Materiały źródłowe

• #1 Toxic shock syndrome – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/329

  Toxic shock syndrome (TSS) is an exotoxin-mediated illness caused by bacterial infection, most commonly group A streptococcus or Staphylococcus aureus. […] Early diagnosis and treatment is essential. […] Treatment includes supportive care in an intensive care unit, early empirical antibiotic treatment, and further culture-sensitive antibiotic treatment. Surgical debridement may be needed for deep-seated streptococcal infections.

• #2 Toxic Shock Syndrome: A Literature Review

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

  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. […] Management of TSS is a medical emergency and relies on early detection, immediate resuscitation, source control and eradication of toxin production, bactericidal antibiotic treatment, and protein synthesis inhibiting antibiotic administration. […] It is crucial to eradicate the source of toxin production. In the case of m-TSS, the foreign bodies (tampon, intrauterine device, menstrual cup, etc.) must be removed as soon as possible. […] Intravenous bactericidal antibiotics must be administered as soon as possible and within the first hour following suspicion according to the Surviving Sepsis Campaign Guidelines.

• #3 Toxic Shock Syndrome (for Teens) | Nemours KidsHealth

  https://kidshealth.org/en/teens/tss.html

  Toxic shock syndrome (TSS) is a medical emergency. So it’s important to know how to prevent it and what signs to watch for. With prompt treatment, it’s usually cured. […] If doctors think someone has toxic shock syndrome, they’ll start intravenous (IV) fluids and antibiotics as soon as possible, even before they’re sure the person has TSS. […] Besides giving antibiotics and IV fluids, as needed doctors will: remove tampons, contraceptive devices, or wound packing; clean wounds; drain a pocket of infection (an abscess). […] People with TSS usually need to stay in the hospital, often in the intensive care unit (ICU), for several days. There, doctors can watch their blood pressure and breathing and check for signs of other problems, such as organ damage.

• #4 Toxic Shock Syndrome – StatPearls – NCBI Bookshelf

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

  Most current guidelines recommend Norepinephrine as a first option. […] Intravenous immunoglobulin (IVIG) is thought to work by neutralizing the activity of the toxins produced and can be considered for shock refractory to fluids and vasopressors. […] While there are no randomized controlled trials supporting its use, observational trials have shown a reduction in mortality with IVIG compared to patients who only received antibiotics. […] The optimal dosing is not well established, but high dose at 2 g/kg is acceptable. […] All patients should be admitted to an intensive care unit. […] Although a small study from 1984 showed reduced illness severity with steroids, there was no improvement in mortality. […] Corticosteroids are currently not recommended as adjunctive therapy for TSS.

• #5 Therapy of toxic shock syndrome – PubMed

  https://pubmed.ncbi.nlm.nih.gov/2196166/

  Toxic shock syndrome (TSS) is an acute febrile, exanthematous illness associated with multisystem failure including shock, renal failure, myocardial failure and adult respiratory distress syndrome (ARDS). […] The signs and symptoms of toxic shock syndrome should be recognised early to permit successful therapy. Patients are usually suffering from hypovolaemia due to leaky capillaries and fluid loss into the interstitial space, and consequently large volumes of fluid, both crystalloid (e.g. saline, electrolyte-solutions) and colloid (e.g. albumin, intravenous gamma-globulin), may be necessary to maintain adequate venous return and cardiac output. […] The site of infection should be adequately drained and treated with antimicrobial therapy. […] Recurrences of TSS can be avoided by appropriate antimicrobial treatment and avoidance of recurrent conditions which might favour staphylococcal toxin production (e.g. use of tampons during menstruation). More than 95% of patients survive toxic shock syndrome if appropriate therapy is instituted early.

• #6 Toxic Shock Syndrome Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/169177-treatment

  Toxic shock syndrome (TSS) has a rapid, dramatic, and fulminant onset. Quick recognition of the syndrome is important for enabling appropriate and prompt treatment. […] The principles in the management of septic shock in general must be instituted as soon as possible. These include the following components: Early recognition, Early and adequate antibiotic therapy, Source control and early debridement of infected/necrotic wounds, Early hemodynamic resuscitation and continued support, Corticosteroids (refractory vasopressor-dependent shock), Tight glycemic control (glucose target of 180 mg/dL is considered to be adequate based on present data), Proper ventilator management with low tidal volume in patients with acute respiratory distress syndrome (ARDS) with maintenance of plateau pressures of less than 30 cm of water.

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

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

  Treatment for toxic shock syndrome includes basic sepsis resuscitation, antibiotics, source control, and intravenous immunoglobulin (IVIG). […] For patients at higher risk of death, consider 1 gram/kg IV on day #1, followed by 0.5 grams/kg daily on days #2-3. […] Debride and/or drain any possible focus of infection. […] The treatment for toxic shock syndrome is fairly benign (and similar to the treatment for septic shock). […] For suspected toxic shock syndrome due to Staphylococcus or Streptococcus, a reasonable initial regimen is often as follows: Linezolid 600 mg IV q6hr. […] Any focus of infection which is potentially secreting toxin must be aggressively drained or debrided. […] IVIG is generally safe. […] The most commonly utilized regimen for IVIG is 1 gram/kg on day #1, followed by 0.5 grams/kg daily on days 2-3. […] Initiate IVIG for patients with known or highly suspected streptococcal toxic shock syndrome with persistent vasopressor requirements or high predicted mortality.

• #7 Toxic Shock Syndrome – StatPearls – NCBI Bookshelf

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

  Patients 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 surgical consultation should be obtained for any wound debridement or surgical cause. This is critical in the early management of toxic shock syndrome. […] Broad-spectrum antibiotics should be administered for those with an unidentified organism, if possible after blood cultures and cultures from the suspected source have been drawn. […] For most institutions, this will include vancomycin or linezolid given the high prevalence of methicillin-resistant Staphylococcus aureus (MRSA). […] Clindamycin should also be administered to suppress toxin production.

• #8 Clinical Guidance for Streptococcal Toxic Shock Syndrome | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/streptococcal-toxic-shock-syndrome.html

  Treatment focuses on addressing issues with shock and specific organs that are failing. […] Treatment includes antibiotics and frequently surgery to remove the source of infection. […] STSS requires hospitalization. Standard treatment of shock and organ failure, such as fluid resuscitation, is imperative as the first step in treatment. […] Start antibiotics as soon as possible, and other needed therapies. […] Once STSS is confirmed, antibiotics can be tailored. […] Penicillin and clindamycin are used in conjunction as first-line antibiotic choices for STSS. […] Removal of the source of infection, if possible, is important in the management of STSS. Surgical debridement of deep tissue infection may be necessary. […] Use of intravenous immunoglobulin can be considered for severely ill patients early in the clinical course although efficacy hasn’t been proven.

• #9 Toxic Shock Syndrome (TSS): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15437-toxic-shock-syndrome

  Treatment typically involves hospitalization due to the potentially life-threatening nature of toxic shock syndrome. First, your healthcare provider will remove any tampons or contraceptive devices from your vagina if that is suspected to be the cause. Then, you’ll be given intravenous (IV) fluids and possibly medications to raise your blood pressure if it’s low. […] The standard treatment for Staphylococcus or Streptococcus infection involves antibiotics through an IV. Antibiotics will help control the growth of bacteria, but they will not eliminate the toxins that have already accumulated in your body. […] Treatment for TSS may involve: […] Antibiotics to treat the infection. […] Purified antibodies taken from donated blood (known as pooled immunoglobulin) to help your body fight the infection.

• #10 Azthena logo with the word Azthena

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

  Patients with toxic shock syndrome are usually admitted to hospital. While in the hospitals, patients may need intensive care for the necessary interventions including intravenous antibiotics, ventilation and symptomatic support. […] The initial step in the management of a patient with toxic shock syndrome is to remove any material that may be responsible for the growth of the infection. […] Following the removal of foreign materials from the body, the infection site should be drained to reduce the colonization of the bacteria. […] As bacteria are the primary cause of toxic shock syndrome, antibiotics are indicated to help control the infection. Given the severity of the condition, such that it can be fatal in a matter of hours, antibiotics are routinely administered intravenously to provide faster and more comprehensive results.

• #10 Azthena logo with the word Azthena

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

  Each patient suffering from toxic shock syndrome presents with a unique situation that needs specific management to be addressed. As a result, there are various other management techniques that are widely used in the treatment of toxic shock syndrome, but are not necessary for all cases. […] The intravenous administration of fluids is commonly practiced to prevent dehydration. This is particularly useful to prevent organ damage as a result of toxic shock syndrome. […] Some patients may experience severe malfunction of the kidney, such that they are unable to successfully filter urine of their own accord. In this instance, dialysis may be required to help them filter urine and excrete unneeded electrolytes. […] Blood pressure can also vary considerably as a result of the shock, which may indicate the need of specific medications to manage this effect of the infection. […] Additionally, some patients require hyperbaric oxygen administration to help support breathing and ensure adequate supply of oxygen to the bodily organs.

• #11 Toxic Shock Syndrome | Sepsis Alliance

  https://www.sepsis.org/sepsisand/toxic-shock/

  Because the symptoms for TSS occur so quickly, its vital that they be recognized, and TSS diagnosed and treated as quickly as possible. Blood tests will be done to find out what type of bacteria caused the TSS. Other tests, such as swabs from parts of your body that could be infected, urine tests, CT scans, and lumbar punctures may also be done. […] The treatment for TSS is the same as for septic shock. If the cause of the infection is removable (tampon, wound packing, etc.), this will be done right away. The doctors will order intravenous (IV) fluids and antibiotics to start fighting the infection right away. Other treatments may include: […] Medications for blood pressure: If your blood pressure is too low, you might need medications to bring it back up. […] Dialysis: If your kidneys have stopped working, you may need dialysis until your kidneys can do their job again.

• #11 Toxic Shock Syndrome | Sepsis Alliance

  https://www.sepsis.org/sepsisand/toxic-shock/

  Oxygen: You may have an oxygen mask that delivers oxygen to help you breathe better. […] Ventilator: If you have trouble breathing, you may need intubation (a tube placed in your trachea) and a ventilator, or breathing machine. […] Surgery: If necessary, a surgeon will operate to remove infected or gangrenous tissue that is causing the TSS.

• #12 Toxic Shock Syndrome: Symptoms, Causes, Tampons, and More

  https://www.healthline.com/health/toxic-shock-syndrome

  Other treatment methods for TSS vary depending on the underlying cause. These can include: If a vaginal sponge or tampon triggered toxic shock, your doctor may need to remove this foreign object from your body. If an open or surgical wound caused TSS, the doctor will drain pus or blood from the wound to clear any infection.

• #12 Toxic Shock Syndrome: Symptoms, Causes, Tampons, and More

  https://www.healthline.com/health/toxic-shock-syndrome

  TSS is a medical emergency. Some people with the condition have to stay in the intensive care unit for several days so that medical staff can closely monitor them. […] Your doctor will most likely give you intravenous (IV) hydration of water, electrolytes, and glucose (crystalloids). This is to help you fight the bacterial infection in your body and dehydration. This will help you manage TSS initially. […] Next, your doctor will likely administer antibiotics that are appropriate for your specific case. Antibiotics for treatment of GAS infection or TSS are typically given for 7 to 14 days. […] Other possible treatments include: medication to stabilize blood pressure, gamma globulin injections to suppress inflammation and boost your body’s immune system, surgical debridement (removal of infected deep tissue).

• #13 Toxic Shock Syndrome: A Literature Review

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

  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. […] Management of TSS is a medical emergency and relies on early detection, immediate resuscitation, source control and eradication of toxin production, bactericidal antibiotic treatment, and protein synthesis inhibiting antibiotic administration. […] It is crucial to eradicate the source of toxin production. In the case of m-TSS, the foreign bodies (tampon, intrauterine device, menstrual cup, etc.) must be removed as soon as possible. […] Intravenous bactericidal antibiotics must be administered as soon as possible and within the first hour following suspicion according to the Surviving Sepsis Campaign Guidelines.

• #14 Streptococcal toxic shock syndrome in the intensive care unit | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-018-0438-y

  In shocked patients, large volumes of crystalloids are usually required, together with significant doses of vasopressors. Invasive hemodynamic monitoring is generally useful in those patients to guide fluid loading, vasopressor treatment, and the possible requirement of inotropic drugs. Virtually all patients with STSS need intubation and ventilatory support, frequently develop ARDS, as well as renal failure requiring renal replacement therapy. Acute kidney injury with elevated creatinine at the time of admission is frequently found in severe GAS infections and STSS, and when present should make the clinician think of this disease. […] Surprisingly, S. pyogenes remains universally susceptible to penicillin despite the widespread use of penicillin for over 7 decades. Some strains have, however, developed resistance to macrolides, tetracyclins and clindamycin. Penicillin G is bactericidal and remains, at high parenteral doses, the first-line treatment for infections due to SGA. In vivo, the efficacy of penicillin might be affected by the inoculum size. Clinical failures of penicillin alone have been reported. Due to the inoculum and steady-state volume of distribution disturbance, maximal parenteral doses of penicillin G are required (e.g., 4 mio IU/4 h.).

• #14 Streptococcal toxic shock syndrome in the intensive care unit | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-018-0438-y

  The management of STSS requires a multidisciplinary team involving intensivists, specialists in infectious diseases, microbiologists, and surgeons. Early identification of the disease, as well as rapid treatment, is key to minimize both morbidity and mortality in this deadly disease. Of extreme importance, a rapid source control and quick initiation of effective antibiotic therapy are both crucial. In the case of STSS, the admission to the ICU, and the initiation of supportive treatment of several dysfunctional organs, is usually necessary. […] When a patient presents with elevated and persistent fever, pain in soft tissues out of proportion with the clinical examination, and/or signs of shock, the multidisciplinary team should meet at the bedside, including a surgeon, discuss the investigation strategy, usually CT, MRI and/or surgical review of the painful region (or the site with radiological abnormalities). The surgical approach has the advantage to look for fascia involvement visually, and to be able to perform a surgical biopsy and histopathology, deep bacteriological cultures, to open fascias if necessary, to check muscle viability underneath the fascia, and perform debridement of necrotic tissues. In case of necrotizing fasciitis and/or myositis, this aggressive surgical approach is the only one that may help stabilize the patient and save his life. The more unstable is the patient (heavy requirement of norepinephrine), the more rapid should this assessment be, and surgical debridement be performed.

• #14 Streptococcal toxic shock syndrome in the intensive care unit | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-018-0438-y

  Lower levels of neutralizing antibodies against streptococcal toxins and the M-protein in patients plasma are correlated with invasive diseases of GAS. Case reports in the 1990s described a lower mortality in patients with STSS who benefited from polyclonal immunoglobulins. These findings pointed at possible importance of antibodies in the protection against invasive diseases and suggested that addition of IV polyclonal immunoglobulins (IVIG) to the treatment may be useful as an adjunctive therapy. Possible mechanisms of action of immunoglobulins in STSS are: neutralization of toxins, improvement in bacterial opsonization, phagocytosis, and killing, as well as a possible immunomodulatory effect mediated by the interaction of Fc receptors and immune cells. […] The first report suggesting a lower mortality in the group of patients with STSS treated with IVIG was reported in an observational cohort study. In a randomized, double-blind placebo-controlled study reported in 2003, patients with IVIG had a recovery of organ function significantly more rapid but no survival advantage. This study was stopped prematurely because of a slow recruitment and was not powered to demonstrate the possible effect of IVIG on mortality. A recent randomized double-blinded placebo-controlled trial tested the effect of IVIG in necrotizing soft tissue infections (INSTINCT trial). There was no statistically significant difference between placebo and the interventional groups concerning the primary outcome (functional status assessed by the physical component summary (PCS) score of the 36-item short-form health survey (SF-36) 6 months after randomization) and the secondary outcome (mortality and multiple organ failure). However, patients suffering from documented STSS represented 10% of the study population making it impossible to draw definite conclusions for this subgroup. Another recent retrospective study could not demonstrate a benefit of routine use of IVIG in necrotizing fasciitis. Guidelines from the Infectious Disease Society of America (IDSA) state that additional studies testing the efficacy of IVIG in this indication are needed and also point to the fact that not all IVIG preparations are alike, in particular with the titers of neutralizing antibodies. Therefore, the use of IVIG in STSS cannot be routinely recommended and should be discussed on a case-by-case basis. Plasmapheresis has been proposed, but level of evidence for its use is even smaller than that for IVIG, and only based on isolated cases reports.

• #14 Streptococcal toxic shock syndrome in the intensive care unit | Annals of Intensive Care | Full Text

  https://annalsofintensivecare.springeropen.com/articles/10.1186/s13613-018-0438-y

  Clindamycin, a lincosamide antibiotic, is usually added to penicillin or aminopenicillin since it inhibits the protein synthesis by blocking the 50S sub-unit of the bacterial ribosome. It thus may therefore block the production of exotoxins such as the superantigens. The effect of decreased production of superantigens by clindamycin treatment has been demonstrated in animal studies. Interestingly, penicillin and clindamycin both inhibit in vitro the production of the streptococcus superantigen pyrogenic exotoxins A (SPEA) and B (SPEB) isolated in S. pyogenes strains implicated in toxic shock syndrome, but the inhibition by clindamycin was significantly more important. […] The addition of clindamycin to penicillin may improve patient outcomes and reduce mortality. Concentrations of the SPEA toxin were significantly lower 1 h after treatment when clindamycin or linezolid was added to penicillin, compared with penicillin alone. The mode of action of linezolid is similar to that of clindamycin, but its use in STSS is limited, and has no theoretical advantage over clindamycin. The optimal duration of antibiotic treatment for STSS remains controversial and is usually guided by the clinical evolution, and by the need for recurrent surgical interventions. Duration of 2 weeks for the antibiotic therapy is often proposed, however, without any strong evidence supporting this duration of treatment. Again, it is important to stress that antibiotic therapy alone is not sufficient to treat and cure STSS. Antibiotic penetration into infected tissues, and sites of soft tissue and muscle necrosis is frequently very low, if not absent. This is essentially due to the poor vascularization of these sites, partly due to infection-induced microvascular thrombosis. Only surgical debridement of infected and necrotic tissues associated with high-dose systemic antibiotic therapy may improve mortality.

• #15 Toxic Shock Syndrome Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/169177-treatment

  The combination of clindamycin and beta-lactam antibiotics may be associated with improved outcomes. Clindamycin may have better tissue penetration than beta-lactam antibiotics, may enhance phagocytosis of pathogens, and may inhibit bacterial superantigen production. […] The administration of empiric broad-spectrum beta-lactam antibiotics in addition to clindamycin or linezolid (as antitoxin) is recommended. […] TSS causes refractory hypotension and diffuse capillary leak; therefore, judicious and even large-volume intravenous fluid resuscitation and invasive hemodynamic monitoring may be necessary. […] Patients with TSS will require supportive measures, including intubation and mechanical ventilation, dialysis in patients who have developed renal failure, and adequate nutritional support.

• #15 Toxic Shock Syndrome Treatment & Management: Medical Care, Surgical Care, Consultations

  https://emedicine.medscape.com/article/169177-treatment

  Although intravenous immunoglobulin (IVIG) therapy in TSS has been suggested, there is no clear clinical evidence to support its use in this setting. […] The administration of IVIG as an adjunctive treatment for TSS requires further evaluation. […] High-dose corticosteroid therapy has not been shown to be beneficial. Stress-dose steroids (hydrocortisone 50 mg IV every 6 hours) may be considered in patients with septic shock despite adequate fluid resuscitation, antimicrobial theory, and source control. […] A deep-seeded pyogenic infection constitutes a surgical emergency, and prompt, aggressive exploration and debridement of infected tissue is strongly indicated. […] Consultation with a surgeon should occur early. A consultation with an infectious diseases specialist is mandatory, and a consultation with an intensivist also is required for management of these patients in an intensive care unit.

• #16 Toxic Shock Syndrome – StatPearls – NCBI Bookshelf

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

  Studies have shown improved outcomes when Clindamycin is added to antibiotic regimens. […] It should not be given alone as it is bacteriostatic, rather than bactericidal. […] Given that it is initially impossible to tell if the infection is polymicrobial, initial therapy should also cover gram-negative organisms. […] Once the organism is identified, and sensitivities have been determined, antibiotics should be optimized and narrowed in the spectrum. […] Penicillin is the preferred antibiotic for group A strep. […] For MSSA, clindamycin is recommended, plus flucloxacillin or a beta-lactamase-resistant penicillin such as nafcillin. […] Current recommendations are to treat for seven to 14 days. […] Vasopressors should be administered for patients with shock refractory to IV fluids.

• #16 Toxic Shock Syndrome – StatPearls – NCBI Bookshelf

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

  Most current guidelines recommend Norepinephrine as a first option. […] Intravenous immunoglobulin (IVIG) is thought to work by neutralizing the activity of the toxins produced and can be considered for shock refractory to fluids and vasopressors. […] While there are no randomized controlled trials supporting its use, observational trials have shown a reduction in mortality with IVIG compared to patients who only received antibiotics. […] The optimal dosing is not well established, but high dose at 2 g/kg is acceptable. […] All patients should be admitted to an intensive care unit. […] Although a small study from 1984 showed reduced illness severity with steroids, there was no improvement in mortality. […] Corticosteroids are currently not recommended as adjunctive therapy for TSS.

• #17 Toxic Shock Syndrome (TSS) – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/gram-positive-cocci/toxic-shock-syndrome-tss

  Treatment of Toxic Shock Syndrome includes antibiotics, intensive support, and IV immune globulin. […] Patients suspected of having TSS should be hospitalized immediately and treated intensively. Tampons, diaphragms, and other foreign bodies should be removed at once. […] Provide aggressive supportive care, and decontaminate and/or debride the source site. […] Give antibiotics (eg, clindamycin or linezolid plus vancomycin, daptomycin, linezolid, or ceftaroline) pending culture and susceptibility testing. […] Give IV immune globulin if TSS is severe.

• #18 Toxic Shock Syndrome Management: A tale of two patients

  https://emcrit.org/pulmcrit/toxic-shock-syndrome-management-a-tale-of-two-patients/

  Toxic shock syndrome (TSS) is a true resuscitationist’s disease. It is potentially quite lethal, with many series of streptococcal toxic shock syndrome reporting mortality in the range of 30-50%. However, recent observational studies suggest that treatment with modern critical care, toxin-suppressive antibiotics, and IVIG may reduce the mortality to 10% (Linner 2014). […] Treatment primarily consists of high-quality sepsis care, but there are some important points that are unique to TSS. […] Clindamycin is the most widely recommended antibiotic for toxin suppression. Clindamycin has activity against 99% of Group A streptococci as well as some activity against staphylococci including some MRSA. Clindamycin acts on the 50s ribosomal subunit to inhibit protein synthesis, thereby stopping toxin synthesis.

• #18 Toxic Shock Syndrome Management: A tale of two patients

  https://emcrit.org/pulmcrit/toxic-shock-syndrome-management-a-tale-of-two-patients/

  TSS may occur due to staph infection including MRSA, or rarely Group A streptococci resistant to clindamycin. Therefore, adding a second antibiotic is advisable. Linezolid may be a logical choice here, because it has excellent coverage for gram positive pathogens and acts similarly to stop toxin synthesis by inhibiting the 50s ribosomal subunit. […] The primary problem in TSS is often not the presence of bacteria in the tissues, but rather toxin secretion causing massive cytokine release. Therefore, antibiotic therapy focuses on protein-synthesis inhibiting drugs which act immediately to shut off toxin synthesis. […] Toxic shock occurs in a minority of people who lack protective antibodies. Pooled immunoglobulin (IVIG) provides such antibodies, and in theory could be a powerful treatment.

• #18 Toxic Shock Syndrome Management: A tale of two patients

  https://emcrit.org/pulmcrit/toxic-shock-syndrome-management-a-tale-of-two-patients/

  Most authors recommend a treatment regimen for TSS based on Darenberg 2003 (1 g/kg IVIG initially, followed by 0.5 g/kg on days 2-3). […] For patients refractory to this therapy, it is reasonable to escalate to higher doses (e.g. 2 g/kg/day, based on data from Norrby-Teglund 2005 discussed further below). […] Source control is a cornerstone of sepsis management in general. This is especially critical if the focus of infection is continuing to secrete toxin. […] Surgeons should be involved early with consideration to debride or drain any possible infectious focus.

• #19 Toxic shock syndrome

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

  Treatment requires hospitalisation and intravenous antibiotics active against the causative organisms are given to eradicate the focus of the infection. […] Flucloxacillin, nafcillin, oxacillin, linezolid, and first generation cephalosporin are the usual choices. Vancomycin can be used in patients sensitive to penicillin. […] For STSS, penicillin plus clindamycin is the most effective combination treatment.

• #19 Toxic shock syndrome

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

  What is the treatment of toxic shock syndrome and STSS? […] Women who have had toxic shock syndrome should avoid using tampons during menstruation as reinfection can occur. If worn, they should be changed every 48 hours. The use of diaphragms and vaginal sponges may also increase the risk of toxic shock syndrome. […] Prompt and thorough wound care will help to avoid toxic shock syndrome and STSS. […] Removing the source of infection ie, tampons, vaginal sponges, nasal packing […] Supportive measures may include: […] Intravenous fluids to treat shock and prevent organ damage […] Medications for very low blood pressure […] Dialysis for renal failure […] Administration of blood products […] Infusions of intravenous immunoglobulin in severe resistant cases […] Oxygen and mechanical ventilation to assist with breathing.

• #20 Toxic shock syndrome – Infectious Disease Advisor

  https://www.infectiousdiseaseadvisor.com/home/decision-support-in-medicine/infectious-diseases/toxic-shock-syndrome/

  If early clinical findings and appropriate cultures and Gram stains do not provide a definitive diagnosis, the empiric broad spectrum antibiotic treatment is crucial. Coverage for MRSA, other Gram-positive microbes, Gram-negative aerobic microbes, and anaerobes is important. […] Several empiric regimens have been suggested and the reader is referred to the section on Treatment of Septic Shock. Piperacillin/tazobactam (3.375g every 6 hours) plus vancomycin (1g every 12 hours), or meropenem (0.51g every 8 hours) plus vancomycin (1g every 12 hours) are reasonable choices. […] In general, if clinical suspicion suggests a toxic shock syndrome but empiric broad spectrum coverage is desired, clindamycin or linezolid should be used early in the course. […] Aggressive fluid replacement with normal saline. Note both strep and staph TSS are associated with capillary leak syndrome, thus crystalloid requirements may be large, i.e. 10-12 L/day.

• #21 Toxic shock syndrome – Wikipedia

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

  Treatment includes intravenous fluids, antibiotics, incision and drainage of any abscesses, and possibly intravenous immunoglobulin. […] Antibiotic treatment should cover both S. pyogenes and S. aureus. This may include a combination of cephalosporins, penicillins or vancomycin. The addition of clindamycin or gentamicin reduces toxin production and mortality. […] The severity of this disease frequently warrants hospitalization. Admission to the intensive care unit is often necessary for supportive care (for aggressive fluid management, ventilation, renal replacement therapy and inotropic support), particularly in the case of multiple organ failure. […] Treatment includes removal or draining of the source of infection—often a tampon—and draining of abscesses. Outcomes are poorer in patients who do not have the source of infection removed.

• #22 HEALTH PROFESSIONALS – TSSIS

  https://www.tssis.com/healthcare_professionals/

  Treatment involves several key components: […] Identification and decontamination of the site of toxin production: Drain or debride the lesion, remove foreign material, and irrigate copiously. Recent surgical wounds should be explored and irrigated even when signs of inflammation are absent. […] Aggressive fluid resuscitation: Loss of fluid into the extravascular compartment can be very substantial. Maintenance of cardiac filling pressures is critical in order to prevent end organ damage. Adult patients with TSS have required up to 10 L of fluid in the first 24 hr. […] Administration of antistaphylococcal antibiotics: Semisynthetic penicillins have been widely used for TSS. Growing evidence, however, suggests that the protein synthesis inhibitor clindamycin is more efficacious in this illness. Accordingly, the author recommends treating suspected TSS patients with clindamycin (900 mg i.v. every 8 hours for adults; 13 mg/kg i.v. every 8 hours for children), either alone or in combination with a cell wall active agent (semisynthetic penicillin or vancomycin). If the diagnosis of TSS is initially uncertain, broader empiric coverage is appropriate.

• #23 Toxic Shock Syndrome – Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/toxic-shock-syndrome-diagnosis/

  Recommended Treatment […] Contact + Droplet Precautions […] Some strains of Streptococcus are more toxogenic than others and outbreaks have been reported. […] High Quality Supportive Care […] High dependency care space – HAU or ICU often required. […] IV fluid resuscitation, targeting euvolemia and normal urine output. […] Vasopressors or Inotropes if required. […] No robust evidence to direct vasopressor selection; Norepinephrine likely still the best first choice. […] Patients with TSS seem to exhibit early myocardial dysfunction, possibly from direct myocardial effects of the toxins, or from robust cytokine release. Consider earlier addition of inotropes compared to the usual septic shock algorithm. […] Steroids if refractory shock, as per septic shock algorithms. […] Beta Lactam Antibiotics to treat both Staphylococcus and Streptococcus, even if infectious source appears benign or subtle.

• #24 Toxic Shock Syndrome: Symptoms and Treatment | Doctor

  https://patient.info/doctor/toxic-shock-syndrome-pro

  Early diagnosis and rapid intervention are the key to arresting the cascade of inflammation that leads to rapid deterioration: […] Any persisting focus of infection, such as abscess, wound pack, wound slough or tampon, should be removed immediately, with surgical assistance if necessary. […] Aggressive haemodynamic resuscitation, preferably with central fluid volume monitoring and regular electrolyte testing, is crucial. […] Vasopressor agents may be used to manage shock, under expert guidance. […] Any abnormality of glucose levels should be closely managed and normalised. […] Antibiotics should include a penicillinase-resistant penicillin, cephalosporin, or vancomycin (in methicillin-resistant S. aureus-prevalent areas) along with either clindamycin or linezolid. […] Steroids may play a role in improving survival. Research has shown that a long course of low-dose corticosteroids reduces 28-day all-cause mortality, and intensive care unit and hospital mortality. […] There is no evidence for the use of activated protein C for treating patients with severe sepsis or septic shock. Activated protein C was therefore withdrawn in 2011.

• #25 Toxic Shock Syndrome (TSS): Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/15437-toxic-shock-syndrome

  Oxygen to help with breathing. […] Fluids to prevent dehydration and organ damage. […] Medicine to help control blood pressure. […] Dialysis if your kidneys stop functioning. […] Surgery to remove dead tissue. Rarely, it may be necessary to amputate the affected area. […] Toxic shock syndrome is serious and life-threatening. Symptoms can progress quickly, and immediate treatment is necessary. Shock, organ failure, amputation of limbs and death can occur if toxic shock syndrome is left untreated. […] No, toxic shock syndrome won’t go away on its own. Prompt treatment is necessary to avoid potentially deadly complications. […] TSS requires prompt treatment with antibiotics, fluids and medication for the best outcomes.

• #26 Toxic shock syndrome – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/toxic-shock-syndrome/diagnosis-treatment/drc-20355390

  If you develop toxic shock syndrome, you’ll likely be hospitalized. In the hospital, you’ll: […] Be treated with antibiotics while doctors seek the infection source […] Receive medication to stabilize your blood pressure if it’s low and fluids to treat dehydration […] Receive supportive care to treat other signs and symptoms. […] Surgery may be necessary to remove nonliving tissue from the site of infection or to drain the infection.

• #27 Toxic shock syndrome

  https://www.nhs.uk/conditions/toxic-shock-syndrome/

  You’ll need urgent hospital treatment for toxic shock syndrome (TSS). […] Treatment can include: antibiotics to treat the infection, fluids to rehydrate you, usually through a drip in your arm, medicine to help control your blood pressure, oxygen, surgery to remove infection from cuts or wounds.

• #28 Toxic Shock Syndrome – Harvard Health

  https://www.health.harvard.edu/a_to_z/toxic-shock-syndrome-a-to-z

  Patients with toxic shock syndrome are hospitalized and treated with: […] intravenous fluids and certain medicines, to raise blood pressure and improve blood flow to vital organs […] antibiotics, to eliminate the bacteria causing the infection and releasing the toxin. […] Your doctor may also prescribe intravenous immune globulin (IVIG) that provides additional antibodies to fight the infection. […] Mechanical ventilation, dialysis, or other supportive measures may be necessary if vital organs fail. […] In some cases of toxic shock syndrome caused by group A streptococci, when there is extensive infection of soft tissues, surgical removal of destroyed tissue may be necessary.

• #29 How Can You Treat and Prevent Toxic Shock Syndrome?

  https://www.webmd.com/women/toxic-shock-syndrome-treatment-prevention

  IV Antibiotics […] This is the most common way doctors treat TSS. Antibiotics will help stop the bacteria from growing in your system. They do not get rid of the toxins that have already built up in your body. The type of antibiotic you get depends on which kind of bacteria is causing your TSS. […] If your TSS is very severe, your doctor may try to treat it with immunoglobulin. Immunoglobulin is a part of blood plasma that has antibodies. You get it through an IV. Immunoglobulin therapy can help boost your bodys defense systems against infection. […] You may also need treatment for the symptoms of TSS, such as: IV fluid for dehydration, shock, and organ damage prevention, Medication to help low blood pressure, Dialysis for kidney failure, Extra oxygen or other devices to help you breathe, Blood transfusion. […] If you have an infection that is very severe, you may have to have surgery to remove dead tissue and deep clean your wound to get rid of all of it.

• #30 Toxic Shock Syndrome – MD Searchlight

  https://mdsearchlight.com/infectious-disease/toxic-shock-syndrome/

  If the bacteria causing the illness is identified through blood or culture tests, then the antibiotics may be changed to ones that specifically target that bacterium. The duration of the antibiotic treatment usually ranges from a week to two weeks. […] In case your condition is severe or you’re in shock, which means that your blood pressure is too low, doctors may use medicines called vasopressors to raise your blood pressure. They might also use a medicine called Intravenous immunoglobulin, or IVIG, which is thought to help neutralize the toxins produced by the bacteria. Importantly, all patients diagnosed with toxic shock syndrome will usually be cared for in an intensive care unit to closely monitor and manage their condition. […] Please note that while steroids were once thought to help reduce the severity of the disease, current recommendations do not suggest their use, as they haven’t been shown to improve survival rates.

• #31 Toxic Shock Syndrome – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/toxic-shock-syndrome-3/

  Drotrecogin alfa, a recombinant activated protein C first used in humans in 2001, may also be used as adjunctive therapy because of its anti-inflammatory and anticoagulant effects. […] The use of systemic corticosteroids as adjunctive therapy in shock is controversial. Low-dose corticosteroids offer hemodynamic improvement but do not affect survival. […] Therapies on the horizon for adjunctive treatment in sepsis include toxoid vaccines that have been found to induce toxin-specific neutralizing antibodies in rabbits. […] Explain to patients and family members that TSS is a potentially life-threatening condition. All organs are at risk of damage, and treatment must be prompt and aggressive in order to minimize morbidity and mortality. If patients fail to respond to supportive care, then adjunctive therapy with IVIG, drotrecogin alfa, or systemic corticosteroids should be considered within 24 hours of onset of illness.

• #32 Toxic shock syndrome | HealthLink BC

  https://www.healthlinkbc.ca/healthlinkbc-files/toxic-shock-syndrome

  TSS cannot be treated at home. Hospital care is required to treat a staph infection and related complications caused by TSS, such as shock. You will be given antibiotics to kill the bacteria and stop further release of toxins. […] If the source of infection involves a tampon, menstrual cup, diaphragm or contraceptive sponge, it should be removed as soon as possible.

• #33 Toxic shock syndrome (TSS) | Better Health Channel

  https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/toxic-shock-syndrome-tss

  If you think you could have toxic shock syndrome, stop using tampons immediately and go to the emergency department of your nearest hospital. Treatment for TSS includes: a stay in hospital, medication (antibiotics) to kill the infection, fluids given through a drip (intravenously) to increase blood pressure and treat dehydration, medical treatment for any complications, such as kidney failure. […] Suggestions to reduce the risk include: Change tampons regularly (at least every four hours). Avoid using super-absorbent tampons. Only unwrap the tampon if you are going to use it immediately. Do not handle the tampon more than you need to. Wash your hands thoroughly before and after inserting the tampon. Be gentle when inserting and removing tampons. Avoid applicator tampons, as the applicator may scrape the vaginal walls. Use pads (sanitary napkins) instead of tampons overnight. Maintain personal hygiene during your period. Do not wear tampons when you do not have your period. Consider using pads or panty liners during the last day or so of your period when your flow is light. Use a lubricating jelly when inserting tampons in the last day or so of your period when your flow is light. There are no clinical trials supporting the use of menstrual cups to reduce the risk of TSS.

• #34 TOXIC SHOCK SYNDROME – TSSIS

  https://www.tssis.com/toxi_shock_syndrome/

  Anyone who suspects they, or someone they know, is suffering from the symptoms of TSS should immediately seek medical attention. If using a tampon, remove it immediately and inform the doctor that you are menstruating and have been using tampons. TSS is treated easily in the early stages but can rapidly become very serious if left untreated.

• #34 TOXIC SHOCK SYNDROME – TSSIS

  https://www.tssis.com/toxi_shock_syndrome/

  With early diagnosis TSS can be successfully treated. […] Quick, effective treatment is vital so its therefore important to recognise the symptoms of TSS. […] If you have TSS, youll need to be admitted to hospital and may need to be treated in an intensive care unit. […] Treatment may involve: Antibiotics to treat the infection, In some cases, pooled immunoglobulin (purified antibodies taken out of donated blood from many people) may also be given to fight the infection, Oxygen to help with breathing, Fluids to help prevent dehydration and organ damage, Medication to help control blood pressure, Dialysis if the kidneys stop functioning, In severe cases, surgery to remove any dead tissue rarely, it may be necessary to amputate the affected area. […] With early diagnosis TSS can be treated with antibiotics to kill the Staphylococcus aureus bacteria, and other medicines which help counteract the symptoms. Most people will start to feel better within a few days, but it may be several weeks before theyre well enough to leave hospital.

• #35 Toxic shock syndrome (TSS) – including symptoms, treatment and prevention | SA Health

  https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/conditions/infectious+diseases/toxic+shock+syndrome/toxic+shock+syndrome+tss+-+including+symptoms+treatment+and+prevention

  Toxic shock syndrome (TSS) is a very rare but potentially serious illness that can affect males or females at any age, but is more common during adolescence. […] Treatment for TSS includes antibiotics. If severely ill, patients may need to be supported in the intensive care unit in a hospital. […] Women who have had an episode of TSS are at increased risk of a second episode. Therefore a doctor may advise against tampon use in women who have had TSS.

• #36 About Streptococcal Toxic Shock Syndrome | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/about/streptococcal-toxic-shock-syndrome.html

  People with STSS need immediate care in a hospital and antibiotics. […] Treatment focuses on managing low blood pressure and multiple organ failure. […] Healthcare providers treat STSS with antibiotics. […] People with STSS need care in a hospital. They often need fluids given through a vein and other treatments to help treat shock and organ failure. Many people with STSS also need surgery to remove infected tissue.

• #37 Toxic shock syndrome: Symptoms, causes, and diagnosis

  https://www.medicalnewstoday.com/articles/175736

  The medical teams aim is to fight the infection as well as supporting any body functions that the infection may have affected. The patient will be hospitalized and may be placed in an intensive care unit. […] Treatment may include: […] Oxygen: The patient will usually be given oxygen to support breathing […] Fluids: These can prevent dehydration and bring blood pressure back up to normal […] Kidneys: A dialysis machine can treat kidney failure by filtering toxins and waste out of the bloodstream […] Damage to skin, fingers, or toes: Treatment may include draining and cleaning wounds in these locations, and, in severe cases, amputation […] Antibiotics: The can be given by IV, directly into the bloodstream […] Immunoglobulin: Samples of donated human blood with high levels of antibodies can be administered to fight the toxin, sometimes alongside antibiotics. […] Patients normally respond to treatment within a couple of days, but they may have to spend several weeks in the hospital.

• #38 Sepsis and toxic shock syndrome (TSS) in children – Children’s Health Neonatology

  https://www.childrens.com/specialties-services/conditions/septic-and-toxic-shock

  Medication and fluids – Treatments for both septic shock and TSS include antibiotics, medications to stabilize blood pressure and fluids to address dehydration. […] Surgery may be necessary to treat the infection. […] Dialysis – In the event of kidney failure, a child may need dialysis. […] Pediatric ICU (PICU) – To provide support for patients with acute life-threatening conditions, Children’s Health has 83 intensive care beds. Children’s Health Pediatric ICU also conducts leading-edge research and brings new therapies to patients often years before they are available at other institutions. Our critical care physicians deliver a full range of intensive care services for children, including those with septic shock or toxic shock syndrome.

• #39 Toxic shock syndrome (TSS) | Healthify

  https://healthify.nz/health-a-z/t/toxic-shock-syndrome-tss/

  TSS gets worse very quickly and can be fatal if it’s not treated quickly. If it’s diagnosed and treated early, most people make a full recovery. If you have TSS, you’ll need to be admitted to the hospital for treatment. […] Treatment can include: removal of infection sources such as tampons, nasal pack or contraceptive diaphragm, draining and cleaning your wound site, antibiotics to treat the infection, intravenous fluids (given through a drip), medicines to help control your blood pressures, oxygen and any other necessary support depending on your condition.

• #40

  https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=zc1905

  Toxic shock syndrome needs treatment right away in a hospital. […] Follow-up care is a key part of your treatment and safety. […] Call your doctor or nurse advice line now or seek immediate medical care if: […] You do not get better as expected.

• #41 Orphanet: Staphylococcal toxic-shock syndrome

  https://www.orpha.net/en/disease/detail/99919

  The onset of staphylococcal TSS is sudden and requires immediate medical treatment in an intensive care unit. Treatment of staphylococcal TSS involves antibiotics (clindamycin) along with supportive therapy (fluid resuscitation, inotropes and vassopressors) and intravenous immunoglobins (IVIGs) that block superantigens. Corticosteroids and recombinant activated protein C (derotrecogin-alpha) can also be helpful in some cases. Dialysis may be necessary for those with renal dysfunction and oxygen supplementation along with mechanical ventilation is required for patients with ARDS. […] Women should refrain from using intravaginal devices, unless necessary, in order to minimize the risk of menstrual related staphylococcal TSS.

• #42

  https://www.healthychildren.org/English/health-issues/conditions/infections/Pages/Toxic-Shock-Syndrome.aspx

  If your child develops TSS, she will need to be hospitalized. She will be treated with antibacterials such as nafcillin, penicillin, or clindamycin for at least 10 to 14 days. […] Supportive treatment, such as giving intravenous fluids and stabilizing blood pressure with medicines, will be necessary. Kidney dialysis may be required in cases of kidney failure and ventilators (respirators) are used for failure of the lungs. […] Intravenous immune globulin treatment may be given to get rid of bacterial toxins in the bloodstream and help speed up recovery.

• #43 Toxic shock syndrome – UF Health

  https://ufhealth.org/conditions-and-treatments/toxic-shock-syndrome

  Treatment includes: […] Removal of materials, such as tampons, vaginal sponges, or nasal packing […] Drainage of infection sites (such as a surgical wound) […] The goal of treatment is to maintain important body functions. This may include: […] Antibiotics for any infection (may be given through an IV) […] Dialysis (if severe kidney problems are present) […] Fluids through a vein (IV) […] Medicines to control blood pressure […] Intravenous gamma globulin in severe cases […] Staying in the hospital intensive care unit (ICU) for monitoring.

• #44 Toxic Shock Syndrome (TSS) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/toxic-shock-syndrome

  Symptoms usually evolve very quickly and treatment almost always requires hospitalization, intravenous antibiotics, and IV fluids, often with medicines to increase blood pressure. […] If you or your child has TSS, hospitalization will likely be needed. Treatment for TSS may include: […] Intravenous (IV) antibiotics […] Intravenous (IV) fluids […] Cardiac medications (if blood pressure is very low) […] Dialysis (for children who develop kidney failure) […] Administration of blood products […] Supplemental oxygen or mechanical ventilation (to assist with breathing) […] Deep surgical cleaning of an infected wound […] Consultation with an infectious diseases specialist.

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