Both types of TSS are mediated by exotoxins which activate the immune system to release inflammatory cytokines. These exotoxins act as superantigens, causing T cell activation and the resulting “cytokine storm” (TNF-alpha, interleukin [IL]-1, and IL-6) leads to profound shock and multi-organ failure.
Staphylococcal TSS produce Toxic-shock syndrome toxin-1 (TSST-1) and various enterotoxins whereas streptococcal TSS produces streptococcal pyrogenic exotoxins and virulence factors (M strains with M proteins 1 and 3).
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Staphylococcal TSS
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Streptococcal TSS
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Toxins
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Toxic-shock syndrome toxin-1 (TSST-1) and various enterotoxins
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Streptococcal pyrogenic exotoxins and virulence factors (M strains with M proteins 1 and 3)
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Organisms
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Methicillin-sensitive (MSSA) or methicillin-resistant (MRSA) Staphylococcus aureus
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Group A streptococcus (Streptococcus pyogenes)
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Source
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Menstrual TSS
Non-menstrual TSS (post-partum instrumentation; post abdominal surgery)
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Any source (central nervous system, musculoskeletal, lung, intra-abdominal, skin)
Often no source identified
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Other
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Notifiable disease
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