So fatal have been the results, so fearful the ravages, so widespread the devastation of the disease, so interesting the period of life at which it commonly occurs … that the very name (Scarlet Fever) is a signal of distress, and its introduction into the family circle is looked upon as the angel of death with an irreprievable warrant to destroy.

CASPAR MORRIS, 1851

In developed countries, shock associated with gram-negative bacillus infections most commonly occurs in hospitalized, debilitated patients. In contrast, toxic shock syndrome caused by either Staphylococcus aureus or Streptococcus pyogenes occurs most commonly in the healthy patient with an intact immune system. There are features common to both infections, such as the early onset of shock and organ failure, and there are also major differences in the clinical signs and symptoms, as well as morbidity and mortality. Both S. pyogenes and S. aureus cause a variety of distinctive infections in the human host (Table 1) that may or may not be associated with a toxic shock syndrome. In order to understand the clinical features, epidemiology and pathogenesis of each toxic shock syndrome, there must be a firm understanding of the scope of infections caused by each organism.