Materiały źródłowe

• #1 Toxic Shock Syndrome in the United States: Surveillance Update, 1979–1996 – Volume 5, Number 6—December 1999 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/5/6/99-0611_article

  Menstrual toxic shock syndrome (TSS) emerged as a public health threat to women of reproductive age in 197980. […] We reviewed surveillance data for the period 1979 to 1996, when 5,296 cases were reported, and discuss changes in the epidemiologic features of TSS. […] TSS became a nationally notifiable disease in 1980. […] After the initial epidemic, the number of reported cases decreased significantly. […] In 1986, active surveillance was conducted in many areas in the United States (total population 34 million) to confirm that trend. […] Ongoing surveillance in the United States allows us to estimate the current incidence of TSS and monitor whether new menstrual or vaginal products affect the risk for disease. […] To address these questions and describe the current epidemiologic characteristics and recent temporal trends of the syndrome, we reviewed data from the ongoing national surveillance for TSS from 1979 through 1996.

• #2 Toxic Shock Syndrome: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/969239-overview

  TSS was first described in children in 1978. […] Subsequent reports identified an association with tampon use by menstruating women. […] Menstrual TSS is more likely in women using highly absorbent tampons, using tampons for more days of their cycle, and keeping a single tampon in place for a longer period of time. […] Over the past decades, the number of cases of menstrual TSS (0.5-1.0 per 100,000 population) has steadily declined; this is thought to be due to the withdrawal of highly absorbent tampons from the market. […] Notably, 50% of cases of TSS are not associated with menstruation. […] In the 1980s, Cone initially reported and Stevens subsequently characterized GAS as a pathogen responsible for invasive soft tissue infection ushered by toxic shocklike syndrome. […] The streptococcal TSS is similar to staphylococcal TSS; however, the blood cultures usually are positive for staphylococci in TSS.

• #3 Toxic Shock Syndrome: Keys in Diagnosis and Management – emDocs

  https://www.emdocs.net/toxic-shock-syndrome-keys-in-diagnosis-and-management/

  Toxic shock syndrome (TSS) is an acute, toxin-mediated sickness with fever, hypotension, multi-organ dysfunction, and a diffuse rash with desquamation. The annual incidence is between 1.5-11 per 100,000 people. […] Cases occur most commonly at the extremes of age, with one study finding that the highest incidence occurred in adults aged > 45 years, followed by children < 5 years. [...] Another study found higher rates among children < 2 years of age and adults ≥ 65 years of age. [...] The usual organisms include Staphylococcus aureus and Streptococcus pyogenes, though others include Streptococcus agalactiae, Streptococcus viridans, Group C Streptococcus, Group G Streptococcus, and Clostridium soredellii are also involved. [...] Staphylococcal TSS was first described in 1978 in kids due to S. aureus, followed by the 1980s with an epidemic in association with tampons.

• #4 Volume 1, Chapter 43. Toxic Shock Syndrome

  http://www.glowm.com/resources/glowm/cd/pages/v1/v1c043.html

  Menses-associated cases linked to the use of diaphragms and vaginal sponges are now well described. […] The proportion of nonmenstrual cases is greater in studies in which active case finding techniques have been used. […] Probably because of improved recognition and treatment, case-fatality ratios as high as 24% in 1980 dropped to approximately 2.6% from 1983 to 1991. […] However, mortality rates for streptococcal TSS remain at 15% to 30%. […] At the height of TSS reporting in 1980, up to 14 cases per 100,000 menstruating women per year were tallied. […] Fewer cases have been reported to the Centers for Disease Control nationally in every succeeding year since. […] Primarily, it is the occurrence of TSS in menstruating women that has appeared to decrease since 1980. […] Active surveillance studies carried out in 1986 showed only 1 case per 100,000 women.

• #5 Toxic Shock Syndrome: A Literature Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10812596/

  Toxic shock syndrome (TSS) is a rare, life-threatening, toxin-mediated infectious process linked, in the vast majority of cases, to toxin-producing strains of Staphylococcus aureus or Streptococcus pyogenes. […] Scientific literature on TSS mainly consists of observational studies, clinical cases, and in vitro data; although more data on TSS are required, additional studies will be difficult to conduct due to the low incidence of the disease. […] Staphylococcal TSS is rare. According to recent studies, the annual incidence of TSS is estimated to be between 0.03 and 0.07/100,000 population and seems to be stable. […] A peak in incidence (13.7/100,000 persons) was observed in the 1980s in the USA, linked to the use of highly absorbent tampons, but its incidence decreased after changes in tampon manufacture.

• #6 Staphylococcal toxic shock syndrome – UpToDate

  https://www.uptodate.com/contents/staphylococcal-toxic-shock-syndrome

  Staphylococcal toxic shock syndrome (TSS) is a clinical illness characterized by rapid onset of fever, rash, hypotension, and multiorgan system involvement. TSS due to Staphylococcus aureus was initially described in 1978; the disease came to public attention in 1980 with the occurrence of a series of menstrual-associated cases. […] TSS associated with S. aureus was first described in a series of pediatric cases in 1978. The incidence rose sharply in 1980; more than 800 cases of menses-related TSS occurred, largely among young women. Clinical illness arose during menstruation and was associated with use of highly absorbent tampons. The incidence of TSS declined sharply after the withdrawal of some tampon brands. […] Subsequently, between 2000 and 2003, the incidence rose slightly; in one report, the incidence increased from 0.8 to 3.4 per 100,000. These cases occurred among women of menstrual age but included both menstrual and nonmenstrual cases. The observed increase in the number of cases may reflect increased recognition due to active laboratory testing for toxin-producing strains, rather than an overall increase in incidence. One study in Minneapolis between 2000 and 2006 noted a stable incidence of staphylococcal TSS overall, with decreasing annual incidence of menstrual TSS among patients >24 years. A review of patients with TSS in Colorado demonstrated no significant change in the incidence of staphylococcal TSS between 1993 and 2006. A survey of TSS cases in the United Kingdom from 2008 to 2012 noted a stable incidence of nonmenstrual TSS but a decline in menstrual TSS cases; in this study, 59 percent of cases were nonmenstrual.

• #7 Toxic shock syndrome epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Toxic_shock_syndrome_epidemiology_and_demographics

  Toxic shock syndrome (TSS) became a nationally notifiable disease in 1983. After the initial epidemic, the number of reported cases decreased significantly. […] Incidence rates declined from 6 to 12 per 100,000 among women 12-49 years of age in 1980 to 1 per 100,000 among women 15-44 years of age in 1986. […] Apart from menstruation associated TSS, non-menstruating cases having a skin or soft tissue infection have also been identified. […] In a study conducted during 2000-2006, the average annual incidence per 100,000 persons of all TSS cases was 0.52 cases, of menstrual cases was 0.69, and of non-menstrual cases was 0.32. […] Women aged 13-24 years had the highest incidence with an annual rate of menstrual TSS of 1.41 cases per 100,000. […] Approximately half the cases of staphylococcal TSS reported today are associated with tampon use during menstruation, usually in young women, though TSS also occurs in children, men, and non-menstruating women.

• #8 Toxic Shock Syndrome – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459345/

  The incidence of menstrual and non-menstrual TSS is estimated to be around 0.8 to 3.4 per 100,000 in the United States. […] The incidence tends to be higher in the winter and is more prevalent in developing countries. […] Infants and the elderly are at highest risk for developing invasive Group A Strep infection, however between 1/5 and 1/3 occur in patients without any predisposing risk factors. […] The skin is the most common source/risk factor for developing severe infection. […] The case fatality rate of Streptococcal TSS may exceed 50%, particularly with delayed diagnosis; whereas non-streptococcal TSS is less than 3%. […] A small study in France showed that non-menstrual Toxic Shock Syndrome had a higher mortality (22%) than that of the menstrual toxic shock syndrome (0%). […] The CDC does not recommend routine screening and chemoprophylaxis of household contacts of patients with invasive Group A Strep (GAS) infections.

• #9 Toxic Shock Syndrome: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/969239-overview

  Most cases are related to the staphylococcal toxin, now called TSS toxin-1 (TSST-1). […] Estimates from population-based studies have documented an incidence of invasive GAS infection of 1.5-5.2 cases per 100,000 people annually. […] Approximately 8-14% of these patients also will develop TSS. […] A history of recent varicella infection markedly increases the risk of infection with GAS to 62.7 cases per 100,000 people per year. […] Staphylococcal TSS is much more common, although data on prevalence do not exist. […] The incidence of menstrual TSS is currently estimated to be 0.5-1.0 per 100,000 population. […] The incidence of nonmenstrual TSS now exceeds menstrual TSS after the hyperabsorbable tampons were removed from the market. […] TSS has occurred in all races, although most cases have been reported from North America and Europe.

• #10 Toxic Shock Syndrome, 2006 – MN Dept. of Health

  https://www.health.state.mn.us/diseases/reportable/dcn/sum06/tss.html

  Surveillance for staphylococcal toxic shock syndrome (STSS) over much of the last 20 years has been passive, relying on infection control and health care providers to notify MDH and report the syndrome. […] Recently, there have been more strains of Staphylococcus aureus isolated carrying the toxin which can lead to STSS. […] No change had been observed in the number of passively reported cases over the last few years, including in 2006, with three to six cases reported annually in the metropolitan area (seven statewide in 2006). […] In order to identify if there was a true increase in the incidence of STSS, MDH began a retrospective review to identify cases of STSS hospitalized during 2000-2003 in the metropolitan area. […] The average yearly incidence was 0.52 cases per 100,000 with a 95% confidence interval (CI) of 0.32-0.77 for all ages.

• #11 Staphylococcal Toxic Shock Syndrome 2000–2006: Epidemiology, Clinical Features, and Molecular Characteristics | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0022997

  Circulating strains of Staphylococcus aureus (SA) have changed in the last 30 years including the emergence of community-associated methicillin-resistant SA (MRSA). A report suggested staphylococcal toxic shock syndrome (TSS) was increasing over 2000-2003. The last population-based assessment of TSS was 1986. […] Population-based active surveillance for TSS meeting the CDC definition using ICD-9 codes was conducted in the Minneapolis-St. Paul area (population 2,642,056) from 2000-2006. […] TSS incidence remained stable across our surveillance period of 2000-2006 and compared to past population-based estimates in the 1980s. MRSA accounted for a small percentage of TSS cases. […] The current passive surveillance system for TSS is limited given the complexity of the clinical diagnosis and lack of a single diagnostic test. It is unclear whether the continually evolving epidemiology of circulating SA strains is leading to a change in the incidence of TSS cases.

• #12 Toxic Shock Syndrome: A Literature Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10812596/

  These features explain the differentiation in the literature of staphylococcal TSS between menstrual (m-TSS) and nonmenstrual (nm-TSS) syndromes. […] In the UK, the incidence of m-TSS was estimated to be 0.09/100,000 and that of nm-TSS was estimated to be 0.04/100,000 persons. […] The highest incidence of m-TSS (1.41/100,000 persons) is observed in women aged 13 to 24 years. […] Streptococcal TSS is rare. Overall, 8 to 22% of patients with severe S. pyogenes infection will develop streptococcal TSS. […] Approximately 40 to 50% of patients with necrotizing soft tissue infection (NSTI) will develop streptococcal TSS. […] The source of infection remains unknown in 50% of cases. […] The mortality rate of staphylococcal TSS is estimated to be approximately 5%. […] The mortality rate of streptococcal TSS is high and estimated to be between 14 and 64% in different published series.

• #13 Toxic Shock Syndrome: A Literature Review

  https://www.mdpi.com/2079-6382/13/1/96

  While m-TSS cases were largely predominant in the 1980s, compared to nm-TSS cases, the proportion of nm-TSS cases gradually increased over time. […] In the UK, the incidence of m-TSS was estimated to be 0.09/100,000 and that of nm-TSS was estimated to be 0.04/100,000 persons. […] The mortality rate of staphylococcal TSS is estimated to be approximately 5%. […] The mortality rate of streptococcal TSS is high and estimated to be between 14 and 64% in different published series.

• #14 Toxic shock syndrome epidemiology and demographics – wikidoc

  https://www.wikidoc.org/index.php/Toxic_shock_syndrome_epidemiology_and_demographics

  Menstruating females had the highest incidence with an annual rate of menstrual TSS of 1.41 cases per 100,000 based on incidence data from 2000-2003. […] It has been estimated that each year 1 to 17 of every 100,000 menstruating females will get TSS. […] About 25 percent of non-menstrual cases of Toxic shock syndrome occur in males. […] Women aged 13-24 years have the highest incidence with an annual rate of menstrual TSS of 1.41 cases per 100,000. […] To date, 42% of cases have occurred in females under the age of 19 years. […] Epidemiology studies conducted in the late 1980s showed that women who develop mTSS tended to be predominately white. […] White population are more likely to be carriers of toxigenic S. aureus than black, Hispanic, or Asian population.

• #15 Toxic Shock Syndrome: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/969239-overview

  Staphylococcal TSS most commonly occurs in women, usually those who are using tampons. […] Some studies have shown no predilection for any particular age for either the streptococcal TSS or staphylococcal TSS. […] However, other studies have reported staphylococcal TSS to be more common in older individuals with underlying medical problems.

• #16 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Toxic-Shock-Syndrome-Incidence.aspx

  Toxic shock syndrome is a rare illness involving a broad inflammatory response and multi-organ failure as a result of exposure to bacterial toxins. […] Since this observation, the incidence of toxic shock syndrome rose significantly throughout the following decade until it reached a peak in the 1980s. From that point, the incidence of toxic shock syndrome continues to decline and is now seen as a relatively rare condition. […] Data from research conducted over the period of 2000-2006 reported that the incidence of toxic shock syndrome remains low and stable. Of all population groups, the incidence per 100,000 people was 0.52. Some particular population groups, such as women aged between 13 and 25 years, were more likely to be affected by the syndrome, with an incidence of 1.41 per 100,000.

• #17 Toxic Shock Syndrome in the United States: Surveillance Update, 1979–1996 – Volume 5, Number 6—December 1999 – Emerging Infectious Diseases journal – CDC

  https://wwwnc.cdc.gov/eid/article/5/6/99-0611_article

  The national TSS surveillance system has been described. […] Cases of TSS are reported to the Centers for Disease Control and Prevention (CDC) by state health departments in standardized case reports that include information on demographic and clinical characteristics, hospitalization status, outcome, laboratory data, products used during menses, and recurrence of menstruation-associated cases. […] Our review of recent passive surveillance data confirms the declining trend previously noted by active surveillance in 1986. […] Changes observed in the epidemiologic characteristics of TSS include an increase in the proportion of nonmenstrual cases and the difference in the risk for death between menstrual and nonmenstrual cases. […] Continued surveillance will monitor the effect of these changes on TSS occurrence.

• #18 Toxic Shock Syndrome | Health & Human Services

  https://hhs.iowa.gov/center-acute-disease-epidemiology/epi-manual/reportable-diseases/toxic-shock-syndrome

  Toxic shock syndrome (TSS) is a serious complication of infection with strains of Staphylococcus aureus. […] In 1980, TSS became widely recognized when an association between TSS and the use of tampons was established. Since that time, the proportion of TSS cases associated with menstruation has decreased. Cases of TSS have been associated with childbirth, abortions, vaginal infections, surgical wound infections, focal lesions of the bone or respiratory tract, and cutaneous or subcutaneous lesions. The source of infection is unknown in up to one-third of cases. Cases are seen in both males and females. […] Persons considered at risk for TSS include: 1) menstruating women using tampons or other inserted vaginal devices (such diaphragms or contraceptive sponges), and 2) persons with focal S. aureus or GAS infections. […] The Council of State and Territorial Epidemiologists (CSTE) surveillance case definitions for Toxic Shock Syndrome can be found at: www.cdc.gov/osels/ph_surveillance/nndss/phs/infdis.htm#top.

• #19 Toxic shock syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Toxic_shock_syndrome

  A rise in reported cases occurred in the early 2000s: eight deaths from the syndrome in California in 2002 after three successive years of four deaths per year, and Schlievert’s study found cases in part of Minnesota more than tripled from 2000 to 2003. Schlievert considers earlier onset of menstruation to be a cause of the rise; others, such as Philip M. Tierno and Bruce A. Hanna, blame new high-absorbency tampons introduced in 1999 and manufacturers discontinuing warnings not to leave tampons in overnight. […] TSS is more common during the winter and spring and occurs most often in the young and old. […] Toxic shock syndrome is commonly known to be an issue for those who menstruate, although fifty percent of toxic shock syndrome cases are unrelated to menstruation. TSS in these cases can be caused by skin wounds, surgical sites, nasal packing, and burns.

• #20 Toxic Shock Syndrome: Keys in Diagnosis and Management – emDocs

  https://www.emdocs.net/toxic-shock-syndrome-keys-in-diagnosis-and-management/

  Following changes in tampon manufacturing and use, a decline in menstrual-related staphylococcal TSS occurred, though non-menstrual staphylococcal TSS has increased. […] Other causes of staphylococcal TSS include post-surgical, post-partum, post-abortion, intrauterine device placement, burns, soft tissue injuries, and focal infections (pneumonia). […] Streptococcal TSS is more common after viral infections, pharyngitis, and local soft tissue trauma. […] Streptococcal TSS is more common with deeper sites of infection and has greater morbidity and mortality than staphylococcal TSS. […] Mortality rates in adults ranges from 30-80%, while pediatric patients demonstrate lower rates (3-10%). […] The CDC recommends using several criteria for diagnosis of TSS, though streptococcal and staphylococcal TSS differ in several components.

• #21 What is the epidemiology of Toxic Shock Syndrome (TSS)? | The Faculty of Intensive Care Medicine

  https://www.ficm.ac.uk/documents/case-of-the-month-33-toxic-shock-syndrome/what-is-the-epidemiology-of-toxic-shock

  TSS is rare and may occur in previously fit and healthy adults. Antibodies to TSST-1 develop in 90% to 95% of the population by the fourth decade so Staphylococcal TSS is predominantly a disease of young adults. Once thought to be predominantly due to retained sanitary products, the majority of staphylococcal TSS is now thought to be caused by non-menstrual factors. […] Streptococcal TSS can occur in all age groups and occurs in about a third of patients with Group A Streptococcal infection. Outbreaks within the community have been reported hence it being a notifiable disease to public health authorities. […] Staphylococcal TSS: approximately 0.07 per 100,000 people per year. Streptococcal TSS: approximately 1 case per 100,000 people per year.

• #22 Toxic shock syndrome | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/toxic-shock-syndrome?embed_domain=hackmd.io%252F%2540yIPUAFeCSL2JsU8smR5nJQ%252Fbnjhjgjghjghjghfavicon.icofavicon.icofavicon.ico&lang=gb

  The staphylococcal toxic shock syndrome is the commonest form, with an annual incidence of 0.5 cases per 100,000 population, with a slightly lower incidence of the second commonest form, streptococcal toxic shock syndrome, estimated at 0.4/100,000 1. […] Mortality rates vary widely, 5-22% for staphylococcal toxic shock syndrome, and from 30-70% for streptococcal toxic shock syndrome 1,2.

• #23 Toxic Shock Syndrome (TSS) – EMCrit Project

  https://emcrit.org/ibcc/tss/

  In an adult population, streptococcal toxic shock appears to be considerably more common than staphylococcal toxic shock syndrome. Staphylococcal toxic shock syndrome occurs predominantly among younger patients, because the vast majority of people develop antibodies to staphylococcal toxins by mid-adulthood. […] The prevalence has increased over the last few decades, due to shifts in the circulating strains of group A streptococcus. […] Streptococcal toxic shock always occurs in combination with invasive streptococcal infection. It occurs in ~10-20% of invasive streptococcal infections due to groups A, C, or G streptococcus (and also potentially Group B streptococcus). […] The possibility of toxic shock syndrome should be considered in any patient with invasive streptococcal infection.

• #24 Surveillance of toxic shock syndrome in the paediatric population in the UK | Archives of Disease in Childhood

  https://adc.bmj.com/content/96/Suppl_1/A5.1

  A UK-wide study of Toxic Shock Syndrome (TSS) cases in UK children under 16 years of age was undertaken beginning November 2008 until the end of November 2009. […] Little data regarding incidence, management and outcomes has been published about children with TSS. […] 50 confirmed and probable cases were identified. […] This study demonstrates streptococcal TSS to have a higher incidence than staphylococcal TSS, in contrast to previous literature. […] A significantly higher mortality was seen with streptococcal TSS indicating it may be a more virulent disease than staphylococcal TSS. […] This study highlights the need for education on patho-aetiology and management of TSS.

• #25 Invasive group A streptococcal disease: Management and chemoprophylaxis | Canadian Paediatric Society

  https://cps.ca/documents/position/Invasive-group-A-streptococcal-disease

  The most common clinical presentations of IGAS infections are toxic shock syndrome (TSS), with or without a focus of infection, necrotizing fasciitis (NF) or myositis, bacteremia with no septic focus, and pneumonia. […] The incidence of IGAS disease in Canada, based on reported cases, has increased over the past decade. […] In Canada and the United States, rates are highest in infants, young children and the elderly. […] Two studies assessing secondary cases in household contacts reported rates of 0.66 and 2.94 per 1000, respectively, which were 20 to 100 times the rates in the overall populations studied. […] Nosocomial transmission is well documented, including transmission to health care workers. […] Currently, IGAS is reportable in all provinces and territories in Canada. […] The PHAC Guidelines for the prevention and control of invasive group A streptococcal disease are based on consensus definitions and summarized below:

• #26 Reporting Toxic Shock Syndrome – MN Dept. of Health

  https://www.health.state.mn.us/diseases/tss/report.html

  Toxic shock syndrome must be reported to MDH within one working day. […] For toxic shock syndrome, submission of clinical materials (isolate, if available) to MDH is required by rule. […] Health care practitioners (health care facilities, medical laboratories, and in certain circumstances veterinarians and veterinary medical laboratories) are required to report disease to the Minnesota Department of Health (MDH) under Minnesota state law. […] Any person in charge of any institution, school, child care facility, or camp is also required to report disease to MDH.

• #27 Toxic Shock Syndrome | Wisconsin Department of Health Services

  https://www.dhs.wisconsin.gov/invasive-bacteria/toxic-shock-syndrome.htm

  Toxic shock syndrome (TSS) is a serious illness most often caused by the bacterium Staphylococcus aureus and less commonly Streptococcus pyogenes (group A Streptococcus) both of which can produce „toxins.” […] TSS is now known to be associated with other risk factors such as surgical wounds and childbirth. […] This is a Wisconsin disease surveillance category II disease: […] Report to the patient’s local public health department electronically, through the Wisconsin Electronic Disease Surveillance System (WEDSS), by mail or fax using an Acute and Communicable Disease case report, F-44151 (Word) or by other means within 72 hours upon recognition of a case.

• #28 Staphylococcal Toxic Shock Syndrome 2000–2006: Epidemiology, Clinical Features, and Molecular Characteristics | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0022997

  Over the years 2000-2006, the annual incidence rate of all TSS, menstrual TSS, and non-menstrual TSS did not change significantly (test of trend p=0.63, p=0.71, and p=0.77 respectively). […] In conclusion, we observed a stable incidence of both menstrual and non-menstrual TSS in the years 2000-2003 compared to the late 1980s, with the highest incidence among women aged 13-24 years. There was also no significant increase in annual TSS incidence over the years 2000-2006.

• #29 Toxic Shock Syndrome, 2006 – MN Dept. of Health

  https://www.health.state.mn.us/diseases/reportable/dcn/sum06/tss.html

  We identified an increase in the incidence of menstrual STSS among ages 13-24 years during 2000-2003 (0.1 to 2.3, p=.02) but a decrease in the incidence of menstrual STSS among females aged 25-54 years (1.0 to 0.2, p=0.01). […] Currently, MDH is reviewing cases of possible STSS from 2004-06 to identify if there is a continued increasing trend in the incidence of menstrual STSS cases aged 13-24 years. […] Reporting of STSS continues to be a challenge, especially for nonmenstrual cases.

• #30 Streptococcal toxic shock and other toxic shock syndromes | Deranged Physiology

  https://derangedphysiology.com/main/required-reading/sepsis-and-infections/Chapter-342/toxic-shock-syndrome

  Toxic shock syndrome is exceedingly uncommon in Australia, with one paper by Chen et al (2016) finding only 62 paediatric cases from eleven years in Victoria. […] Invasive Group A strep infections are „notifiable” here, meaning that the cases are now recorded centrally, allowing the generation of reports such as this one. […] That specific health district had a peak incidence of 9 cases per 100,000 of population, with an increasing trend. […] Mortality was 12.6% for all cases (whereas in Europe the mortality from this is 30%), with a median age of 36, which makes sense considering the pathophysiology. […] Wright et al (2021) also noted an increased incidence among Indigenous Australians.

• #31 Toxic shock syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/toxic-shock-syndrome/symptoms-causes/syc-20355384

  Toxic shock syndrome is a rare, life-threatening complication of certain types of bacterial infections. […] Toxic shock syndrome can affect anyone, including men, children and postmenopausal women. […] Risk factors for toxic shock syndrome include skin wounds, surgery, and the use of tampons and other devices, such as menstrual cups, contraceptive sponges or diaphragms. […] Most commonly, Staphylococcus aureus (staph) bacteria cause toxic shock syndrome. The syndrome can also be caused by group A streptococcus (strep) bacteria. […] Toxic shock syndrome can affect anyone. About half the cases of toxic shock syndrome associated with staphylococci bacteria occur in women of menstruating age; the rest occur in older women, men and children. […] Streptococcal toxic shock syndrome occurs in people of all ages.

• #32 Toxic Shock Syndrome – Epidemiology

  https://www.vdh.virginia.gov/epidemiology/epidemiology-fact-sheets/toxic-shock-syndrome/

  Toxic shock syndrome (TSS) is a serious bacterial infection that affects many systems of the body. Staphylococcus aureus (commonly referred to as staph) and Streptococcus pyogenes (usually referred to as group A Streptococcus or strep) are the two bacteria most often associated with toxic shock syndrome. […] Anyone can get TSS but some factors can increase risk. Women that use tampons, contraceptive sponges, diaphragms or other devices may be at increased risk of staph TSS. […] TSS from S. pyogenes is most commonly seen in children and older adults. […] TSS is an uncommon and serious complication from a bacterial infection and does not spread to others. […] Early recognition and treatment of staphylococcal and streptococcal infections can help prevent serious complications such as TSS.

• #33 Toxic shock syndrome – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/toxic-shock-syndrome/symptoms-causes/syc-20355384

  Toxic shock syndrome has been associated with having cuts or burns on your skin, having had recent surgery, using contraceptive sponges, diaphragms, superabsorbent tampons or menstrual cups, and having a viral infection, such as the flu or chickenpox. […] Toxic shock syndrome can recur. People who’ve had it once can get it again. If you’ve had toxic shock syndrome or a prior serious staph or strep infection, don’t use tampons.

• #34 Toxic Shock Syndrome: Keys in Diagnosis and Management – emDocs

  https://www.emdocs.net/toxic-shock-syndrome-keys-in-diagnosis-and-management/

  Based on these criteria, you can see that official diagnosis in the ED is difficult. […] Patients may not exhibit the necessary signs or symptoms to meet the complete CDC criteria for diagnosis. […] In fact, these criteria were initially designed for research, not clinical use, and most of the criteria develop later in the disease course. […] Another difficult aspect is that many other dangerous conditions may present in a similar fashion including meningococcemia, septic shock, and primary adrenal insufficiency. […] If the disease is likely but does not meet official CDC criteria, treatment for TSS is recommended, while focusing on resuscitation and broad-spectrum antibiotics. […] Knowledge of the clinical features, laboratory testing, and treatment can assist emergency clinicians in diagnosing and management this condition.

• #35

  https://journals.lww.com/pidj/fulltext/2018/12000/epidemiology_and_clinical_relevance_of_toxic_shock.5.aspx

  It is important for clinicians to recognize the contribution of toxic shock syndrome (TSS) to the overall burden of pediatric septic shock because the clinical features, optimal therapy and prognosis differ from non-TSS septic shock. […] Of 8,226 cases of pediatric septic shock, 909 (11.1%) were classified as TSS and 562 (6.8%) were possible TSS cases. Staphylococcal TSS represented the majority (83%) of TSS cases and occurred more commonly in females and at an older age. […] Results demonstrate a significant contribution of TSS to the burden of pediatric septic shock in the United States. The findings emphasize the importance of inclusion of TSS diagnostic and therapeutic considerations in sepsis treatment protocols for children.

• #36 Toxic shock syndrome

  https://dermnetnz.org/topics/toxic-shock-syndrome-and-toxic-shock-like-syndrome

  Non-menstrual toxic shock syndrome and STSS occur in males and females of all age groups, associated with localised or systemic infections. […] The majority of cases are in healthy persons aged between 20 to 50 years, despite those most susceptible to staphylococcal and streptococcal infections being infants and young children, elderly, and immunocompromised individuals. […] Toxic shock syndrome diagnosis is confirmed if all 5 CDC clinical criteria are fulfilled. […] A probable case fulfils 4 of the 5 criteria. […] Toxic shock syndrome is a medical emergency that requires prompt treatment. […] Early diagnosis and appropriate treatment prevents progression of the disease and possible complications such as heart problems, acute renal failure, adult respiratory distress syndrome, and disseminated intravascular coagulation. […] The mortality rate of toxic shock syndrome is approximately 515%, and recurrences have been reported in as many as 3040% of cases.

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