Infectious Disease Compendium

Toxic Shock Syndrome


There is streptococcal and S. aureus. See each organism for details.

Epidemiologic Risks

The streptococcal form is associated with clinical infection often a necrotizing fascitis or myositis, and rarely with strep throat (The use of NSAIDS is highly associated with the development of streptococcal necrotizing fasciitis).

The staphylococcal is not associated with an obvious infection; half of staphylococcal toxic shock syndromes are due to tampons, half are due to surgical wound infections, which usually occur within 48 hours after surgery. Classic is with nasal packing, the tampon equivalent.

In both cases there is MOSF with a sunburn rash that involves the palms and soles.


Group A streptococci or S. aureus.

Empiric Therapy

Nafcillin / oxacillin OR cefazolin OR vancomycin PLUS clindamycin (900 mg q 8) PLUS IVIG (1 gram/kg on day one and 0.5 gm/kg on day 2 and 3 (PubMed)) PLUS debridement.

IVIG may not help in children for Group A strep (PubMed).

See each organism for details.


Debridement is key. No debridement and the patient will die. And with wound associated TSS the source DOES NOT LOOK INFECTED. It still HAS TO BE DEBRIDED. The caps are there for a purpose. Pay attention.

Not all IVIG preparations have the same anti-TSST activity (PubMed), so response could be less than you would hope.


Curious Cases

Relevant links to my Medscape blog


Once, Twice, Three Times a Toxin

Close Enough