title: Group B streptococcus toxic shock-like syndrome in a healthy woman: a case report.
abstract: BACKGROUND
  Toxic shock syndrome (TSS) is caused by Staphylococcus aureus infection. The disease entity manifests clinically as fever, hypotension, diffuse macular erythema that progresses to desquamation, and dysfunction of > 3 organ systems. Toxic shock-like syndrome (TSLS) has the same clinical manifestation as TSS but is caused by Streptococcus, usually group A, C or G. Here we report on a healthy woman who experienced group B Streptococcus (GBS)-related TSLS, possibly related to tampon use.
  
  
  METHODS
  A 37-year-old woman, gravida 1, para 1, met the diagnostic criteria for TSS/TSLS 5 days after her last tampon use. Blood, urine and vaginal cultures were positive only for GBS. Analysis of the blood isolate suggested a novel GBS superantigen.
  
  
  CONCLUSIONS
  This is the second reported case of GBS causing tampon-associated TSS/TSLS. Up to 40% of healthy menstruating women are vaginally colonized with GBS. Superantigens elaborated by staphylococci and streptococci induce an immunologic mediator storm that affects the circulatory and end-organ systems to produce the clinical picture. Prompt medical therapy involves large-volume isotonic fluid resuscitation and antibiotic coverage with vancomycin and an antistaphylococcal beta-lactam. Clindamycin may dampen the immunologic response and endotoxin production. Corticosteroids and intravenous immunoglobulin may be useful adjuncts; however, nonsteroidal antiinflammatories should be avoided.
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Virginia Mason Medical Center, Seattle, Washington 98101, USA.
authors.forename: J Sean
authors.initials: JS
authors.lastname: Begley
authors.forename: Robert C
authors.initials: RC
authors.lastname: Barnes
mesh_terms: D000328:Adult; D005098:Exotoxins / Q000096:biosynthesis*; D005260:Female; D006801:Humans; D052576:Menstrual Hygiene Products / Q000009:adverse effects*; D012772:Shock, Septic / Q000209:etiology*; D013290:Streptococcal Infections / Q000150:complications* / Q000175:diagnosis / Q000209:etiology; D013292:Streptococcus agalactiae / Q000276:immunology* / Q000302:isolation & purification; D018089:Superantigens / Q000097:blood
chemical_list: D005098:Exotoxins; D018089:Superantigens