrane Database Syst Rev. 2002(1):CD001090 [MEDLINE]