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TSST-1 Menstrual TSS — SCE Infectious Diseases MCQ

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EasyHealthcare-Associated InfectionsTSST-1 Menstrual TSSSCE Infectious Diseases

A 30-year-old woman develops suspected toxic shock syndrome. She has fever, hypotension, diffuse erythroderma, and multiorgan dysfunction. Menstrual TSS is suspected (she has a menstrual cup in situ). Which toxin mediates menstrual TSS?

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Correct answer: B — TSST-1 (Toxic Shock Syndrome Toxin-1) — a superantigen produced by S. aureus that causes non-specific T-cell activation and massive cytokine release

Menstrual TSS is mediated by TSST-1, a superantigen that cross-links MHC class II molecules and T-cell receptors without antigen processing, activating up to 20% of the T-cell population (vs <0.01% in normal antigen presentation). This causes massive cytokine release (TNF-alpha, IL-1, IL-6, IFN-gamma) → capillary leak → shock → multiorgan failure. Management: remove the foreign body (menstrual cup/tampon), aggressive fluid resuscitation, IV anti-staphylococcal antibiotics (Flucloxacillin) PLUS IV Clindamycin (toxin suppression). IVIG (2 g/kg) for severe cases.

Reference: NICE NG141 2019; UKHSA 2024 – TSS; PHE 2019