Corticosteroid therapy for patients with toxic shock syndrome

Infectious Shock and Toxic Shock Syndrome Diagnoses in Hospitals, Colorado, USA

“…The latter has been noted in other studies as well (12,13). The observation that TSS accounts for a substantial proportion of all infectious shock is of clinical importance because TSS may respond to therapies (e.g., clindamycin, intravenous immune globulin, steroids) not ordinarily used for septic shock caused by other organisms, with more favorable outcomes as evidenced by significantly lower case-fatality rates for TSS noted in our study (5)(6)(7)(8). For the current study period of 1993-2006, <20% of cases with a specific ICD-9-CM diagnosis of TSS (presumed staphylococcal) were reported to the state's passive surveillance system.…”

“…Investigations based on extensive chart review and/or microbiology laboratory data suggest little or no decrease in overall TSS incidence and an increase in streptococcal TSS (2)(3)(4). Given the persistence and severity of TSS and the differences in its treatment from other causes of septic shock, its evolving epidemiology needs to be accurately monitored (5)(6)(7). To this end, we assessed International Classification of Diseases, Ninth revision, Clinical Modification (ICD-9-CM)-coded TSS cases in Colorado, USA.…”

Superantigen-Induced Steroid Resistance Depends on Activation of Phospholipase Cβ2

“…Corticosteroids are not recommended for TSS (see http://www.uptodate. com), because clinical evidence for their efficacy is lacking, and a single small retrospective study showed that steroids may alleviate some symptoms of TSS, but they do not affect mortality (15). The limited efficacy of glucocorticoids in TSS is likely related to the fact that superantigens induce steroid resistance, and mechanisms to alleviate this may help to improve therapy.…”

Toxic shock syndrome

“…High-risk groups appear to be postpartum women (24,30,35,67,68,187)-and patients with surgical wound infections (8,25,57,187), focal staphylococcal infections (175), and nasal surgery (78,85,162,166 Incidence It is difficult to determine the true incidence of TSS in populations for which reliance is placed on passive reporting (29,120,159). Davis and Vergeront demonstrated that self-reporting of TSS cases was encouraged by frequent newspaper coverage of the topic and seemed to diminish when articles on the subject were infrequent (49).…”

“…In one study, a defect in S. aureus 502A (not a TSS strain) neutrophil killing was noted to be menses associated. In addition, methylprednisolone has been shown to be effective in treating early clinical TSS (175) Although some level of genetic regulation is operative in TSST-1 production, it also appears that TSST-1-positive S. aureus strains have the potential for posttranslational modification of extracellular protein expression (Fig. 1).…”