Toxic Shock Syndrome
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:
- Sex: female
- Not having antibodies to toxic shock syndrome toxins
- Tampon use
Birth control devices placed in the vagina:
- Cervical cap
- Skin lesions, such as burns]]>
- Nasal surgery, with packing
- Surgical wounds
- Recent childbirth
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:
- Fever of 102 degrees fahrenheit or greater
- Sunburn-like rash
- Low blood pressure
- Abdominal pain
- ]]>Sore throat]]>
- Red eyes
- Joint or muscle pain
- Vaginal discharge (may be watery or bloody)
- Swelling in the face and eyelids
- Skin peeling off, especially palms of hands and soles of feet (occurs late in disease, 1 to 2 weeks after initial illness)
The initial symptoms may improve, but the disease progresses and causes multiple organs to fail. Symptoms of severe TSS include:
- Kidney failure—little or no urine production
- Seriously low blood pressure
- Difficulty breathing
- Low platelet count
- Heart problems
- Fluid retention
- Liver failure
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.
Cleaning and Draining the Infection Site
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:
- Do not use tampons continuously when menstruating.
- Alternate using a tampon with a sanitary pad.
- Switch to sanitary pads at night.
- Do not use super absorbency tampons.
- Change tampons frequently during the day.
- Store tampons in a clean, dry place.
- Wash your hands with soap and water before and after you put in or take out a tampon.
- Use a lower absorbency tampon if you find the tampon is irritating or hard to pull out.
- Use tampons only during menstruation.
- Seek medical care for infected wounds.
- If you have had toxic shock syndrome, do not use tampons or place birth control devices in your vagina.
American College of Obstetricians and Gynecologists
National Center for Infectious Diseases, Centers for Disease Control and Prevention
The Society of Obstetricians and Gynaecologists of Canada
Women's Health Matters
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]]>
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