Toxic shock syndrome is caused by

Toxic shock syndrome is a potentially fatal multisystem disease caused by Staphylococcus aureus. Present as fever, hypotension, myalgia, vomiting, diarrhea, mucosal hyperemia and an erythematous rash which desquamates subsequently. This is associated with infection of mucosal or sequestered sites by toxic shock syndrome toxin (TSST)-Producing S.aureus strains usually belonging to bacteriophage group I.TSST type I (formerly known as enterotoxin type F or pyrogenic exotoxin C)is most often responsible, though enterotoxin B or C may also cause the syndrome . Staphylococcal enterotoxins and TSST -1 are superantigens which are a potent activator of T lymphocytes. Being Vbeta-restricted T cell mitogens, such superantigens stimulates large numbers of T cells without relation to their epitope specificity. This leads to excessive and deregulated immune response, with the release of cytokines interleukins 1,2, tumour necrosis factor and interferon gamma. This explains multisystem involvement and florid manifestation in staphylococcal food poisoning and TSS. Soft tissue infections with some M types of S.pyogens (1,3,12,28) may sometimes cause a toxic shock syndrome resembling staphylococcal TSS. Streptococcal TSS and necrotizing fasciitis occur in persons not immune to the infecting M types Ref: Textbook of Microbiology; Ananthanarayanan and Panicker; Tenth Edition; Page No: 204, 215