Toxic Shock Syndrome (TSS)

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.

Immune System

The immune system creates antibodies to fight bacteria.

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Risk Factors

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

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

Symptoms

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:

• Fever of 102ºF (39ºC) or greater
• Sunburn-like rash
• Low blood pressure
• Chills
• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Sore throat
• Red eyes
• Headache
• Confusion
• Agitation
• Sleepiness
• 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, 1-2 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
• Seizures
• Gangrene
• Pancreatitis
• Low platelet count
• Heart problems
• Fluid retention
• Liver failure

Diagnosis

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

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

Treatment includes:

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.

Replacing Fluids

You will be given an infusion of fluids to replace lost fluids.

Medications

Medicines 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 are important in managing the condition. Blood components, like immunoglobulin, may be given.

Respirators

Artificial breathing with a machine may be needed.

Dialysis

Some patients may require dialysis as a result of kidney failure.

Prevention

For TSS associated with menstruation and tampon use, strategies to decrease your risk 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 TSS, do not use tampons or place birth control devices in your vagina.

Most other forms of the disease are not currently preventable.