Staphylococcus aureus is a gram-positive bacterium. It can cause a wide range of clinical presentations, depending on the site of infection and thepatient’s immune status.
Toxic Shock Syndrome (TSS): Toxic shock syndrome (TSS) is a rare but potentially life-threatening condition caused by toxins produced by certain strains of Staphylococcus aureus and Streptococcus pyogenes bacteria. TSS is characterised by a sudden onset of high fever, hypotension, rash, and multi-organ dysfunction. Here is an overview of TSS, including its history, pathophysiology, mortality rate, and treatment:
TSS was first described in the 1970s and became widely recognised in the 1980s. It was initially associated with the use of high-absorbency tampons in menstruating women, leading to the term “tampon-associated TSS.” However, TSS can also occur in men, children, and non-menstruating women, and is now recognised as being caused by a variety of factors, including skin wounds, surgical procedures, and postpartum infections.
TSS is caused by the release oftoxins, known as superantigens, from certain strains of bacteria. Superantigens stimulate a massive immune response, leading to the release of inflammatory mediators such as cytokines. This causes a systemic inflammatory response syndrome (SIRS), which can lead to the characteristic symptoms of TSS, including fever, hypotension, and organ dysfunction.
The mortality rate of TSS has decreased significantly since its recognition in the 1980s, thanks to improved recognition and management strategies. However, TSS can still be life-threatening, especially if not diagnosed and treated promptly. The mortality rate of TSS varies depending on the underlying cause, patient age, and the presence of complicating factors, but is generally reported to be around 5-10%.
The treatment of TSS involves supportive care to stabilise the patient and manage symptoms. This may include intravenous fluids, vasopressors to maintain blood pressure, and antibiotics to target the underlying bacterial infection. In severe cases, patients may require admission to an intensive care unit (ICU) for close monitoring and advanced supportive care.
Early recognition and treatment of TSS are crucial for a favourable outcome. Patients who survive an episode of TSS are at increased risk of recurrence and should be counselled on preventive measures, such as avoiding high-absorbency tampons and promptly treating skin wounds.
Other common clinical presentations of Staphylococcus aureus infections are as below:
Skin and Soft Tissue Infections (SSTIs): It is a common cause of SSTIs, including impetigo, folliculitis, furuncles (boils), and carbuncles. These infections typically present with erythema (redness), swelling, warmth, and tenderness at the affected site. Pus or drainage may be present.
Abscesses: Abscesses are characterised by a localised collection of pus, which may require drainage for resolution. Commonly seen as a soft tissue infection but can also happen in organs ie. The lung or liver. Treatment include antibiotics and drainage.
Pneumonia: Staphylococcus aureus can cause community-acquired or healthcare-associated pneumonia. Patients with Staphylococcus aureus pneumonia may present with fever, cough, chest pain, and shortness of breath. Severe cases can progress to acute respiratory distress syndrome (ARDS).
Bloodstream Infections (Bacteremia): Staphylococcus aureus bacteremia can occur as a primary infection or secondary to other infections. It can lead to sepsis, a life-threatening condition characterized by systemic inflammatory response syndrome (SIRS) and organ dysfunction.
Endocarditis: Staphylococcus aureus is a common cause of infective endocarditis, particularly in patients with prosthetic heart valves or intravenous drug use. Endocarditis can present with fever, chills, fatigue, and new or changing heart murmurs.
Osteomyelitis: Staphylococcus aureus is a common cause of osteomyelitis, especially in children and adults with predisposing factors such as diabetes or peripheral vascular disease. Osteomyelitis presents with localized bone pain, swelling, and tenderness.
It’s important to note that the clinical presentation of Staphylococcus aureus infections can vary widely, and some infections may be asymptomatic. Prompt diagnosis and appropriate treatment are essential to prevent complications and transmission to others.
