Toxic shock syndrome is a toxin-mediated, acute, life-threatening condition that is characterized by a sudden collapse in the hemodynamic system of a person, manifested by a decrease in arterial pressure, tachycardia, an increase in body temperature, which are followed by multiorgan damage and death . It occurs mainly in menstruating women and is associated with the use of highly absorbent tampons. Toxic shock syndrome was first described in the 1980s among young girls who used super absorbent tampons, which were later recalled. In addition to the use of tampons in women during menstruation, its occurrence is associated with the use of barrier methods of contraception, with postpartum infections, burns, retention of foreign bodies, as a result of postoperative infections, etc. Group A streptococci (Streprococcus pyogenes) and toxin-producing representatives of the Staphylococcus aureus species are considered the main etiological cause of toxic shock syndrome. St.aureus produces exotoxins, the main importance of which are the so-called TTS type 1 toxin (TSST-1) and staphylococcal enterotoxin B. Among group A streptococci, the so-called M-protein. Pyrogenic toxins of streptococci and enterotoxins of staphylococci act as superantigens and stimulate the production of cytokines (substances of inflammation) such as interleukin-1, interleukin-6, tumor necrosis factor alpha (TNF-a), etc. The incidence of toxic shock syndrome in the past was much higher than it is today. However, its mortality rate reaches 30-70% of cases. Recognition of early symptoms and timely medical intervention are essential for a good outcome. According to the criteria of the Center for Disease Control and Prevention (CDC), toxic shock syndrome is characterized by several main signs: Hypotension – a decrease in systolic blood pressure to or below 90 mmHg; Sudden increase in body temperature; Appearance of a diffuse macular rash, mainly on the chest. It is possible to affect the oral mucosa with the so-called strawberry tongue; on the vaginal mucosa or conjunctiva; Multiorgan failure manifested by renal failure, liver failure, acute respiratory distress syndrome, coagulopathy, necrotizing fasciitis or gangrene. Nonspecific symptoms include nausea, vomiting, diarrhea, myalgias, headache, shortness of breath, etc. Among the risk factors that increase the likelihood of developing toxic shock syndrome are the use of drugs and alcohol; patients suffering from HIV, diabetes, cancer or those who have recently had chickenpox; patients taking non-steroidal anti-inflammatory drugs. How is toxic shock syndrome diagnosed? A large number of patients reach a doctor in the stage of severe multiorgan failure, where the main goal is to combat shock and stabilize the patient.Laboratory tests may reveal leukocytosis or leukopenia, thrombocytopenia, elevated creatinine phosphokinase, elevated creatinine, elevated liver enzymes. Isolation of staphylococci or streptococci from blood culture, urine, vaginal discharge, cervix, cerebrospinal fluid, etc. The prevention of toxic shock syndrome consists in frequent replacement of tampons when using them – it is recommended to change them no later than every 3-4 hours. In terms of differential diagnosis, the condition can be mistaken for Kawasaki disease, meningococcemia, scarlet fever, toxic epidermal necrolysis, necrotizing fasciitis. Treatment of toxic shock consists of controlling hypotension and multiorgan failure. Large amounts of crystalloids are infused to manage shock. If the shock is refractory to crystalloids, vasopressors are also administered – e.g. norepinephrine. Antibiotic treatment is also applied, preferring preparations such as vancomycin and linezolid, which act on methicillin-resistant St. aureus. Bibliography: https://www.ncbi.nlm.nih.gov/books/NBK459345/ https://emedicine.medscape.com/article/169177-treatment https://www.webmd.com/women/guide/understanding -toxic-shock-syndrome-basics