title: Toxic shock syndrome: major advances in pathogenesis, but not treatment.
abstract: Toxic shock syndrome (TSS) is primarily the result of a superantigen-mediated cytokine storm and M protein-mediated neutrophil activation, resulting in the release of mediators leading to respiratory failure, vascular leakage, and shock. Mortality for streptococcal TSS still hovers at 50%. There is evidence to support a role for intravenous immunoglobulin (IVIG) in the treatment of streptococcal TSS. An observational study suggests that an initial conservative surgical approach combined with the use of immune modulators, such as IVIG, may reduce the morbidity associated with extensive surgical exploration in hemodynamically unstable patients without increasing mortality.
authors.affiliation: Department of Microbiology, Mount Sinai Hospital, University Health Network, University of Toronto, 600 University Avenue, Room 1487, Toronto, Ontario M5G 1X5, Canada. delow@mtsinai.on.ca
authors.forename: Donald E
authors.initials: DE
authors.lastname: Low
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D016207:Cytokines / Q000276:immunology; D019115:Fasciitis, Necrotizing / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D015994:Incidence; D052576:Menstrual Hygiene Products / Q000009:adverse effects* / Q000382:microbiology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity; D018410:Pneumonia, Bacterial / Q000150:complications / Q000382:microbiology; D012772:Shock, Septic / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology; D012871:Skin Diseases / Q000150:complications* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000276:immunology / Q000302:isolation & purification / Q000472:pathogenicity; D013290:Streptococcal Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000187:drug effects / Q000276:immunology / Q000302:isolation & purification / Q000472:pathogenicity; D014946:Wound Infection / Q000150:complications* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D016207:Cytokines; D016756:Immunoglobulins, Intravenous
keywords: Cytokine storm; Group A streptococcus; Necrotizing fasciitis; Staphylococcus aureus; Superantigen; Toxic shock syndrome