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Toxic Shock Syndrome

Overview

Staphylococcal toxic shock syndrome, commonly known simply as toxic shock syndrome or TSS, is a rare phenomenon. However, it is potentially serious, and can be fatal. It is caused by certain types of a bacteria called Staphylococcus aureus. Although this bacteria is normally harmless (and exists in the skin, nose, armpit, groin, or vagina of one in every three people), it can also produce the toxins that cause TSS. The syndrome was a mystery upon its discovery two decades ago. With the revelation that linked TSS with Staphylococcus aureus, came the connection between TSS and “superabsorbent” tampons. This link was established by two theories – the first, that microscopic ulcerations produced by the absorbent fibers in tampons could allow bacteria to enter the body; and the second, that stagnating blood collected within or around a tampon could be a bacterial breeding ground. “Superabsorbent” tampons were taken off the market with this discovery. It should be noted that toxic shock syndrome can also occur in men and children, though this is rare. The Staphylococcus aureus bacteria can also enter the body through infected wounds such as burns, boils, or insect bites, in the throat, lungs, skin, and bone. In other uncommon cases, it can also occur following surgery, particularly that associated with childbirth. Because the antibodies that protect against the toxin can develop naturally over many years, young people are slightly more susceptible to TSS than older people. Roughly half of reported cases of TSS have been associated with the use of tampons, and roughly half have been fatal. Moreover, toxic shock syndrome can recur.

Symptoms

The symptoms of toxic shock syndrome are severe, and can resemble very intense, sudden flu symptoms. Usually one suffering from TSS experiences a high fever, which may be accompanied by chills. Profound malaise is a typical symptom, and all documented cases of TSS have shown patients to feel extreme fatigue. A weakness or soreness of the general musculature is possible, as is kidney or liver failure.

Other symptoms of toxic shock syndrome can include:

  • Nausea, vomiting, and diarrhea, often accompanied by a redness of the eyes, nose, and throat
  • A red rash on the skin, similar in appearance to a sunburn, and followed by a peeling of the skin
  • A general sense of confusion, vertigo, severe headaches, or seizures
  • Hypotension

Toxic shock syndrome is a medical emergency, and the sudden, severe onset of its symptoms should always be immediately followed by a medical examination. Patients who have developed these symptoms in conjunction with menstruation, tampon use, or recent surgery are advised to be particularly timely in seeking medical attention.

Diagnosis

The physician suspecting toxic shock syndrome may take blood cultures, which may prove to be positive for the growth of Staphylococcus aureus. Vaginal/cervical smear samples may also be taken. TSS is unique in the suddenness and severity of its symptoms, and if the patient is experiencing this, TSS will generally be the subject of all initial investigations. Although it is extremely rare – most healthcare providers will never see a case of the syndrome – it is in the public consciousness due to the informational material about TSS that is enclosed in every package of tampons. This information is regularly updated as scientists learn more about the syndrome, and is a legal requirement of tampon manufacturers. With early diagnosis, TSS can be treated and eliminated from the system.

Treatment

The management of toxic shock is largely supportive. It also requires examination for the presence of foreign material (e.g., tampons, vaginal sponges, nasal packing) and drainage of any identified site of infection (e.g., surgical wounds) to decrease the inflammatory state. The healthcare provider will institute a regimen of treatments, which may include intravenous fluids and blood pressure support. If the patient is experiencing severe kidney dysfunction, dialysis may be suggested, and antibiotics may be prescribed to kill the bacteria. In addition, the physician attending to TSS will generally prescribe other medications to help counteract the symptoms. Menstrual TSS can generally be prevented by avoiding the use of highly absorbent tampons. Leaving tampons in too long can also increase susceptibility to the syndrome. Risk can also be reduced using tampons only intermittently in the menstrual cycle. In addition, women who have experienced TSS in the past should always use sanitary napkins, or some other means of containing the menstrual flow, as opposed to tampons. A water-soluble lubricant applied to the tampon applicator prior to insertion can help prevent the tiny fibers in the tampon from tearing the vaginal skin. Tampons with plastic applicators should be avoided.

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