Treatment of streptococcal toxic shock syndrome
- Dennis L Stevens, MD, PhD
Dennis L Stevens, MD, PhD
- Professor of Medicine
- University of Washington School of Medicine
Streptococcal toxic shock syndrome (TSS) is a clinical illness characterized by shock and multiorgan failure; it occurs as a result of capillary leak and tissue damage due to release of inflammatory cytokines induced by streptococcal toxins.
Streptococcal TSS occurs most frequently in the setting of infection due to group A Streptococcus (GAS; Streptococcus pyogenes). GAS typically causes pharyngitis or skin and soft tissue infection; these are generally responsive to appropriate antibiotic therapy . Less commonly, GAS causes invasive disease such as necrotizing infection of the skin and fascia, gangrenous myositis, bacteremia, or pneumonia . Invasive disease is complicated by TSS in approximately one-third of cases [3-5].
The treatment of streptococcal toxic shock syndrome will be reviewed here. The epidemiology, clinical manifestations, and diagnosis of streptococcal toxic shock syndrome are discussed separately. (See "Epidemiology, clinical manifestations, and diagnosis of streptococcal toxic shock syndrome".)
Management of streptococcal toxic shock syndrome (TSS) includes treatment of septic shock and associated complications, surgical debridement of infection (if feasible), and antimicrobial therapy (table 1). Such cases frequently require coordinated care from a team, including individuals with clinical expertise in critical care, surgery, and infectious disease.
Treatment of septic shock — Streptococcal sepsis leads to diffuse capillary leak and intractable hypotension. Therefore, large quantities of intravenous (IV) fluids may be necessary to maintain perfusion (up to 10 to 20 L/day); vasopressors may also be required. The approach to management of septic shock is discussed separately. (See "Evaluation and management of suspected sepsis and septic shock in adults".)
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- Treatment of septic shock
- Surgical debridement
- Antibiotic therapy
- - General principles
- - Antibiotic regimens
- Empiric therapy
- Tailored therapy
- - Duration of therapy
- Adjunctive therapy
- - Intravenous immune globulin
- - Other therapies
- MANAGEMENT OF HOUSEHOLD CONTACTS
- SUMMARY AND RECOMMENDATIONS