6

Schematic Diagram of the Pathophysiology of Toxic Shock Syndrome

Continued

Staph. Aureus Strep.
Pyogenes
Production of superantigen toxins
and absorption into the systemic
circulation
Binding of Tcell
receptor to MHC II
Excessive Tcell
proliferation and activation
Proinflammatory
mediators activation
Activation of
complement system
Cytokines
proliferation
Activation of
Coagulation system
Binding to
endothelial tissues
Vasodilatation, increased
vascular permeability
Activation of clotting
factors; decreased ATIII,
protein C and S
Endothelial
damage Hypotension
Microvascular
thrombi; DIC
Clot formation, thrombosis
of small vessels,
Decreased tissue
perfusion

Pyrogenic
effect on the
hypothalamus
Fever
Chills

7


Continuation


Clot formation, thrombosis of small
vessels,
Decreased tissue perfusion

Brain Heart Skin Gastrointestinal
Lungs
Kidneys
Liver
Altered mental
status,
confusion,
headaches,
seizures
Increased dead
space
Impaired gas
exchange
Hypoxemia
Tachycardia
Salt and water
retention
Decreased
urine output
Weakening of the
intestinal wall barrier
Bacterial/endooxin
translocation
Nausea, vomiting,
diarrhea
Damage to
hepatocytes
Increased liver enzymes,
inability to excrete toxins
Diffuse rash,
desquamation
Tachypnea
Sepsis
Increasd levels
of ammonia
Encephalopathy