Clinical Efficacy of Intravenous Immunoglobulins in Management of Toxic Shock Syndrome: An Updated Literature Review.

Sana Amreen,Simrandeep K Brar,Safeera Khan,Sarah Albabtain,Muhammad Reza Chaudhry,Sumera Perveen

doi:10.7759/cureus.12836

Abstract

Toxic shock syndrome (TSS) is an uncommon complication of infection caused by streptococci and staphylococci. It is associated with a high mortality rate. When evaluating patients with shock symptoms from skin or soft tissue sources, a high index of suspicion for TSS must be maintained. Prompt diagnosis and integrative management with surgical intervention, antibiotics, hemodynamic stabilization, and adjuvants like intravenous immunoglobulins improve survival.

Highlights

BackgroundToxic shock syndrome (TSS) is a toxin-mediated disease, most commonly caused by invasive Group A streptococcal (GAS) and staphylococcal infections leading to immune activation and massive cytokine release
While streptococci are well known to cause a range of infections from benign pharyngitis to more serious conditions like endocarditis, scarlet fever, pneumonia, meningitis, osteomyelitis, rheumatic fever; skin infections like cellulitis, necrotizing fasciitis, myositis, and bacteremia; and septic shock [1], Streptococcal TSS may result from any condition caused by the streptococci
The superantigen binds and forms the superantigen-major histocompatibility (MHC) class-II complex with the MHC class-II, which binds to T cell receptors, leading to non-specific activation of T cells, leading to a massive release of pro-inflammatory cytokines, which are responsible for the systemic toxicity

Summary

Introduction

Toxic shock syndrome (TSS) is a toxin-mediated disease, most commonly caused by invasive Group A streptococcal (GAS) and staphylococcal infections leading to immune activation and massive cytokine release. TSS's exact pathogenesis is unclear, but studies have shown a complex interplay between bacterial toxins and the body's response to the infection as the cause of the severity of the clinical manifestations seen [1]. The toxins that cause TSS are referred to as superantigen and include staphylococcal enterotoxins, toxic shock syndrome toxin-1 (TSST-1), and streptococcal pyrogenic exotoxins [4]. They are generated by toxigenic strains of Streptococcus pyogenes and Staphylococcus aureus that have acquired an underlying genetic material needed to transcribe the toxins from a plasmid or a bacteriophage. We aim to shed light on IVIG's use in its treatment, as it remains a serious and life-threatening condition

Objectives

Methods

Findings

Discussion

Conclusion