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Alpha toxin
14%
60/436
Endotoxin
5%
20/436
Exfoliative toxin
11%
49/436
Pyogenic exotoxin A
59/436
Toxic shock syndrome toxin 1
53%
232/436
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This patient has classic symptoms of toxic shock syndrome, including hypotension and rash. The toxin responsible for toxic shock syndrome is toxic shock syndrome toxin (TSST-1). While toxic shock syndrome is frequently associated with tampon use and nasal packing, it is also associated with surgical site infections, burns, and childbirth. This syndrome is due to the production of TSST-1 by Staphylococcus aureus. TSST-1 is a super-antigen that results in polyclonal T-cell activation. This produces inflammatory symptoms such as fever, rash, shock, and end-organ failure. The rash desquamates in the recovery period. Incorrect Answers: Answer 1: Alpha toxin is produced by Clostridium perfringens, which causes gas gangrene due to a phospholipase that destroys cell membranes. Answer 2: Endotoxin refers to a component of the outer membrane of gram-negative bacteria. S. aureus is a gram-positive bacteria. Answer 3: Exfoliative toxin is produced by S. aureus, but is associated with scalded skin syndrome. Answer 4: Streptococcus pyogenes produces pyogenic exotoxin A, which causes a toxic shock-like syndrome associated with a painful skin infection. Bullet Summary: Rash, fever, and hypotension after a surgical site infection are consistent with toxic shock syndrome due to toxic shock syndrome toxin 1 (TSST-1).
3.9
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