Toxic shock syndrome is thought to be due to Staphylococcal exotoxin, toxic shock syndrome toxin 1, TSST 1, which is thought to trigger a number of processes.
Monocytes are stimulated to produce cytokines such as tumour necrosis factor and interleukin-1. The complement system is directly activated and this in turn activates neutrophils which adhere to each other and vascular endothelium. Factor XII is also stimulated, resulting in the promotion of coagulation and the release of hypotensive agents such as bradykinin.
These events cumulatively result in tissue damage, capillary leakage, fever, metabolic changes, vasodilation and in some cases disseminated intravascular coagulation.
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