Antibiotic therapy does not affect the outcome of the acute syndrome, but it does decrease the recurrence rate of TSS (which can be as high as 60%). The source of infection (e.g., nasal pack, tampon) should be sought and removed. The most important principle is aggressive treatment of shock. Shock that is resistant to volume resuscitation may require pressor agents. Mild cases of TSS may go unrecognized. In severe cases, the onset is acute with fever, chills, profuse watery diarrhea, and vomiting. The characteristic diffuse erythematous rash is followed by desquamation of the palms, fingers, and feet. TSS can be associated with tampon use, childbirth, nasal packing, postoperative wound infections, and infection of superficial wounds. Menstrual-related TSS case mortality is less than 10%.