Toxic shock syndrome (TSS) refers to a combination of symptoms that results from toxins produced by an infection with Staphylococcus aureus 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:
The 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.
The nonmenstrual type—associated with a wound. It can occur in men, women, and children.
A different bacterium, Streptococcus pyogenes , can cause a similar condition, called streptococcal toxic shock-like syndrome.
Staphylococcus aureus produces the toxin that causes TSS. The immune system in many adults have developed antibodies to fight these common bacteria. In people who do not have the antibodies, the toxins can damage multiple body systems.
A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:
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.
Symptoms of both types include:
The initial symptoms may improve, but the disease progresses and causes multiple organs to fail. Symptoms of severe TSS include:
The doctor will perform 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:
The doctor irrigates open wounds and removes any packing. If a tampon or birth control device is in the vagina, the doctor takes it out.
You will be given an infusion of fluids to replace lost fluids.
Medications help raise blood pressure that does not improve after an infusion of fluids. Other drugs may help in lowering fever. Antibiotics do not cure TSS, but they may help prevent a recurrence.
Artificial breathing with a machine may be needed.
Some patients may require dialysis as a result of kidney failure.
Strategies to decrease your risk of toxic shock syndrome include:
RESOURCES:
American College of Obstetricians and Gynecologists
http://www.acog.org
National Center for Infectious Diseases, Centers for Disease Control and Prevention
http://www.cdc.gov/ncidod
CANADIAN RESOURCES:
The Society of Obstetricians and Gynaecologists of Canada
http://sogc.medical.org/
Women's Health Matters
http://www.womenshealthmatters.ca/index.cfm
References:
Emergency Medicine: Concepts and Clinical Practice . 4th ed. Mosby-Year Book, Inc.; 1998.
Griffith's 5-Minute Clinical Consult . 1999 ed. Lippincott Williams and Wilkins; 1999.
Harrison's Principles of Internal Medicine . 16th ed. The McGraw-Hill; 2005.
Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000653.htm .
National Center for Infectious Diseases website. Available at: http://www.cdc.gov/ncidod .
Principles and Practice of Infectious Diseases . 5th ed. Churchill Livingstone, Inc.; 2000.
US Food and Drug Administration website. Available at: http://www.fda.gov/ .
Last reviewed November 2008 by Jeff Andrews, MD, FRCSC, FACOG
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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