Toxic Shock Syndrome

• Superantigen (Exotoxin)
  • Bacterial protein from Staphylococcus
    • Polyclonal T-lymphocyte activators
    • Induce prolific cytokine cascades
  • Streptococcus pyogenic superantigen
    • Generates toxic shock syndrome via profound cytokine cascade through macrophage activation
• Clinical
  • Erythematous macular rash
• Diagnosis
  • Clinical
• Exotoxin
  • Low doses
    • Activates Monocytes & Macrophages (via TNF, IL-1, IL-6, Chemokines)
  • Moderate doses
    • Cytokine-induced secondary effectors (NO) become important
    • Systemic effects of TNF, IL-1 (fever, acute phase reactants)
    • Inhibits thrombomodulin & TFPI – tips cascade toward thrombosis
  • High doses
    • Same cytokines cause
    • Systemic vasodilation, diminished myocardial contractility, widespread endothelial injury & activation
    • ARDS, activation of coagulation system, DIC, MSOF