Toxic Shock Syndrome or Rocky Mountain Spotted Fever?
Publication Date: 22-DEC-07
Publication Title: The Forensic Examiner
Format: Online
Author: Crowe, Kristin

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Description

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Many illnesses manifest themselves in similar ways, making it hard for clinicians to diagnose and treat patients accurately; two of these infections are Toxic Shock Syndrome and Rocky Mountain Spotted Fever. It is important that clinicians, toxicologists, and expert witnesses are able to recognize the possibility of either of these infections and their overlapping symptoms. There is such an overlap that misdiagnosis of one infection for the other must be carefully guarded against and always regarded as a possibility.

In 1978, Todd, Fishaut, Kapral, and Welch first reported and named Toxic Shock Syndrome (TSS) after treating seven children aged 8-17, of which one died and one developed gangrene of the toes. There was an outbreak of Toxic Shock Syndrome in 1981 found to be associated with menstruating women and tampon use. Since then, much has been discovered about TSS, but there is much left unknown.

Many people associate Toxic Shock Syndrome exclusively with tampon use, however, "the incidence of nonmenstrual TSS now exceeds that of menstrual TSS" (Issa & Thompson, 2001). Non-menstrual TSS may come from multiple different "surgical procedures (e.g., rhinoplasty, nasal packing, postpartum procedures) and medical conditions (e.g., pneumonia, influenza, infection)" (Issa & Thompson). TSS may affect men, children, and non-menstruating women, contrary to popular belief. The disorder "is now recognized as a toxin-mediated, multisystem illness that strikes primarily in healthy people of any age" (Issa & Thompson). This infection may attack anywhere the bacterium Staphylococcus aureus enters the blood stream, from the smallest prick to a surgical site and, as it is a systemic illness, it affects the entire body (Nemours Foundation, 2007).

The bacterium S. aureus causes TSS "by release of superantigens into the blood stream" (Todar, 2005). S. aureus "secretes two types of toxin with superantigen activity, enterotoxins, of which there are six antigenic types (SE-A, B, C, D,...



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