Staphylococcal aureus producing exotoxins causes diseases because they are superanatigens activating T-cells resulting in massive cytotoxin production interleukins tumor necrosis factor and interferon). Toxic shock syndrome toxin (Superantigens) -1 (TSST-1) and other enterotoxins (A, C, D, E and H) Methecilin resistents staphylococcal aureus can cause the syndrome. Symptoms: Temperature > 38,9oC, hypotension < 90 mmHg Multisystem involment: 3 or more of the following. Gastric intestinal: vomiting and diarrhea. Muscular: Severe myoalgia CPK > 2 times normal upper limit. Mucous membranes hyperemia. Renal: Se-creatinin > 2 times upper limit or pyuria Hepatic: Bilirubin transaminase > 2 times normal upper limit. Hemathologic: Platlets < 100.000 µ/L CNS system: Deterioration. All patients have fever, hypotension and skin manifestation (macular erythema) with a mean of 2 days after surgery with desquamation 1-2 weeks after onset of illness, particularly involment palms and soles. Differential diagnose: Streptococcal TTS (severe pain), meningococcemia (petechia) and Rocky Mountain spotting fever. Treatment:
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