Podcast 586:  Toxic Shock Syndrome

<p><strong>Contributor: Don Stader, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li><span style="font-weight: 400;">Toxic shock syndrome (TSS) is a rare cause of shock typically caused by <em>Staph aureus</em> or <em>Strep pyogenes</em>, that produces a toxin that leads to rapid onset hypotension with a diffuse erythematous rash.</span></li> <li><span style="font-weight: 400;">Signs of TSS may include rapid onset of altered mental status, dizziness, nausea, abdominal discomfort, hypotension, and rash</span></li> <li><span style="font-weight: 400;">TSS is associated with foreign bodies, such as tampons or nasal packing - make sure to remove any offending object</span></li> <li><span style="font-weight: 400;">Clindamycin is the drug of choice because it stops protein synthesis which helps treat toxic shock because toxic shock is caused by a protein (TSST-1) made by the bacteria.  </span></li> <li><span style="font-weight: 400;">TSS is associated iwth high morbidity and mortality despite treatments</span></li> <li><span style="font-weight: 400;">Despite the association with TSS, there is little supporting evidence for prophylactic antibiotics when placing nasal packing</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-size: 10pt;"><span style= "font-weight: 400;">Gottlieb M, Long B, Koyfman A.</span> <a href= "https://pubmed.ncbi.nlm.nih.gov/29366615/"><span style= "font-weight: 400;">The Evaluation and Management of Toxic Shock Syndrome in the Emergency Department: A Review of the Literature.</span></a> <span style="font-weight: 400;">J Emerg Med. 2018;54(6):807-814. doi:10.1016/j.jemermed.2017.12.048</span></span></p> <p><span style="font-size: 10pt;"><span style= "font-weight: 400;">Lange JL, Peeden EH, Stringer SP.</span> <a href="https://pubmed.ncbi.nlm.nih.gov/28716175/"><span style= "font-weight: 400;">Are prophylactic systemic antibiotics necessary with nasal packing? A systematic review.</span></a> <span style= "font-weight: 400;">Am J Rhinol Allergy. 2017;31(4):