Definition
Causes
Risk Factors
Symptoms
Diagnosis
Treatment
Prevention

Definition

Toxic shock syndrome (TSS) is a group of symptoms throughout the body. This illness can progress rapidly. It can lead to a failure of multiple body systems. Toxic shock syndrome can be fatal.

There are two types of TSS:

  • Menstrual type —associated with menstruation and tampon use
  • Nonmenstrual type—can occur in men, women and children

Causes

TSS is caused by toxins released from certain bacteria. Bacteria most often associated with TSS include:

  • Staphylococcus aureus
  • Streptococcus pyogenes

Bacteria infects the body through cuts or sores. The bacteria can create toxins as it grows. These toxins are harmful to many of your body's systems. The damage to your body is what causes the range of symptoms.

Immune System

Immune system white blood cell
The immune system creates antibodies to fight bacteria.
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TSS was originally associated with tampon use. It was most common in women who used a particular type of highly absorbent tampons. As a result, these tampons were removed from the market. The number of TSS infections due to tampons has since significantly decreased.

Risk Factors

Factors that increase your risk of TSS include:

  • Tampon use
  • Birth control devices placed in the vagina (eg, sponge, diaphragm, cervical cap)
  • Chickenpox
  • Skin lesions (eg, burns)
  • Wound packing—done after certain surgeries or procedures such as sinus or nasal surgery
  • Surgical wounds
  • Recent childbirth
  • Alcohol abuse
  • HIV infection

Symptoms

A person with TSS often appears very ill. Symptoms usually come on suddenly. Fever, chills, and body aches may start up to four days before other symptoms develop such as:

  • Fever of 102ºF (39ºC) or greater
  • Sunburn-like rash
  • Lightheadedness, dizziness
  • 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, as the disease progresses. Symptoms of severe TSS include:

  • Fainting, severe lightheadedness and dizziness (due to very low blood pressure)
  • Difficulty breathing
  • Seizures
  • Fluid retention

The infection can lead to severe complications such as:

  • Kidney failure—little or no urine production
  • Gangrene
  • Pancreatitis
  • Heart problems
  • Liver failure
  • Low platelet count

Diagnosis

The doctor will do a physical and pelvic exam. The diagnosis is most often based on the fever, the rash, low blood pressure, and problems affecting multiple body systems.

Tissue from the suspected wound will be tested for bacteria. However, these tests may be negative even if you have TSS.

Other blood and urine 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 need to be monitored in the intensive care unit.

Treatment includes:

The wound will be reopened. Water will be poured over the wound to clean the area. Any packing from a previous procedure will be removed.

If a birth control device is in the vagina, the doctor takes it out. If the TSS is menstrual type, the vagina may be flushed out with saline.

To support your body while you heal:

  • IV fluids will be given to replace lost fluids.
  • Your breathing may need to be supported by a machine. It may be needed if your lungs are affected or you are too fatigued to breathe well on your own.
  • Dialysis may be needed with kidney failure. Dialysis takes over the job of the kidneys.
  • Medication may be given to:
    • Raise blood pressure
    • Lower fever
  • Antibiotics may be given. They do not cure TSS but can help to manage the condition.
  • IV immunoglobulin may be given to support the immune system.

Prevention

You can decrease your risk of menstrual associated TSS with the following steps:

  • 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.