Streptococcal toxic shock syndrome in the setting of recent gynecologic surgery: A case report

Toxic shock syndrome secondary to Group A Streptococcus infection: A case report

Toxic shock syndrome secondary to Group A Streptococcus infection is a rare but serious cause of women's morbidity and mortality which can easily be misdiagnosed. A 37-year-old woman presented to the emergency department in a state of shock after a two-day history of abdominal pain, fever, diarrhoea and green vaginal discharge. Following extensive investigations, she was proved to have septic shock secondary to Group A Streptococcus pyogenes. Despite receiving intravenous antibiotics, she required explorative laparotomy, which proceeded to subtotal hysterectomy and bilateral salpingectomy. Subsequently, she developed multi-organ failure, disseminated intravascular coagulation, and limb ischemia requiring below-knee amputation of the right limb. She was discharged home. The aim of this report is to raise the awareness about toxic shock syndrome from Streptococcus pyogenes. A high index of suspicion is required to promptly diagnose this rare yet potentially fatal infection.

Systematic Review of Intrauterine Contraceptive Use and the Development of Toxic Shock Syndrome

The objective of this systematic review was to characterize the literature regarding the risk factors associated with the development of toxic shock syndrome (TSS) secondary to the use of intrauterine contraceptives (IUCs), as well as patient outcomes. A literature search was conducted spanning origin through December 12, 2022, using Embase and MEDLINE ALL. Primary literature that discussed development of TSS along with the presence of an IUC were included. Extracted data included study and participant demographics, IUC data, and infection data. Reports were evaluated for risk-of-bias using the Joanna Briggs Institute critical appraisal tool for case reports. Thirteen reports met the eligibility criteria, all of which were case reports involving one patient per case who developed TSS following the insertion of an IUC or in the presence of an IUC. The patients included in the review were women aged 23 to 50 years old. Major outcomes reported included time of IUD insertion, bacteria cultured, and antibiotic therapies administered. A minority of the reports (n = 5) provided data related to recent or prior childbirth, miscarriages, or abortions, some of which were proposed to have contributed to development of TSS. Risk-of-bias assessments identified potential concerns in four domains. This systematic review characterized literature pertaining to IUC use and TSS. There may be a low but possible risk of TSS when using an IUC; generalizability is limited given the low quality of available studies. This study was neither registered nor funded.

Toxic Shock Syndrome: A Literature Review

Toxic shock syndrome (TSS) is a rare, life-threatening, toxin-mediated infectious process linked, in the vast majority of cases, to toxin-producing strains of Staphylococcus aureus or Streptococcus pyogenes. The pathophysiology, epidemiology, clinical presentation, microbiological features, management and outcome of TSS are described in this review. Bacterial superantigenic exotoxins induces unconventional polyclonal lymphocyte activation, which leads to rapid shock, multiple organ failure syndrome, and death. The main described superantigenic exotoxins are toxic shock syndrome toxin-1 (TSST-1) and enterotoxins for Staphylococcus aureus and Streptococcal pyrogenic exotoxins (SpE) A, B, and C and streptococcal superantigen A (SsA) for Streptococcus pyogenes. Staphylococcal TSS can be menstrual or nonmenstrual. Streptococcal TSS is linked to a severe group A streptococcal infection and, most frequently, to a necrotizing soft tissue infection. Management of TSS is a medical emergency and relies on early detection, immediate resuscitation, source control and eradication of toxin production, bactericidal antibiotic treatment, and protein synthesis inhibiting antibiotic administration. The interest of polyclonal intravenous immunoglobulin G administration as an adjunctive treatment for TSS requires further evaluation. Scientific literature on TSS mainly consists of observational studies, clinical cases, and in vitro data; although more data on TSS are required, additional studies will be difficult to conduct due to the low incidence of the disease.