Toxic shock syndrome causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

Toxic shock syndrome (TSS) is known to be caused due to intoxication by one of the various exotoxins produced by Staphylococcus aureus, namely toxic shock syndrome toxin-1 (TSST-1). It may also be caused by some strains of Group A streptococcal (GAS) infection. [1] There have been reports of TSS caused by Clostridium perfringens and Clostridium sordelli in women undergoing medical abortion, parturition and gynaecological procedures.[1][2][3][4][5] Some viruses have also been implicated in the development of toxic shock syndrome.

Causes

Common causes:

1.Staphylococcus associated Toxic shock syndrome (TSS)

2.Group A streptococcus associated Toxic shock syndrome (Toxic sock-like syndrome, TSLS)

  • There have been reports of TSS in patients taking NSAIDs during infection by GAS. The possible mechanism that has been proposed, is inhibition of neutrophil function and increased cytokine production. [7]

Less common causes:

1.Clostridium associated Toxic shock syndrome

  • Clostridium sordellii is a part of the normal flora of the vagina and may gain entry into the uterus via the cervix during spontaneous or induced abortion, childbirth, or menstruationC. sordellii is a cause of toxic shock syndrome associated with gynecologic procedures, parturition, and abortion (including spontaneous, surgical, and medical abortion).[8][9][10][11][12]


2.Viral infection[13]

References

  1. Kulhankova K, King J, Salgado-Pabón W (2014). "Staphylococcal toxic shock syndrome: superantigen-mediated enhancement of endotoxin shock and adaptive immune suppression". Immunol. Res. 59 (1–3): 182–7. doi:10.1007/s12026-014-8538-8. PMID 24816557.
  2. Kulhankova K, King J, Salgado-Pabón W (2014). "Staphylococcal toxic shock syndrome: superantigen-mediated enhancement of endotoxin shock and adaptive immune suppression". Immunol. Res. 59 (1–3): 182–7. doi:10.1007/s12026-014-8538-8. PMID 24816557.
  3. Bergdoll MS, Crass BA, Reiser RF, Robbins RN, Davis JP (1981). "A new staphylococcal enterotoxin, enterotoxin F, associated with toxic-shock-syndrome Staphylococcus aureus isolates". Lancet. 1 (8228): 1017–21. PMID 6112412.
  4. Kluytmans J, van Belkum A, Verbrugh H (1997). "Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks". Clin. Microbiol. Rev. 10 (3): 505–20. PMC 172932. PMID 9227864.
  5. Kulhankova K, King J, Salgado-Pabón W (2014). "Staphylococcal toxic shock syndrome: superantigen-mediated enhancement of endotoxin shock and adaptive immune suppression". Immunol. Res. 59 (1–3): 182–7. doi:10.1007/s12026-014-8538-8. PMID 24816557.
  6. Stevens DL, Tanner MH, Winship J, Swarts R, Ries KM, Schlievert PM, Kaplan E (1989). "Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A". N. Engl. J. Med. 321 (1): 1–7. doi:10.1056/NEJM198907063210101. PMID 2659990.
  7. Stevens DL (1995). "Could nonsteroidal antiinflammatory drugs (NSAIDs) enhance the progression of bacterial infections to toxic shock syndrome?". Clin. Infect. Dis. 21 (4): 977–80. PMID 8645850.
  8. McGregor JA, Soper DE, Lovell G, Todd JK (1989). "Maternal deaths associated with Clostridium sordellii infection". Am. J. Obstet. Gynecol. 161 (4): 987–95. PMID 2801850.
  9. "Clostridium sordellii toxic shock syndrome after medical abortion with mifepristone and intravaginal misoprostol--United States and Canada, 2001-2005". MMWR Morb. Mortal. Wkly. Rep. 54 (29): 724. 2005. PMID 16049422.
  10. Fischer M, Bhatnagar J, Guarner J, Reagan S, Hacker JK, Van Meter SH, Poukens V, Whiteman DB, Iton A, Cheung M, Dassey DE, Shieh WJ, Zaki SR (2005). "Fatal toxic shock syndrome associated with Clostridium sordellii after medical abortion". N. Engl. J. Med. 353 (22): 2352–60. doi:10.1056/NEJMoa051620. PMID 16319384.
  11. Sinave C, Le Templier G, Blouin D, Léveillé F, Deland E (2002). "Toxic shock syndrome due to Clostridium sordellii: a dramatic postpartum and postabortion disease". Clin. Infect. Dis. 35 (11): 1441–3. doi:10.1086/344464. PMID 12439811.
  12. Ho CS, Bhatnagar J, Cohen AL, Hacker JK, Zane SB, Reagan S, Fischer M, Shieh WJ, Guarner J, Ahmad S, Zaki SR, McDonald LC (2009). "Undiagnosed cases of fatal Clostridium-associated toxic shock in Californian women of childbearing age". Am. J. Obstet. Gynecol. 201 (5): 459.e1–7. doi:10.1016/j.ajog.2009.05.023. PMID 19628200.
  13. Tolan RW (1993). "Toxic shock syndrome complicating influenza A in a child: case report and review". Clin. Infect. Dis. 17 (1): 43–5. PMID 8353244.


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