Dermatologic Emergencies

dermatology-emergencieskapak-1-0-25

Streptococcal Toxic Shock Syndrome

Talat Cem ÖZDEMİR
Şanlıurfa Ceylanpınar Public Hospital, Clinic of Emergency Medicine, Şanlıurfa, Türkiye

Nurullah İshak IŞIK
Ankara Etlik City Hospital, Clinic of Emergency Medicine, Ankara, Türkiye

Özdemir TC, Işık Nİ. Streptococcal toxic shock syndrome. In: Oğuztürk H, Görmeli Kurt N, eds. Dermatologic Emergencies.  1st ed. Ankara: Türkiye Klinikleri; 2025. p.69-74.

ABSTRACT

Group A Streptococcus (GAS) is a Gram-positive bacterium commonly found in the normal flora and can lead to various infections. In addition to frequently encountered infections in the pharynx, it can cause invasive infections such as necrotizing soft tissue infections, bacteremia, and respiratory tract infections. A complication of these invasive infections is the development of Streptococcal Toxic Shock Syndrome (STSS). STSS occurs due to the production of GAS superantigens (Sags), which activate T cells, leading to an inflammatory response and hypotension. Globally, invasive GAS infections account for approximately 1.8 million cases, with STSS occurring in one-third of these cases. The mortality rate of STSS in adults ranges from 30-70%, while it is lower in children. Risk factors include minor trauma, NSAID use, immunosuppression, and obesity. Clinical manifestations are typically nonspecific and may present with influenza-like symptoms, hypotension, and organ failure. Diagnosis is based on CDC criteria and confirmed through GAS isolation. Management of STSS requires a multidisciplinary approach. Early diagnosis and antibiotic treatment are crucial. In cases requiring intensive care, fluid resuscitation and vasopressor support are provided. Additionally, identifying the source of infection and performing surgical intervention when necessary is important. The use of intravenous immunoglobulin (IVIG) is recommended to mitigate the effects of GAS.

Keywords: Emergencies; streptococcus; shock, septic; toxic shock syndrome toxin 1

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