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Toxic Shock Syndrome

  • Toxic shock syndrome (TSS) is a rare but life-threatening complication of bacterial infection. TSS can affect anyone, male or female. However, it occurs most frequently in young women who wear tampons. It's important to note that tampons themselves don't cause TSS.

    TSS is caused by two types of bacteria: Staphylococcus aureus (commonly called staph) and streptococcus pyogenes (commonly called strep). These bacteria are common in our bodies and don't usually cause any problems. But they make toxins that, in rare cases, can enter the bloodstream and cause TSS.

    • staph bacteria TSS most frequently occurs after a tampon is left in too long
    • manufacturing changes in tampons have reduced the incidence of tampon-induced TSS by more than 40 percent
    • strep bacteria TSS most often occurs after childbirth, surgery and minor cuts or wounds.
    • symptoms can develop quickly.
    • treatment for TSS usually involves IV antibiotics.

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  • What is toxic shock syndrome?

    Toxic shock syndrome (TSS) is a rare but life-threatening complication of bacterial infection. TSS can affect anyone, male or female. However, it occurs most frequently in young women who wear tampons. It's important to note that tampons themselves don't cause TSS.

    • symptoms can develop quickly
    • treatment usually involves intravenous (IV) antibiotics

    Types of toxic shock syndrome

    Two different types of bacteria cause TSS: Staphylococcus aureus and streptococcus pyogenes. These bacteria are common in our bodies and don't usually cause any problems. But they make toxins that, in rare cases, can enter the bloodstream and cause TSS.

    TSS caused by staphylococcal (also known as staph) infection:

    • most often occurs after a tampon is left in too long
    • manufacturing changes in tampons have reduced the incidence of tampon-induced TSS by more than 40 percent.
    • staph bacteria normally exists in a person's nose or vagina and doesn't cause infection
    • 90 percent of people develop antibodies to prevent infection
    • not considered contagious
    • may occur from another infection such as pneumonia, sinusitis, osteomyelitis (infection in the bone), or skin wound, such as a burn or surgical site.

    TSS caused by streptococcal (also known as strep) infection:

    • most commonly seen in people who have recently had chickenpox, bacterial cellulitis (infection of the skin and underlying tissue), given birth, had surgery or suffered a minor cut or wounds.

    What causes toxic shock syndrome?

    TSS results from a bacterial infection. Possible causes of streptococcal and staphylococcal TSS may include:

    • a history of using tampons
    • surgical wounds
    • a local infection in the skin or deep tissue
    • history of using a diaphragm or contraceptive sponge
    • history of childbirth or abortion.

    What are the symptoms of toxic shock syndrome?

    While symptoms may vary child to child, the most common include:

    • For staphylococcus TSS
      • high fever
      • chills
      • malaise (uneasiness and despair)
      • headache
      • fatigue
      • red, flat rash that covers most of the areas of the body
      • shedding of the skin in large sheets (especially the palms and soles) one to two weeks after the onset of symptoms
      • low blood pressure
      • vomiting
      • diarrhea
      • muscle pain
      • increased blood flow to mouth, eyes and vagina making them appear red
      • decreased urine output and sediment in urine
      • decreased liver function
      • bruising
      • disorientation and confusion
    • For streptococcal TSS
      • dangerously low blood pressure
      • shock
      • decreased kidney function
      • bleeding problems
      • bruising
      • red, flat rash that covers large areas of the body
      • liver problems
        • shedding of the skin in large sheets (especially the palms and soles) one to two weeks after the onset of symptoms
      • difficulty breathing

    Can you prevent toxic shock syndrome?

    The following may help prevent TSS:

    • if you've had TSS before, avoid using tampons as reinfection is common
    • take care of any wounds immediately
    • keep vaginal foreign body items (diaphragms, tampons or sponges) to a minimum.

    When using tampons:

    • Use care when inserting tampons. Wash your hands before inserting or taking out your tampon. Make sure your fingernails are not sharp or jagged (to avoid tearing your skin).
    • Change your tampons at least every four to six hours or more often if necessary.
    • Choose the correct tampon absorbency. Use smaller-sized tampons when your flow is lighter. TSS occurs more often when super-absorbent tampons are used. Don't use these unless your menstrual flow is extremely heavy.
    • Alternate between pad and tampon use. Try using pads at night, and tampons in the daytime.
    • Don't use tampons to absorb anything other than your menstrual flow. Only insert a tampon once menstrual blood is present.
  • How does a doctor know that it's toxic shock syndrome?

    There's no one specific test to diagnose TSS. Ruling out similar illnesses, such as Rocky Mountain spotted fever, among others, is critical. Other diagnostic tests may include:

  • If you or your child has TSS, hospitalization is likely. Treatment for TSS may include:

    • intravenous (IV) antibiotics
    • intravenous (IV) fluids (to treat shock and prevent organ damage)
    • cardiac medications (in patients with very low blood pressure)
    • dialysis (may be required in children who develop kidney failure)
    • administration of blood products
    • supplemental oxygen or mechanical ventilation (to assist with breathing)
    • deep surgical cleaning of an infected wound.
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