Toxic shock syndrome (TSS) is a condition caused by bacterial toxins. Symptoms may include fever, rash, skin peeling, and low blood pressure. There may also be symptoms related to the specific underlying infection such as mastitis, osteomyelitis, necrotising fasciitis, or pneumonia.TSS is typically caused by bacteria of the Streptococcus pyogenes or Staphylococcus aureus type, though others may also be involved. Streptococcal toxic shock syndrome is sometimes referred to as toxic-shock-like syndrome (TSLS). The underlying mechanism involves the production of superantigens during an invasive streptococcus infection or a localized staphylococcus infection. Risk factors for the staphylococcal type include the use of very absorbent tampons, and skin lesions in young children characterized by fever, low blood pressure, rash, vomiting and/or diarrhea, and multiorgan failure. Diagnosis is typically based on symptoms.Treatment includes intravenous fluids, antibiotics, incision and drainage of any abscesses, and possibly intravenous immunoglobulin. The need for rapid removal of infected tissue via surgery in those with a streptococcal cause, while commonly recommended, is poorly supported by the evidence. Some recommend delaying surgical debridement. The overall risk of death is about 50% in streptococcal disease, and 5% in staphylococcal disease. Death may occur within 2 days.In the United States, streptococcal TSS occurs in about 3 per 100,000 per year, and staphylococcal TSS in about 0.5 per 100,000 per year. The condition is more common in the developing world. It was first described in 1927. Due to the association with very absorbent tampons, these products were removed from sale.
Chicken Pox)
Contraceptive sponges
History of a recent birth, miscarriage, or abortion
Using super-absorbent tampons
Previously having TSS

Diagnosis
For staphylococcal toxic shock syndrome, the diagnosis is based upon CDC criteria defined in 2011, as follows:
Body temperature > 38.9 °C (102.02 °F)
Systolic blood pressure < 90 mmHg
Diffuse macular erythroderma
Desquamation (especially of the palms and soles) 1–2 weeks after onset
Involvement of three or more organ systems:
Gastrointestinal (vomiting, diarrhea)
Muscular: severe myalgia or creatine phosphokinase level at least twice the upper limit of normal for laboratory
Mucous membrane hyperemia (vaginal, oral, conjunctival)
Kidney failure (serum creatinine > 2 times normal)
Liver inflammation (bilirubin, AST, or ALT > 2 times normal)
Low platelet count (platelet count < 100,000 / mm3)
Central nervous system involvement (confusion without any focal neurological findings)
Negative results of:
Blood, throat, and CSF cultures for other bacteria (besides S. aureus)
Negative serology for Rickettsia infection, leptospirosis, and measlesCases are classified as confirmed or probable as follows:

Confirmed: All six of the criteria above are met (unless the patient dies before desquamation can occur)
Probable: Five of the six criteria above are met

Treatment
The severity of this disease frequently warrants hospitalization. Admission to the intensive care unit is often necessary for supportive care (for aggressive fluid management, ventilation, renal replacement therapy and inotropic support), particularly in the case of multiple organ failure. Treatment includes removal or draining of the source of infection—often a tampon—and draining of abscesses. Outcomes are poorer in patients who do not have the source of infection removed.Antibiotic treatment should cover both S. pyogenes and S. aureus. This may include a combination of cephalosporins, penicillins or vancomycin.