Nejm 1998;339:527

Cause:Staph. aureus; occasionally by group A Strep. pyogenes, which produces scarlet fever toxin A (Nejm 1991;325:783; 1989;321:1)

Pathophys:Enterotoxins produced at any body site

Initially 97% cases were associated with tampon use during menses, now none since change in tampon manufacture, but some cases still assoc w menstruation. Associated w influenza (Jama 1987;257:1053)

Sx:Diarrhea (98%), vomiting (92%), headache and sore throat (77%), myalgias

Si:Fever (87%), hypotension, scarletiniform rash, which later desquamates

10-15% mortality

Hepatitis and renal failure; recurrent (25%)

r/o Kawasaki's disease (Kawasaki's Disease) and Clostridium sordellitoxic shock (Nejm 2005;353:2352); often w/o fever but fatal, after childbirth, or medical or surgical abortions; initial sx often obscured because like the side effects of misoprostol

Lab:Bact: Staph. aureusin cultures of infected site; blood cultures usually negative

Rx:Fluids; staph antibiotics like clindamycin, which shut down toxin production; perhaps steroids; perhaps gamma globulin