Toxic Shock Syndrome

Toxic shock syndrome (TSS) refers to a combination of symptoms that results from toxins produced by an infection with either Staphylococcus aureus or group A Streptococcus pyogenes bacteria. The disease can progress rapidly, causing failure of multiple body systems. Toxic shock syndrome can be fatal. There are two types of the disease:

• Menstrual type (associated with menstruation and tampon use)—The number of tampon-associated cases has decreased since the 1980s. Women have become more aware of the danger and modified their use of tampons. In addition, a highly absorbent type of tampon was removed from the market. Doctors are not sure what role tampons play in the disease. Absorbent tampons may cause dryness and breaks in the lining of the vagina.
• Nonmenstrual type (sometimes associated with a wound)—It can occur in men, women, and children.

Staphylococcus aureus and Streptococcus pyogenes produce the toxin that causes TSS. Under some circumstances, the bacteria grow rapidly, making toxins that damage multiple body systems.

A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:

• Skin lesions (eg, burns)
• Alcohol abuse
• Birth control devices placed in the vagina (eg, sponge, diaphragm, cervical cap)
• Chickenpox
• HIV infection
• Recent childbirth
• Sex: female (for menstrual-associated TSS)
• Sinus or nasal surgery with packing
• Surgical wounds
• Tampon use

Symptoms usually come on suddenly. Some patients may have fever, chills, and body aches for up to four days prior to other symptoms developing. Wounds in the nonmenstrual type may not appear infected. A person with TSS often appears very ill.

Symptoms of both types include:

• Abdominal pain
• Agitation
• Chills
• Confusion
• Diarrhea
• Fever of 102ºF (39ºC) or greater
• Headache
• Joint or muscle pain
• Low blood pressure
• Nausea
• Red eyes
• Skin peeling off, especially palms of hands and soles of feet (occurs late in disease, 1-2 weeks after initial illness)
• Sleepiness
• Sore throat
• Sunburn-like rash
• Swelling in the face and eyelids
• Vaginal discharge (may be watery or bloody)
• Vomiting

The initial symptoms may improve, but the disease progresses and causes multiple organs to fail. Symptoms of severe TSS include:

• Difficulty breathing
• Fluid retention
• Gangrene
• Heart problems
• Kidney failure—little or no urine production
• Liver failure
• Low platelet count
• Pancreatitis
• Seizures
• Seriously low blood pressure

The doctor will do a physical and pelvic exam. The doctor may test tissue in your vagina or in a wound that could be the source of the bacteria. Although these tests are often done, they can be commonly negative. The diagnosis is based on the fever, the rash, low blood pressure, and problems affecting multiple body systems. Other tests may be done to rule out other medical conditions.

Treatment aims to support your life and reverse the process of organ deterioration. You may require monitoring in the intensive care unit.

Treatment includes:

For TSS associated with menstruation and tampon use, strategies to decrease your risk include:

• Alternate using a tampon with a sanitary pad.
• Change tampons frequently during the day.
• Do not use super absorbency tampons.
• Do not use tampons continuously when menstruating.
• If you have had TSS, do not use tampons or place birth control devices in your vagina.
• Seek medical care for infected wounds.
• Store tampons in a clean, dry place.
• Switch to sanitary pads at night.
• Use a lower absorbency tampon if you find the tampon is irritating or hard to pull out.
• Use tampons only during menstruation.
• Wash your hands with soap and water before and after you put in or take out a tampon.

Most other forms of the disease are not currently preventable.