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Staphylococcal toxic shock syndrome (TSS) is a severe, life-threatening infection attributed to Staphylococcus aureus that can progress rapidly to multisystem dysfunction, severe electrolyte disturbances, renal failure, and shock. Risk factors for TSS include retained foreign bodies (e.g., tampons, female barrier contraceptives), skin and soft tissue infections (e.g., abscess, cellulitis, and mastitis), varicella infection, sinusitis, surgery, trauma, childbirth, and influenza.

Clinical Features

TSS is characterized by high fever, profound hypotension, diffuse macular rash, desquamation (1 to 2 weeks after onset of rash), and multiorgan dysfunction. The details regarding the diagnostic criteria for TSS are listed in Table 88-1. Patients presenting early in the course may exhibit nonspecific symptoms such as fever, chills, malaise, myalgias, headache, sore throat, vomiting, diarrhea, or abdominal pain. The rash associated with TSS is described as a “painless sunburn” that typically fades within 3 days and is followed by full-thickness desquamation.

Table 88-1

Case Definition for Toxic Shock Syndrome

Diagnosis and Differential

TSS is a clinical diagnosis characterized by an acute febrile illness associated with erythroderma, hypotension, and multiorgan involvement. Laboratory evaluation reveals evidence of end-organ damage, and testing often includes CBC, comprehensive metabolic panel, coagulation studies, creatine phosphokinase level, urinalysis, chest radiograph, ECG, blood gas, and cultures of blood and other potential sites of infection. Other infections to consider in the differential diagnosis of TSS include streptococcal toxic shock syndrome (STSS), myonecrosis due to Clostridium perfringens, TSS due to Clostridium sordellii, staphylococcal ...

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