TSS is an acute, multisystemic disease characterized by high fever, hypotension, vomiting, abdominal pain, diarrhea, myalgias, nonfocal neurologic abnormalities, and an erythematous rash. Many cases occur in menstruating women between 15 and 25 yr of age who use tampons or other vaginal devices (e.g., diaphragm, contraceptive sponge) in the presence of vaginal colonization or infection with toxin-producing strains of S. aureus.
TSS, however, also occurs in children, nonmenstruating women, and men. Nonmenstrual TSS has been associated with wounds, nasal packing, sinusitis, tracheitis, pneumonia, empyema, abscesses, burns, osteomyelitis, and primary bacteremia.
CLINICAL MANIFESTATIONS. The diagnosis of TSS is based on clinical manifestations . The onset is abrupt with high fever, vomiting, and diarrhea and is accompanied by sore throat, headache, and myalgias. A diffuse erythematous macular rash (sunburn-like) appears within 24 hr and may be associated with hyperemia of pharyngeal, conjunctival, and vaginal mucous membranes. Petechiae may develop on day 3-4. Symptoms often include alterations in the level of consciousness, oliguria, and hypotension, which in severe cases may progress to shock and disseminated intravascular coagulation. The most frequent manifestations include diarrhea (98%), myalgia (96%), emesis (92%), fever of more than 40º C (87%), headache (72%), and sore throat (75%). Recovery occurs within 7-10 days and is associated with desquamation, particularly of palms and soles; hair and nail loss have also been observed after 1-2 mo. As is evident from above there are many things that do not fit in to TSS. Those that fit in are the rash, conjunctivitis and the fever. Age, severity of disease and other associated features do not favour TSS. Dr Sharad Kumar wrote:
High grade fever and diffuse sunburn like rash gives a suspicion of TSS. Leucocytosis also favours the infection (15000 or more). Has blood culture been send, does the child has any lymphadenopathy. Azotemia should also be looked.
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