Health Encyclopedia

Toxic shock syndrome

Definition

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

Alternative Names

TSS; Staphylococcal toxic shock syndrome

Causes, incidence, and risk factors

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

Symptoms

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)

Signs and tests

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.

Treatment

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)

Expectations (prognosis)

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

Complications

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

Calling your health care provider

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.

Prevention

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.

References

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.

Review Date:9/6/2006
Reviewed By:Hilary M. Babcock, M.D., Medical Director of Occupational Infection Control, Barnes-Jewish and St. Louis Children's Hospitals; Instructor of Medicine, Infectious Disease Division, Washington University School of Medicine, St. Louis, MO. Review provided by VeriMed Healthcare Network.

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