Distribution of Etiologies: Streptococcus-associated toxic shock syndrome is more commonly associated with skin or soft tissue infection (including necrotizing fasciitis, myositis, gangrene, and/or cellulitis) than Staphylococcus-associated toxic shock syndrome
Microbiology
Streptococcus Pyogenes (Group A Streptococcus) (see Streptococcus Pyogenes, [[Streptococcus Pyogenes]])
May be associated with elaboration of pyrogenic exotoxin A (although this is controversial): toxin may act as a superantigen, causing T-cell release of inflammatory cytokines
Osteomyelitis (see Osteomyelitis, [[Osteomyelitis]])
Myometritis
Diagnosis
Blood Culture/Sensitivity: bacteremia is more common in Streptococcus-associated toxic shock syndrome than in Staphylococcus-associated toxic shock syndrome
Mortality: over 30% (most deaths occur due to shock and/or respiratory failure)
References
Defining the group A streptococcal toxic shock syndrome. Rationale and consensus definition. The Working Group on Severe Streptococcal Infections. JAMA. 1993 Jan 20;269(3):390-1 [MEDLINE]