by Debra Wood, RN
En Espaol (Spanish Version) Toxic shock syndrome (TSS) refers to a combination of symptoms that results from toxins produced by an infection with Staphylococcus aureus 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:
The menstrual typeassociated 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.
The nonmenstrual typeassociated with a wound. It can occur in men, women, and children.
A different bacterium, Streptococcus pyogenes , can cause a similar condition, called streptococcal toxic shock-like syndrome.
Staphylococcus aureus produces the toxin that causes TSS. The immune system in many adults have developed antibodies to fight these common bacteria. In people who do not have the antibodies, the toxins can damage multiple body systems.
Risk Factors A risk factor is something that increases your chance of getting a disease or condition.Risk factors include: Sex: femaleYouthNot having antibodies to toxic shock syndrome toxinsTampon use Birth control devices placed in the vagina: SpongeDiaphragmCervical cap Skin lesions, such as burnsNasal surgery, with packingSurgical woundsRecent childbirth SymptomsSymptoms 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. Symptoms of both types include: Fever of 102 degrees fahrenheit or greaterSunburn-like rashLow blood pressureChillsNauseaVomitingDiarrheaAbdominal painSore throatRed eyesHeadacheConfusionAgitationSleepinessJoint or muscle painVaginal discharge (may be watery or bloody)Swelling in the face and eyelidsSkin peeling off, especially palms of hands and soles of feet (occurs late in disease, 1 to 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 failurelittle or no urine productionSeriously low blood pressureDifficulty breathingSeizuresGangrenePancreatitisLow platelet countHeart problemsFluid retentionLiver failure Organ SystemFemale 2008 Nucleus Medical Art, Inc.
DiagnosisThe doctor will perform 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. TreatmentTreatment 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 SiteThe 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 FluidsYou will be given an infusion of fluids to replace lost fluids. MedicationsMedications 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 they may help prevent a recurrence. RespiratorsArtificial breathing with a machine may be needed. DialysisSome patients may require dialysis as a result of kidney failure. Prevention Strategies to decrease your risk of toxic shock syndrome 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 toxic shock syndrome, do not use tampons or place birth control devices in your vagina. RESOURCES: American College of Obstetricians and Gynecologistshttp://www.acog.org National Center for Infectious Diseases, Centers for Disease Control and Preventionhttp://www.cdc.gov/ncidod CANADIAN RESOURCES: The Society of Obstetricians and Gynaecologists of Canadahttp://sogc.medical.org/ Women's Health Mattershttp://www.womenshealthmatters.ca/index.cfm References: Emergency Medicine: Concepts and Clinical Practice . 4th ed. Mosby-Year Book, Inc.; 1998. Griffith's 5-Minute Clinical Consult . 1999 ed. Lippincott Williams and Wilkins; 1999. Harrison's Principles of Internal Medicine . 16th ed. The McGraw-Hill; 2005.
Medline Plus website. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000653.htm . National Center for Infectious Diseases website. Available at: http://www.cdc.gov/ncidod . Principles and Practice of Infectious Diseases . 5th ed. Churchill Livingstone, Inc.; 2000. US Food and Drug Administration website. Available at: http://www.fda.gov/ . Last reviewed February 2008 by David L. Horn, MD, FACPPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
