{ "schemaVersion": 2, "eyebrow": "Infectious Diseases", "title": "Toxic Shock Syndrome", "summary": "Toxic shock syndrome is a rapidly progressive toxin-mediated shock syndrome from Staphylococcus aureus or group A Streptococcus. Treat suspected disease before surveillance criteria are complete: resuscitate, obtain cultures, remove or debride the source, and provide pathogen-directed antitoxin therapy.", "seoDescription": "Point-of-care diagnosis and management of staphylococcal and streptococcal toxic shock syndrome, including resuscitation, source control, antibiotics, and IVIG.", "clinicalQuestion": "How should clinicians recognize and immediately manage suspected staphylococcal or streptococcal toxic shock syndrome?", "specialty": "Infectious Diseases", "audience": "U.S. physicians and medical trainees", "tags": [ "toxic shock syndrome", "streptococcal toxic shock syndrome", "staphylococcal toxic shock syndrome", "group A streptococcus", "necrotizing fasciitis", "source control", "clindamycin", "intravenous immunoglobulin" ], "keyTakeaways": [ "Suspect TSS in rapidly evolving shock with gastrointestinal symptoms, diffuse erythema or mucosal hyperemia, and organ dysfunction—even when rash is absent or a source is clinically subtle. [11][18]", "For suspected streptococcal toxic shock syndrome (STSS), hospitalization, shock resuscitation, urgent source control, and penicillin plus clindamycin are CDC-supported first-line management. [16]", "Do not delay surgical evaluation when pain is severe or soft-tissue findings progress; deep infection may require debridement, and STSS mortality can exceed 30% despite aggressive care. [16][17]", "IVIG may be considered early for severely ill STSS, but efficacy remains unproven; it is an adjunct, never a substitute for resuscitation, antibiotics, and source control. [16]" ], "sections": [ { "id": "clinical-recognition", "eyebrow": "Recognition", "heading": "Recognize TSS before surveillance criteria are complete", "intro": "TSS is a clinical emergency, not a diagnosis to defer pending desquamation or microbiologic confirmation.", "paragraphs": [ "TSS results from toxin-producing Staphylococcus aureus or Streptococcus pyogenes. Superantigen activity causes broad T-cell activation and cytokine release, producing capillary leak, hypotension, and multiorgan dysfunction. [19][24] STSS is defined by GAS infection with abrupt shock and organ failure; hypotension generally develops within 24 to 48 hours after initial symptoms. [16]", "A diffuse rash is helpful but not required for early action. In a pediatric series, 48% of STSS cases lacked rash; delayed use of clindamycin and IVIG was associated with longer hospitalization among children without rash. [18] TSS may arise from a small or occult focus, and blood cultures can be negative in staphylococcal disease. [11]", "STSS should be especially considered with severe focal pain out of proportion to examination, recent surgery or skin disruption, varicella-associated skin lesions, diabetes, alcohol use disorder, or age 65 years or older. NSAID exposure may increase risk, although evidence is limited. [16]" ], "bullets": [ "Clinical triggers for immediate escalation: rapidly progressive hypotension; fever or hypothermia; vomiting or diarrhea; myalgias; altered mental status; diffuse erythema or mucosal hyperemia; thrombocytopenia, coagulopathy, kidney injury, liver injury, hypoxemia, or rapidly expanding soft-tissue abnormalities. [16][18][24]", "Actively inspect for a retained tampon, vaginal device, nasal packing, postoperative wound, abscess, cellulitis, burn, deep soft-tissue infection, or necrotizing infection. [11][24]" ], "subsections": [], "table": { "caption": "High-yield distinctions between streptococcal and staphylococcal toxic shock syndromes. [16][18][24]", "columns": [ "Feature", "STSS", "Staphylococcal TSS" ], "rows": [ [ "Usual microbiology", "Group A Streptococcus infection with hypotension, multiorgan involvement, and isolation of GAS required for the CSTE case definition. [16]", "Toxin-producing Staphylococcus aureus; often associated with localized mucosal, wound, or skin infection. [18][24]" ], [ "Clinical source pattern", "Often invasive deep-tissue or bloodstream disease; necrotizing fasciitis or myositis may be present. [16][17]", "May arise from menstrual or nonmenstrual localized sources, including wounds, burns, retained foreign material, or packing. [11][24]" ], [ "Rash", "May be absent; do not use its absence to lower urgency. [18]", "Diffuse erythroderma and later desquamation are characteristic but may not be present initially. [24]" ], [ "Prognosis", "CDC states mortality can exceed 30% despite aggressive treatment. [16]", "Mortality varies by syndrome and setting; prompt recognition, source control, and supportive care remain essential. [11][24]" ] ] } }, { "id": "diagnostic-workup", "eyebrow": "Diagnosis", "heading": "Order cultures and organ-injury testing while resuscitation proceeds", "intro": "The diagnostic task is to establish a toxin-mediated syndrome, identify the organism and source, and exclude competing causes of shock.", "paragraphs": [ "There is no single diagnostic test for TSS. Obtain blood cultures and cultures from any suspected source before antimicrobials when this does not delay treatment. Evaluate organ involvement with CBC and platelets, comprehensive metabolic panel, creatine kinase, coagulation studies, urinalysis, and assessment for pulmonary involvement. [16][24]", "For STSS surveillance classification, the CSTE case definition requires hypotension, multiorgan involvement, and GAS isolation; isolation from a sterile site supports a confirmed case. [16] These criteria optimize specificity and should not be treated as bedside prerequisites for empiric therapy. [18]", "Early imaging should be directed by the suspected source and must not postpone exploration when necrotizing soft-tissue infection is plausible. In STSS, severe pain can precede prominent local findings, and bullae or violaceous progression should prompt emergent surgical exploration. [17]" ], "bullets": [ "Obtain immediately: blood cultures; culture or Gram stain of wound, deep tissue, vaginal/cervical, or other implicated source; CBC with differential and platelets; serum creatinine, hepatic tests, bilirubin, electrolytes, CK, lactate, and coagulation studies. [16][24]", "Assess for occult organ dysfunction: urinalysis, chest imaging or oxygenation assessment when respiratory involvement is suspected, and serial evaluation for kidney injury, coagulopathy, hepatic injury, and tissue necrosis. [18]", "Maintain a broad differential for shock with rash or multisystem disease, including bacterial sepsis, necrotizing soft-tissue infection, rickettsial illness, leptospirosis, measles, Kawasaki disease with shock, and drug reactions. [18][24]" ], "subsections": [], "table": { "caption": "Bedside actions linked to diagnostic findings in suspected TSS. [16][17][18][24]", "columns": [ "Finding", "Interpretation", "Immediate action" ], "rows": [ [ "Hypotension with suspected GAS infection and at least two organ-system abnormalities", "Meets the clinical severity framework for STSS; sterile-site GAS establishes confirmed surveillance classification. [16][17]", "Treat as STSS: resuscitate, start penicillin plus clindamycin when GAS is established or strongly suspected, and seek source control. [16]" ], [ "Severe focal pain, rapidly progressive edema/erythema, vesicles, bullae, or violaceous skin", "Suggests deep soft-tissue infection or necrotizing fasciitis; examination may initially underestimate disease extent. [17]", "Obtain immediate surgical consultation and explore/debride as indicated; do not await late skin findings. [16][17]" ], [ "Diffuse pulmonary infiltrates, pyuria, or coagulation abnormalities", "May occur in TSS even when not uniformly represented in case definitions. [18]", "Document organ involvement, intensify monitoring and organ support, and continue source-directed evaluation. [18]" ], [ "No rash or negative blood cultures", "Does not exclude TSS, particularly early disease or staphylococcal TSS from a localized source. [11][18]", "Continue syndrome-based treatment and aggressively search for a source. [11][24]" ] ] } }, { "id": "initial-management", "eyebrow": "Management", "heading": "Resuscitate, control the source, and start antitoxin-active therapy", "intro": "Early ICU-level care is appropriate when shock or evolving organ failure is present.", "paragraphs": [ "Hospitalize patients with suspected STSS. Begin standard shock management with intravenous fluid resuscitation and organ support; add vasopressors when hypotension persists despite fluids. [16][24] Serially reassess hemodynamics, urine output, respiratory failure, renal function, hepatic injury, coagulation abnormalities, and evolving skin or soft-tissue findings. [16][24]", "Source control is time-critical. Remove tampons, packing, or other retained foreign material; drain abscesses; and obtain urgent surgical assessment for suspected deep infection. CDC specifically notes that surgical debridement may be necessary in STSS. [16]", "For confirmed or strongly suspected STSS, CDC identifies penicillin plus clindamycin as first-line antibiotics. [16] Clindamycin is used in combination, not alone, because it suppresses toxin production but is bacteriostatic. [24] The supplied sources do not provide a U.S. dosing regimen for penicillin or clindamycin; use current institutional severe invasive GAS pathways and adjust to kidney function, allergy history, and microbiology results." ], "bullets": [ "At presentation, use empiric therapy broad enough for MRSA, GAS, and potential polymicrobial soft-tissue infection when the organism and source are uncertain; narrow once cultures and source evaluation clarify the syndrome. [24]", "When GAS is identified, transition to penicillin plus clindamycin unless patient-specific contraindications require an alternative. [16]", "Do not treat antibiotics as a substitute for debridement or removal of an infected device/foreign body. [16][24]" ], "subsections": [ { "heading": "Role of intravenous immunoglobulin", "paragraphs": [ "CDC states that IVIG can be considered early for severely ill patients with STSS, but efficacy has not been proven. [16] A pediatric review found variable outcomes with IVIG and no significant difference in measured outcomes among treatment groups in its retrospective cohort. [18] Use should therefore be individualized, generally as an adjunct in severe or refractory toxin-mediated illness after immediate resuscitation, antimicrobials, and source-control planning are underway. [16][18]" ], "bullets": [ "Document the rationale for IVIG as adjunctive, off-label use in this setting; the supplied sources do not establish an optimal dose. [16][18]", "Do not delay surgery, vasopressors, or appropriate antimicrobials while arranging IVIG. [16][24]" ] } ], "table": { "caption": "Immediate management priorities for suspected TSS. [16][24]", "columns": [ "Priority", "Action", "Practical endpoint" ], "rows": [ [ "Shock", "Initiate intravenous fluid resuscitation and treat shock/organ failure in hospital; use vasopressors for fluid-refractory shock. [16][24]", "Stabilizing perfusion and ongoing reassessment for multiorgan failure. [16][24]" ], [ "Microbiology", "Draw blood cultures and culture the suspected source when feasible without delaying treatment. [16][24]", "Identify GAS, S. aureus, and susceptibility profile; narrow therapy when appropriate. [16][24]" ], [ "Antimicrobials", "Use broad empiric coverage when pathogen is unknown; use penicillin plus clindamycin for STSS. [16][24]", "Early pathogen-directed therapy plus toxin-suppression strategy for GAS. [16][24]" ], [ "Source control", "Remove foreign material; drain abscesses; urgently debride deep or necrotizing infection. [16][24]", "No retained nidus or devitalized infected tissue. [16][17]" ], [ "Adjunctive therapy", "Consider IVIG early in severely ill STSS, recognizing uncertain efficacy. [16]", "Adjunct only; never replaces core resuscitative and source-control measures. [16]" ] ] } }, { "id": "monitoring-prognosis", "eyebrow": "Monitoring", "heading": "Anticipate rapid deterioration and high morbidity", "intro": "Deterioration can occur within hours, particularly in STSS with deep-tissue infection.", "paragraphs": [ "STSS can progress from influenza-like symptoms to hypotension within 24 to 48 hours. [16] Organ failure may involve renal, hepatic, respiratory, hematologic, and soft-tissue systems; complications include need for debridement or amputation. [16][20]", "CDC reports that STSS mortality can exceed 30% despite aggressive treatment and is higher with advancing age. [16] In historical clinical descriptions, deep soft-tissue infection commonly required debridement, fasciotomy, or amputation. [17]", "Monitor serial hemodynamics, vasopressor requirement, urine output and creatinine, platelets and coagulation studies, hepatic tests, oxygenation, CK when myositis is suspected, and repeated examination of the implicated soft-tissue compartment. [16][17][24]" ], "bullets": [ "Escalate surgical reassessment for persistent pain, progressive edema/erythema, new bullae, rising CK, or worsening shock despite antimicrobial therapy. [17]", "Reassess microbiology daily and narrow therapy only after source control, cultures, and clinical trajectory support doing so. [16][24]", "For confirmed invasive GAS, CDC does not routinely recommend antibiotic prophylaxis or routine screening for household contacts; clinicians may consider prophylaxis when household members include persons at increased risk. [16]" ], "subsections": [], "table": { "caption": "Monitoring domains in severe TSS. [16][17][24]", "columns": [ "Domain", "What to follow", "Concerning trajectory" ], "rows": [ [ "Perfusion", "Blood pressure, vasopressor requirement, mental status, urine output, renal function. [16][24]", "Persistent or worsening shock, oliguria, or progressive kidney injury. [16][24]" ], [ "Respiratory", "Oxygenation and pulmonary status. [16][18]", "New or worsening pulmonary infiltrates or respiratory failure. [16][18]" ], [ "Hematologic/hepatic", "Platelets, coagulation studies, bilirubin, aminotransferases. [16][24]", "Progressive thrombocytopenia, coagulopathy, or hepatic dysfunction. [16][24]" ], [ "Soft tissue", "Pain, swelling, erythema, bullae, compartment findings, CK when clinically indicated. [17][24]", "Rapid local progression or evidence of necrosis requiring operative source control. [16][17]" ] ] } } ], "faq": [ { "question": "Can toxic shock syndrome be diagnosed without rash?", "answer": "Yes. Rash may be absent early and was absent in 48% of pediatric STSS cases in one series. Absence of rash must not delay resuscitation, cultures, source evaluation, antitoxin-active therapy, or surgical consultation when the clinical syndrome suggests TSS. [18]" }, { "question": "What is the first-line antibiotic regimen for streptococcal toxic shock syndrome?", "answer": "CDC identifies penicillin plus clindamycin as first-line therapy for STSS. Use clindamycin in combination rather than alone, and pair antibiotics with immediate resuscitation and source control. The supplied sources do not provide dosing; follow current institutional severe invasive GAS protocols. [16][24]" }, { "question": "When should surgery be involved?", "answer": "Immediately when deep soft-tissue infection is possible, especially with severe disproportionate pain, rapidly progressive swelling or erythema, vesicles, bullae, violaceous change, or refractory shock. Debridement may be necessary for STSS and should not await definitive imaging or late cutaneous findings. [16][17]" }, { "question": "Should IVIG be routinely given for STSS?", "answer": "No. CDC permits consideration of IVIG early in severely ill STSS, but states that efficacy has not been proven. It should be individualized as adjunctive therapy after core resuscitation, antimicrobial therapy, and source-control planning are underway. [16][18]" } ], "references": [ { "number": 1, "title": "highlights of prescribing information", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=8d2906e3-d059-425d-b971-29423963c2af&type=display", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov" }, { "number": 2, "title": "Colchicine Tablets USP, 0.6 mg\n \n \nThese highlights do not include all the information needed to use colchicine safely and effectively. See full prescribing information for COLCHICINE TABLETS.\n \n \nCOLCHICINE tablets, USP for oral use\n \n \nInitial U.S. Approval: 1961", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=f818ffe0-43df-4cc6-bc86-00b2c79b06fc&type=display", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov" }, { "number": 3, "title": "These highlights do not include all the information needed to use colchicine safely and effectively. See full prescribing information for Colchicine Tablets, USP. \n Colchicine Tablets, USP, for oral use Initial U.S. Approval: 1961", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=fc439ae8-a79e-4942-8d02-22422b19b015&type=display", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov" }, { "number": 4, "title": "These highlights do not include all the information needed to use ZOSYN safely and effectively. See full prescribing information for ZOSYN.\n \n ZOSYN® (piperacillin and tazobactam) injection, for intravenous use\n Initial U.S. Approval: 1993", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=8ab9d90d-2f7f-4599-a44f-3d0a8f8ab623&type=display", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov" }, { "number": 5, "title": "Toxic Shock Syndrome Surveillance in the United States ...", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/10.7326/0003-4819-96-6-875", "authors": "www.acpjournals.org", "host": "www.acpjournals.org" }, { "number": 6, "title": "Volume 11 Issue Supplement_1 | Clinical Infectious Diseases", "detail": "academic.oup.com", "url": "https://academic.oup.com/cid/issue/11/Supplement_1", "authors": "academic.oup.com", "host": "academic.oup.com" }, { "number": 7, "title": "Epidemiology of Toxic Shock Syndrome in the United States", "detail": "academic.oup.com", "url": "https://academic.oup.com/cid/article/11/Supplement_1/S14/306362", "authors": "academic.oup.com", "host": "academic.oup.com" }, { "number": 8, "title": "Tri-State Toxic-Shock Syndrome Study. II. Clinical and ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/jid/article-abstract/145/4/441/862034", "authors": "academic.oup.com", "host": "academic.oup.com" }, { "number": 9, "title": "Recurrent Nonmenstrual Toxic Shock Syndrome", "detail": "academic.oup.com", "url": "https://academic.oup.com/cid/article-abstract/32/10/1470/466771", "authors": "academic.oup.com", "host": "academic.oup.com" }, { "number": 10, "title": "Toxic Shock Syndrome Toxin 1 - an overview", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/toxic-shock-syndrome-toxin-1", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 11, "title": "Lesson of the month 2: Toxic shock syndrome", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S1470211824027854", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 12, "title": "Prognostic factors in patients hospitalised with group A ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0001706X25002153", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 13, "title": "Toxic Shock Syndrome - an overview", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/toxic-shock-syndrome", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 14, "title": "Group A Streptococcal Pharyngitis", "detail": "www.idsociety.org", "url": "https://www.idsociety.org/practice-guideline/streptococcal-pharyngitis2", "authors": "www.idsociety.org", "host": "www.idsociety.org" }, { "number": 15, "title": "Early and Definitive Diagnosis of Toxic Shock Syndrome by Detection of Marked Expansion of T-Cell-Receptor Vβ2-Positive T Cells - Volume 9, Number 3—March 2003 - Emerging Infectious Diseases journal - CDC", "detail": "wwwnc.cdc.gov", "url": "https://wwwnc.cdc.gov/eid/article/9/3/02-0360_article", "authors": "wwwnc.cdc.gov", "host": "wwwnc.cdc.gov" }, { "number": 16, "title": "Clinical Guidance for Streptococcal Toxic Shock Syndrome | Group A Strep | CDC", "detail": "www.cdc.gov", "url": "https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/streptococcal-toxic-shock-syndrome.html", "authors": "www.cdc.gov", "host": "www.cdc.gov" }, { "number": 17, "title": "Streptococcal Toxic-Shock Syndrome", "detail": "wwwnc.cdc.gov", "url": "https://wwwnc.cdc.gov/eid/article/1/3/pdfs/95-0301.pdf", "authors": "wwwnc.cdc.gov", "host": "wwwnc.cdc.gov" }, { "number": 18, "title": "Manifestations of Toxic Shock Syndrome in Children, Columbus, Ohio, USA, 2010–2017 - Volume 26, Number 6—June 2020 - Emerging Infectious Diseases journal - CDC", "detail": "wwwnc.cdc.gov", "url": "https://wwwnc.cdc.gov/eid/article/26/6/19-0783_article", "authors": "wwwnc.cdc.gov", "host": "wwwnc.cdc.gov" }, { "number": 19, "title": "Superantigens and Streptococcal Toxic Shock Syndrome - Volume 9, Number 10—October 2003 - Emerging Infectious Diseases journal - CDC", "detail": "wwwnc.cdc.gov", "url": "https://wwwnc.cdc.gov/eid/article/9/10/03-0042_article", "authors": "wwwnc.cdc.gov", "host": "wwwnc.cdc.gov" }, { "number": 20, "title": "About Streptococcal Toxic Shock Syndrome | Group A Strep | CDC", "detail": "www.cdc.gov", "url": "https://www.cdc.gov/group-a-strep/about/streptococcal-toxic-shock-syndrome.html", "authors": "www.cdc.gov", "host": "www.cdc.gov" }, { "number": 21, "title": "Toxic Shock Syndrome in Patients Younger than 21 Years ...", "detail": "stacks.cdc.gov", "url": "https://stacks.cdc.gov/view/cdc/114464/cdc_114464_DS1.pdf", "authors": "stacks.cdc.gov", "host": "stacks.cdc.gov" }, { "number": 22, "title": "Staphylococcal Toxic Shock Syndrome 2000–2006", "detail": "stacks.cdc.gov", "url": "https://stacks.cdc.gov/view/cdc/22808/cdc_22808_DS1.pdf", "authors": "stacks.cdc.gov", "host": "stacks.cdc.gov" }, { "number": 23, "title": "The Management of Staphylococcal Toxic Shock Syndrome. A Case Report - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC5939132", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 24, "title": "Toxic Shock Syndrome - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK459345", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "highlights of prescribing information", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=8d2906e3-d059-425d-b971-29423963c2af&type=display", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov", "snippet": "Dose adjustment is recommended for severe renal impairment ( 2.4, 12.3) Dose adjustment is recommended for mild or moderate hepatic impairment;", "score": 0.6155738 }, { "number": 2, "title": "Colchicine Tablets USP, 0.6 mg\n \n \nThese highlights do not include all the information needed to use colchicine safely and effectively. See full prescribing information for COLCHICINE TABLETS.\n \n \nCOLCHICINE tablets, USP for oral use\n \n \nInitial U.S. Approval: 1961", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=f818ffe0-43df-4cc6-bc86-00b2c79b06fc&type=display", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov", "snippet": "during therapy. See FPI for a complete list of reported and potential interactions ( 2.4, 5.3, 7). USE IN SPECIFIC POPULATIONS In the presence of mild to moderate renal or hepatic impairment, adjustment of dosing is not required for treatment of FMF, but patients should be monitored closely ( 8.", "score": 0.27410403 }, { "number": 3, "title": "These highlights do not include all the information needed to use colchicine safely and effectively. See full prescribing information for Colchicine Tablets, USP. \n Colchicine Tablets, USP, for oral use Initial U.S. Approval: 1961", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=fc439ae8-a79e-4942-8d02-22422b19b015&type=display", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov", "snippet": "USE IN SPECIFIC POPULATIONS In the presence of mild to moderate renal or hepatic impairment, adjustment of dosing is not required for treatment of gout flare, prophylaxis of gout flare and FMF, but patients should be monitored closely (8.6). In patients with severe renal impairment for prophylaxis", "score": 0.21546665 }, { "number": 4, "title": "These highlights do not include all the information needed to use ZOSYN safely and effectively. See full prescribing information for ZOSYN.\n \n ZOSYN® (piperacillin and tazobactam) injection, for intravenous use\n Initial U.S. Approval: 1993", "detail": "dailymed.nlm.nih.gov", "url": "https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=8ab9d90d-2f7f-4599-a44f-3d0a8f8ab623&type=display", "authors": "dailymed.nlm.nih.gov", "host": "dailymed.nlm.nih.gov", "snippet": "## 8.5 Geriatric Use\n\nPatients over 65 years are not at an increased risk of developing adverse effects solely because of age. However, dosage should be adjusted in the presence of renal impairment see [Dosage and Administration (2)].\n\nIn general, dose selection for an elderly patient should be caut", "score": 0.20563136 }, { "number": 5, "title": "Toxic Shock Syndrome Surveillance in the United States ...", "detail": "www.acpjournals.org", "url": "https://www.acpjournals.org/doi/10.7326/0003-4819-96-6-875", "authors": "www.acpjournals.org", "host": "www.acpjournals.org", "snippet": "by AL REINGOLD · 1982 · Cited by 250 — Ninety-two percent of the reported cases were associated with menstruation. red predominantly in whites (98%) under the age of 25 (65%). clinical guideline", "score": 0.521886 }, { "number": 6, "title": "Volume 11 Issue Supplement_1 | Clinical Infectious Diseases", "detail": "academic.oup.com", "url": "https://academic.oup.com/cid/issue/11/Supplement_1", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "Epidemiology of Toxic Shock Syndrome in the United States: Overview. Claire V. Broome. Reviews of Infectious Diseases, Volume 11, Issue Supplement_1, January", "score": 0.5749443 }, { "number": 7, "title": "Epidemiology of Toxic Shock Syndrome in the United States", "detail": "academic.oup.com", "url": "https://academic.oup.com/cid/article/11/Supplement_1/S14/306362", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by CV Broome · 1989 · Cited by 83 — Toxic Shock Syndrome in the United States: Key findings include the more frequent isolation from nonmenstrual. Clinical and Epidemiologic Aspects. PDF This", "score": 0.5073975 }, { "number": 8, "title": "Tri-State Toxic-Shock Syndrome Study. II. Clinical and ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/jid/article-abstract/145/4/441/862034", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by JP Davis · 1982 · Cited by 111 — Abstract. Clinical and laboratory findings were examined in 80 nonfatal cases of toxic-shock syndrome (TSS) which occurred in women from Minnesota, Wiscons.", "score": 0.34481892 }, { "number": 9, "title": "Recurrent Nonmenstrual Toxic Shock Syndrome", "detail": "academic.oup.com", "url": "https://academic.oup.com/cid/article-abstract/32/10/1470/466771", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by MM Andrews · 2001 · Cited by 125 — We report 3 cases of recurrent nonmenstrual toxic shock syndrome (TSS) and review the clinical manifestations, diagnosis, and treatment. recurrent nonmenstrual", "score": 0.33567795 }, { "number": 10, "title": "Toxic Shock Syndrome Toxin 1 - an overview", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/toxic-shock-syndrome-toxin-1", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "•\nSee diagnostic criteria below.\n\n#### Diagnosis\n\n•\nThe 2011 Centers for Disease Control and Prevention (CDC) criteria for the diagnosis of TSS ( include the following (six criteria are needed for confirmed infection and five criteria are needed for presumed infection; see the CDC site for more info", "score": 0.5928793 }, { "number": 11, "title": "Lesson of the month 2: Toxic shock syndrome", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S1470211824027854", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "and sensitivity (C+S) tests can be negative, thereby making diagnosing this condition challenging. Clindamycin is superior to penicillin in the treatment of this condition and significantly decreases the mortality rate in TSS. However, there is also an important role for intravenous immunoglobulins ", "score": 0.46935064 }, { "number": 12, "title": "Prognostic factors in patients hospitalised with group A ...", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0001706X25002153", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "by ADK Nguyen · 2025 · Cited by 3 — Individuals with a diagnosis of STSS and/or necrotising fasciitis were more likely to die within 30 days than the individuals without STSS or necrotising", "score": 0.3905461 }, { "number": 13, "title": "Toxic Shock Syndrome - an overview", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/toxic-shock-syndrome", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Toxic shock syndrome (TSS) is defined as an acute illness characterized by fever, diffuse erythematous rash, hypotension, gastrointestinal symptoms,", "score": 0.34720555 }, { "number": 14, "title": "Group A Streptococcal Pharyngitis", "detail": "www.idsociety.org", "url": "https://www.idsociety.org/practice-guideline/streptococcal-pharyngitis2", "authors": "www.idsociety.org", "host": "www.idsociety.org", "snippet": "### References\n\n \n\n## Notes\n\n### Acknowledgments\n\nFirst, we would like to acknowledge the previous panel, under the leadership of Stanford Shulman, for their work on the previous iteration of this larger guideline. The panel would like to acknowledge the contributions of Elizabeth Kiscaden and Mary ", "score": 0.055336285 }, { "number": 15, "title": "Early and Definitive Diagnosis of Toxic Shock Syndrome by Detection of Marked Expansion of T-Cell-Receptor Vβ2-Positive T Cells - Volume 9, Number 3—March 2003 - Emerging Infectious Diseases journal - CDC", "detail": "wwwnc.cdc.gov", "url": "https://wwwnc.cdc.gov/eid/article/9/3/02-0360_article", "authors": "wwwnc.cdc.gov", "host": "wwwnc.cdc.gov", "snippet": "On day 3 after admission to the intensive care unit, an abscess was observed around the surgical wound. Bacteriologic tests showed that the vaginal discharge was positive for MRSA, and a preliminary diagnosis of TSS was made. Peripheral blood mononuclear cells were stained with antibodies to CD3, CD", "score": 0.43510985 }, { "number": 16, "title": "Clinical Guidance for Streptococcal Toxic Shock Syndrome | Group A Strep | CDC", "detail": "www.cdc.gov", "url": "https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/streptococcal-toxic-shock-syndrome.html", "authors": "www.cdc.gov", "host": "www.cdc.gov", "snippet": "### Medical conditions\n\nHaving alcohol use disorder or diabetes can increase risk for developing STSS.\n\n### Medications\n\nUse of non-steroidal anti-inflammatory drugs (NSAIDs) may increase risk, although evidence for this is limited.\n\n### Skin injury or breakdown\n\nRecently having surgery, a viral inf", "score": 0.34224224 }, { "number": 17, "title": "Streptococcal Toxic-Shock Syndrome", "detail": "wwwnc.cdc.gov", "url": "https://wwwnc.cdc.gov/eid/article/1/3/pdfs/95-0301.pdf", "authors": "wwwnc.cdc.gov", "host": "wwwnc.cdc.gov", "snippet": "following: a) Death b) Shock (systolic blood pressure <90 mm of Hg). [...] Confusion is present in 55% of patients, and in some, coma or combativeness is manifest (8). Eighty per-cent of patients have clinical signs of soft tissue infection, such as localized swelling and erythema, which in 70% of p", "score": 0.34118778 }, { "number": 18, "title": "Manifestations of Toxic Shock Syndrome in Children, Columbus, Ohio, USA, 2010–2017 - Volume 26, Number 6—June 2020 - Emerging Infectious Diseases journal - CDC", "detail": "wwwnc.cdc.gov", "url": "https://wwwnc.cdc.gov/eid/article/26/6/19-0783_article", "authors": "wwwnc.cdc.gov", "host": "wwwnc.cdc.gov", "snippet": "### Results\n\nDuring the study period, 456 patients had diagnosis codes of TSS, severe sepsis with septic shock, GAS bacteremia, and necrotizing fasciitis at admission, discharge, or both. Our review of electronic medical records indicated that illnesses of 58 patients met the CDC diagnostic criteria", "score": 0.31044397 }, { "number": 19, "title": "Superantigens and Streptococcal Toxic Shock Syndrome - Volume 9, Number 10—October 2003 - Emerging Infectious Diseases journal - CDC", "detail": "wwwnc.cdc.gov", "url": "https://wwwnc.cdc.gov/eid/article/9/10/03-0042_article", "authors": "wwwnc.cdc.gov", "host": "wwwnc.cdc.gov", "snippet": "from the patients 96/2 and 99/1 (H297 and H360) produced only small amounts of SMEZ in vitro despite the relatively large amounts detected in the acute-phase serum samples. In vitro–produced SMEZ could not be detected in Western blots, indicating a concentration of <1 ng/mL, and could only be detect", "score": 0.3025667 }, { "number": 20, "title": "About Streptococcal Toxic Shock Syndrome | Group A Strep | CDC", "detail": "www.cdc.gov", "url": "https://www.cdc.gov/group-a-strep/about/streptococcal-toxic-shock-syndrome.html", "authors": "www.cdc.gov", "host": "www.cdc.gov", "snippet": "Group A Streptococcus (group A strep bacteria) cause STSS.\n\nIt is very rare for someone with STSS to spread the infection to other people. However, less severe group A strep infection can turn into STSS and these bacteria are contagious.\n\n## Prevention\n\nThere are things people can do to protect them", "score": 0.28558657 }, { "number": 21, "title": "Toxic Shock Syndrome in Patients Younger than 21 Years ...", "detail": "stacks.cdc.gov", "url": "https://stacks.cdc.gov/view/cdc/114464/cdc_114464_DS1.pdf", "authors": "stacks.cdc.gov", "host": "stacks.cdc.gov", "snippet": "by J Leung · 2021 · Cited by 4 — It is characterized by high fever, hypotension, a generalized rash and multiorgan system involvement. Mortality rate estimates for TSS in the", "score": 0.23207551 }, { "number": 22, "title": "Staphylococcal Toxic Shock Syndrome 2000–2006", "detail": "stacks.cdc.gov", "url": "https://stacks.cdc.gov/view/cdc/22808/cdc_22808_DS1.pdf", "authors": "stacks.cdc.gov", "host": "stacks.cdc.gov", "snippet": "by AS DeVries · 2011 · Cited by 198 — 90% of TSS cases, with 20% experiencing recurrent episodes, 50% having long-term memory loss and abnormal EEG findings,", "score": 0.20968035 }, { "number": 23, "title": "The Management of Staphylococcal Toxic Shock Syndrome. A Case Report - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC5939132", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "Treatment and monitoring of the baby were undertaken by a multidisciplinary team in the ICU. This included the use of isolation and incubator conditions and maintaining aseptic measures throughout. This resulted in the favourable resolution of the condition without complications or superinfection of", "score": 0.62824833 }, { "number": 24, "title": "Toxic Shock Syndrome - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK459345", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "## Treatment / Management\n\nPatients should receive aggressive intravenous (IV) fluid hydration with crystalloids. Soft tissue infections, especially necrotizing fasciitis should be sought out and managed. Any source of bacteria such as tampons or nasal packing should immediately be removed. Emergent", "score": 0.60245985 } ], "publishedAt": "2026-08-20T23:48:21.660122Z", "updatedAt": "2026-08-20T23:48:21.660122Z", "readingMinutes": 5, "slug": "toxic-shock-syndrome" }