toxic shock syndrome (TSS), a severe acute disease caused by infection with strains of Staphylococcus aureus, phage group I, that produces a unique toxin, enterotoxin F. It is most common in menstruating women using high-absorbency tampons but has been seen in newborns, children, and men. ▪ OBSERVATIONS: The onset of the syndrome is characterized by sudden high fever, headache, sore throat with swelling of the mucous membranes, diarrhea, nausea, and erythroderma. Acute renal failure, abnormal liver function, confusion, and refractory hypotension usually follow, and death may occur. It is probable that mild forms of the syndrome are not reported and therefore are not diagnosed. No seasonal or geographic factor appears involved in the cause of the disease, and there is no evidence of contagion among household members or through sexual contacts of people who have TSS. Bacteremia, or discernible local infection, is absent in most cases. S. aureus may be cultured from many sites, including the pharynx, nares, and cervix, but the drastic effects of infection are the result of the toxin released from the organism rather than from the infection itself. ▪ INTERVENTIONS: Aggressive volume expansion by the administration of large amounts of IV fluids, assisted ventilation, and administration of vasopressors may be necessary in treating severe TSS. Early recognition and active supportive treatment greatly improve the survival rates and decrease both prolonged morbidity and recurrence.
