Toxic shock syndrome

Toxic shock syndrome is a severe disease that involves fever, shock, and problems with the function of several body organs.

Toxic shock syndrome (TSS) is caused by a toxin produced by certain types of Staphylococcus bacteria. (A similar syndrome, called toxic shock-like syndrome (TSLS), can be caused by Streptococcus bacteria.)

Although the earliest described cases of TSS involved women who were using tampons during their periods (menstruation), only 55% of current cases are associated with menstruation. Toxic shock syndrome can also occur in children, postmenopausal women, and men.

Risk factors include:

• Menstruation
• Use of barrier contraceptives such as a diaphragm or vaginal sponge
• Tampon use (particularly if you leave on in for a long time)
• Foreign bodies or packings (such as those used to stop nosebleeds)
• Childbirth
• Surgery
• Current Staphylococcus aureus (S. aureus) infection

• High fever, sometimes accompanied by chills
• Malaise (discomfort, ill feeling)
• Nausea
• Vomiting
• Diarrhea
• Widespread red rash resembling a sunburn
• Rash followed in 1 or 2 weeks by peeling of the skin, particularly on the palms of the hand or bottom of the feet
• Redness of eyes, mouth, throat
• Confusion
• Seizures
• Headaches
• Muscle aches
• Hypotension (low blood pressure)
• Organ failure (usually kidneys and liver)

There is no one diagnostic test for TSS. The diagnosis of toxic shock syndrome is based on several criteria: fever, low blood pressure, rash that peels after 1-2 weeks, and at least 3 organs with signs of dysfunction. In some cases, blood cultures may be positive for growth of S. aureus.

Any foreign materials, such as tampons, vaginal sponges, or nasal packing, will be removed. Sites of infection (such as surgical wound) will be drained.

Treatments maintain important body functions (supportive measures) are essential. This may include:

• Intravenous (IV) fluids
• Methods to control blood pressure
• Dialysis (if severe kidney problems are present)
• Antibiotics for any infection (may be given through an IV)

Toxic shock syndrome may be deadly in up to 50% of cases. The condition may return in those that survive.

• Severe organ dysfunction
  • Kidney failure
  • Heart failure
  • Liver failure
• Shock

TSS is a medical emergency. You must seek immediate attention if you develop fever or rash, particularly during menstruation and tampon use, or if you have had recent surgery.

Menstrual TSS can be prevented by avoiding the use of highly absorbent tampons. Risk can also be reduced by using less absorbent tampons, changing tampons more frequently, and using tampons only intermittently (not regularly) during menstruation.

Rakel P. Conn's Current Therapy 2006. 58th ed. Philadelphia, Pa: WB Saunders; 2006:103-106.

Goldman L, Ausiello D. Cecil Textbook of Medicine, 22nd ed. Philadelphia, Pa: WB Saunders; 2004:1785-1786.