Toxic Shock Syndrome


Toxic shock syndrome is a potentially life‐threatening, multisystem illness characterized by high fever, hypotension, rash and skin desquamation upon recovery. The illness is caused by superantigen toxins produced from Staphylococcusaureus and group A streptococci.

Keywords: Staphylococcus aureus; group A streptococci; hypotension; fever; superantigen


Bergdoll MS, Crass BA, Reiser RF, Robbins RN and Davis JP (1981) A new staphylococcal enterotoxin, enterotoxin F, associated with toxic shock syndrome Staphylococcus aureus isolates. Lancet i: 1017–1021.

Bergdoll MS and Schlievert PM (1984) Toxic‐shock syndrome toxin. Lancet ii: 691.

Cone LA, Woodard DR, Schlievert PM and Tomory GS (1987) Clinical and bacteriologic observations of a toxic shock‐like syndrome due to Streptococcus pyogenes. New England Journal of Medicine 317: 146–149.

Fields BA, Malchiodi EL, Li H et al. (1996) Crystal structure of a T‐cell receptor beta‐chain complexed with a superantigen. Nature 384: 188–192.

Marrack P and Kappler J (1990) The staphylococcal enterotoxins and their relatives. Science 248: 705–711.

Schlievert PM, Shands KN, Dan BB, Schmid GP and Nishimura RD (1981) Identification and characterization of an exotoxin from Staphylococcus aureus associated with toxic shock syndrome. Journal of Infectious Disease 143: 509–516.

Stevens DL, Tanner MH, Winship J et al. (1989) Severe group A streptococcal infections associated with a toxic shock‐like syndrome and scarlet fever toxin A. New England Journal of Medicine 321: 1–7.

Todd JK, Kapral FA, Fishaut M and Welch TR (1978) Toxic‐shock syndrome associated with phage‐group‐I staphylococci. Lancet ii: 1116–1118.

Further Reading

Bohach GA, Fast DJ, Nelson RD and Schlievert PM (1990) Staphylococcal and streptococcal pyrogenic toxins involved in toxic shock syndrome and related illnesses. Critical Reviews in Microbiology 17: 251–272.

Li H, Llera A, Malchiodi EL and Mariuzza RA (1999) The structural basis of T cell activation by superantigens. Annual Review of Immunology 17: 435–466.

Parsonnet J (1996) Nonmenstrual toxic shock syndrome: new insights into diagnosis, pathogenesis and treatment. Current Clinical Topics in Infectious Disease 16: 1–20.

Schlievert PM, Assimacopoulos AP and Cleary PP (1996) Severe invasive group A streptococcal disease: clinical description and mechanisms of pathogenesis. Journal of Clinical Medicine 127: 13–22.

Schlievert PM and MacDonald KL (1998) Toxic shock syndrome. In: Gorbach SL, Bartlett JG and Blacklow NR (eds) Infectious Diseases, pp. 1689–1696. Philadelphia: WB Saunders.

Thiboedau J and Sékaly F‐P (eds) (1995) Bacterial Superantigens: Structure, Function and Therapeutic Potential. Georgetown, TX: RG Landes.

Todd JK (1990) Therapy of toxic shock syndrome. Drugs 39: 856–861.

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(Apr 2001) Toxic Shock Syndrome. In: eLS. John Wiley & Sons Ltd, Chichester. [doi: 10.1038/npg.els.0002185]