toxic shock syndrome

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Related to toxic shock syndrome: Streptococcal Toxic Shock Syndrome

Toxic Shock Syndrome



Toxic shock syndrome (TSS) is an uncommon, but potentially serious, illness that occurs when poisonous substances (toxins) produced by certain bacteria enter the bloodstream. The toxins cause a type of blood poisoning caused by staphylococcal, or less commonly streptococcal, infections in the lungs, throat, skin or bone, or from injuries. Women using super-absorbent tampons during menstruation were found to be most likely to get toxic shock syndrome.


TSS first came to the attention of the public in the 1970s. Shortly after the introduction of a super-absorbent tampon, young women across the United States experienced an epidemic of serious but unexplained symptoms. Thousands went to emergency rooms with high fever, vomiting, peeling skin, low blood pressure, diarrhea, and a rash resembling sunburn. The only thing they had in common was that they all were menstruating at the time they felt sick, and all were using tampons, especially super-absorbent products.
At its height, the epidemic affected 15,000 people in the United States each year between 1980 and 1984; 15% of the women died. Since the offending products were taken off the market, the number of TSS cases has declined sharply. As of 1998, only about 5,000 cases are diagnosed annually in the United States, 5% of which are fatal. The decline most likely is due to tampon manufacturers discontinuing the use of some synthetic materials, and the removal from the market of the brand of tampon associated with most cases of TSS. Today, most of these products are made with rayon and cotton.
In spite of TSS' association with menstruating women, the disease can affect anyone of either sex or any age or race. The infection may occur in children, men, and non-menstruating women who are weakened from surgery, injury, or disease, and who cannot fight off a staphylococcal infection. New mothers also are at higher risk for TSS.
Most cases reported in the recent past, however, still involve menstruating women under age 30. TSS still occurs in about 17 out of every 100,000 menstruating girls and women each year; more than half of these cases are related to tampons. Between five and 10% of patients with TSS die.

Streptococcal toxic shock syndrome (stss)

A new type of toxic shock syndrome is caused by a different bacteria, called Group A streptococcus. This form of TSS is called streptococcal toxic shock syndrome, or STSS. Officially recognized in 1987, STSS is related to the strain of streptococcus nicknamed the "flesh-eating bacterium." STSS affects only one or two out of every 100,000 Americans. It almost never follows a simple strep throat infection.

Causes and symptoms


TSS is caused by a strain of Staphylococcus aureus found in the nose, mouth, and occasionally the vagina. The bacteria produce a characteristic toxin. In large enough quantities, the toxin can enter the bloodstream, causing a potentially fatal infection.
While experts know the name of the bacterium, more than 10 years after the 1980s epidemic scientists still do not fully understand the link between TSS and tampons. Most medical researchers today suspect that the absorbent tampons introduce oxygen into the vagina, which is normally an oxygen-free area of the body. Oxygen triggers bacterial growth, and the more absorbent the tampon, the more bacteria it can harbor. Some experts believe that the reason TSS is linked to tampons in particular is that bacteria can contaminate and multiply in a tampon. If left in place for a long time—as a woman could do with a super-absorbent product—the bacteria have a better chance of multiplying and producing a large amount of toxin. It also is possible that the tampons or the chemicals they contain may irritate the vaginal lining, enabling the toxin to enter the bloodstream.
These types of bacteria normally are present either on hands or in the vagina, and it takes an amount of bacteria only the size of a grain of sand to start an infection. Of the 15% of women who carry Staphylococcus aureus, only about 5% have the strain that produces the TSS toxin.


TSS. TSS begins suddenly, with a high fever of 102°F (38.9°C) or above, vomiting and watery diarrhea, headache, and sunburn-like rash, together with a sore throat and body aches. Blood pressure may plummet a day or two after the first symptoms appear. When the blood pressure drops, a woman may become disoriented or go into shock. Her kidneys may fail. After these developments, the skin on her hands and feet may peel.
STSS. STSS can occur after a streptococcal infection in the body, usually from an infected wound or even chickenpox. Within 48 hours, the patient's blood pressure drops. There also is fever, dizziness, breathing problems, and a weak, rapid pulse. The area around the wound may swell, the liver and kidneys can fail, and bleeding problems may occur.


Any woman who is wearing a tampon and begins to experience the symptoms of toxic shock syndrome should remove the tampon right away and seek medical care.
The doctor will probably examine the vagina for signs of inflammation and rule out common sexually transmitted diseases with similar symptoms. A variety of blood tests, tests of vaginal secretions, and a physical examination are needed to identify this condition.



In a menstruating woman, the vagina first is cleansed with an antiseptic solution to eliminate some of the bacteria that produce the toxin. TSS is treated with antibiotics, together with other drugs and fluids to lower fever and control blood pressure.


Antibiotics are used to treat STSS. Surgery may be needed to remove dead skin and muscle. Research continues on new therapy options to help improve treatment of STSS, including intravenous therapy with immunoglobulin. The therapy doesn't replace use of antibiotics but works along with it.


TSS lasts as long as three weeks, and has a tendency to recur. About a third of the women who are treated for TSS have it again within six months. In addition, TSS can affect the liver, kidneys, lungs, and other organs, depending on the severity of the infection. Untreated toxic shock syndrome can be fatal. A 2003 report noted that a quick diagnosis of TSS is critical to avoiding serious complications and death.

Key terms

Shock — A condition in which the amount of blood circulating in the body is inadequate to meet the body's needs. Shock can be caused by certain diseases, serious injury, or blood loss.
Staphylococcus — A genus of bacteria that is commonly found on human skin and mucous membranes.
Streptococcus — A genus of sphere-shaped bacteria that can cause a wide variety of infections.
Toxin — A poisonous protein that is produced by some bacteria. A toxin is less complex than a poison.



Women who wear tampons should change them often and use different brands and types of pads and tampons. If a woman really prefers tampons, experts recommend using the lowest possible absorbency product made of cotton and rayon, and wearing it only during the day. In the past, it was difficult to compare absorbency rates for different products. Today, the Food and Drug Administration (FDA) requires standardized absorbency measurements on all tampon boxes. Above all, women should wash their hands before inserting a tampon, and change the tampon every four to six hours.
Anyone who has had TSS even once should not use tampons again.


Doctors still are not sure how people can avoid STSS, but they advise patients to clean and bandage open wounds immediately. Anyone with a red, swollen, or tender wound, or a sudden fever should seek medical care.



"A Quick Diagnosis of Toxic Shock Syndrome Is Critical for Avoiding Mortality." Health & Medicine Week December 1, 2003: 616.
"Toxic Shock Syndrome May Be Treatable with IVIG Therapy." Blood Weekly October 2, 2003: 64.


Kids Health Page.


poisonous; see poison.
toxic shock syndrome (TSS) a severe illness characterized by high fever of sudden onset, vomiting, diarrhea, and myalgia, followed by hypotension and, in severe cases, shock and death. A sunburn-like rash with peeling of the skin, especially of the palms and soles, occurs during the late phase. The syndrome affects almost exclusively menstruating women using tampons, although a few women who do not use tampons and a few males have been affected. It is thought to be caused by a toxin secreted by a strain of Staphylococcus aureus.

Treatment includes supportive therapy for shock, antibiotics, and management of respiratory distress, gastrointestinal, and renal involvement when indicated.
Prevention. The Centers for Disease Control and Prevention suggest that toxic shock syndrome could be almost entirely eliminated if the use of vaginal tampons were stopped. However, this is not acceptable for many women. Most authorities do recommend that women who have had the condition and are at risk for recurrence not use tampons at all. Any woman who has had the infection should at least refrain from using tampons until three months after the attack or until she has a negative vaginal culture for Staphylococcus aureus. All women should be cautioned to wash their hands thoroughly before inserting a tampon and to change tampons at least every 6 to 8 hours.

tox·ic shock syn·drome (TSS),

infection with toxin-producing staphylococci, occurring most often in the vagina of menstruating women using superabsorbent tampons but also prevalent in many soft tissue infections and characterized by high fever, vomiting, diarrhea, a scarlatiniform rash followed by desquamation, and decreasing blood pressure and shock, which can result in death; hyperemia of the conjunctival, oropharyngeal, and vaginal mucous membranes also occurs.

tox·ic shock syn·drome (TSS),

infection with toxin-producing staphylococci, occurring most often in the vagina of menstruating women using superabsorbent tampons but also prevalent in many soft tissue infections and characterized by high fever, vomiting, diarrhea, a scarlatiniform rash followed by desquamation, and decreasing blood pressure and shock, which can result in death; hyperemia of the conjunctival, oropharyngeal, and vaginal mucous membranes also occurs.

toxic shock syndrome

An acute infection characterized by high fever, a sunburnlike rash, vomiting, and diarrhea, followed in severe cases by shock, that is caused by a toxin-producing strain of the common bacterium Staphylococcus aureus, occurring chiefly among menstruating females who use tampons.

toxic shock syndrome (TSS)

a severe acute disease caused by infection with strains of Staphylococcus aureus, phage group I, that produces a unique toxin, enterotoxin F. It is most common in menstruating women using high-absorbency tampons but has been seen in newborns, children, and men.
observations The onset of the syndrome is characterized by sudden high fever, headache, sore throat with swelling of the mucous membranes, diarrhea, nausea, and erythroderma. Acute renal failure, abnormal liver function, confusion, and refractory hypotension usually follow, and death may occur. It is probable that mild forms of the syndrome are not reported and therefore are not diagnosed. No seasonal or geographic factor appears involved in the cause of the disease, and there is no evidence of contagion among household members or through sexual contacts of people who have TSS. Bacteremia, or discernible local infection, is absent in most cases. S. aureus may be cultured from many sites, including the pharynx, nares, and cervix, but the drastic effects of infection are the result of the toxin released from the organism rather than from the infection itself.
interventions Aggressive volume expansion by the administration of large amounts of IV fluids, assisted ventilation, and administration of vasopressors may be necessary in treating severe TSS. Early recognition and active supportive treatment greatly improve the survival rates and decrease both prolonged morbidity and recurrence.

toxic shock syndrome

Infectious disease A disease caused by Staphylococcus aureus strains that produce a superantigen toxin, TSST-1; the early cases of TSS occurred in tampon users; most began as vaginal lesions; TSS are also linked to foreign bodies–eg, sutures Clinical Abrupt onset of high fever–> 40ºC, N&V, watery diarrhea, which may occur during menstruation, followed by an intense blanching mucocutaneous erythema, desquamative palmoplantar rash and cleavage of the basal layer of the epidermis; without therapy, the Pts deteriorate, become lethargic and confused, develop capillary leakage, hypotension, ARDS, renal, multiorgan failure and shock; with appropriate therapy–non- β-lactam antibiotics, mortality is 5-10%. See Superantigen. Cf Toxic shock-like syndrome, Toxic Sock syndrome.

tox·ic shock syn·drome

(TSS) (tok'sik shok sin'drōm)
Infection with toxin-producing staphylococci, occurring most often in the vagina of menstruating women using superabsorbent tampons; characterized by high fever, vomiting, diarrhea, a scarlatiniform rash followed by desquamation, and decreasing blood pressure and shock, which can result in death; hyperemia of the conjunctival, oropharyngeal, and vaginal mucous membranes also occurs.

toxic shock syndrome

A rare but dangerous condition caused by the damaging effect of toxins of Staphylococcus aureus and Streptococcus species on the lining of blood vessels. One form of the condition has been associated with the use of high-absorbency vaginal tampons and a rise in the numbers of staphylococci in the vagina, with local inflammation. There is high fever, a scaly rash, vomiting and diarrhoea, muscle pain, liver damage, disorientation and an acute and sometimes fatal drop in blood pressure. Blood transfusion and antibiotics are given. In toxic shock, staphylococcal ENTEROTOXINS can act as SUPERANTIGENS which react directly with T cells causing massive release of CYTOKINES. In streptococcal toxic shock, the M PROTEINS of the streptococcal wall are involved. See also SEPTIC SHOCK.

tox·ic shock syn·drome

(TSS) (tok'sik shok sin'drōm)
Infection with toxin-producing staphylococci, occurring most often in vagina of menstruating women using superabsorbent tampons but also prevalent in many soft tissue infections.


poisonous; pertaining to poisoning.

toxic algae
see algal poisoning.
toxic biotransformations
enzymatic changes of nontoxic to toxic substances, usually in the liver.
toxic epidermal necrolysis
see toxic epidermal necrolysis.
toxic fat syndrome
see chicken edema disease.
toxic granulation
see toxic granules.
toxic hepatitis, toxic liver disease
caused by a very large number of poisons including inorganic, organic, plant.
toxic myopathy
uncommon but is caused by e.g. gossypol, Cassia spp., monensin and the other ionophore coccidiostats.
toxic nephrosis
caused by many toxins, e.g. mercury, arsenic, copper, aminoglycoside antibiotics.
toxic shock
see toxemic shock.
toxic shock syndrome
see toxemic shock.
References in periodicals archive ?
A fatal case of streptococcal toxic shock syndrome due to Streptococcus dysgalactiae subsp.
Mediators in the pathogenesis of toxic shock syndrome : o0 verview.
Toxic shock syndrome (TSS) is caused by harmful toxins released by staphylococcus aureus or streptococcus bacteria - which are found on the skin of up to four in 10 healthy people and aren't usually harmful.
Corticosteroid therapy for patients with toxic shock syndrome.
You can get toxic shock syndrome from wounds, chest infections, injecting drugs and infections after giving birth.
A spokeswoman for the Toxic Shock Syndrome Information Service, said: "Children and young people are more at risk of TSS.
Toxic Shock Syndrome is a very, very rare but potentially fatal disease you can get if you don't change your tampons often enough or if you use them when your flow is extremely light.
Some cases of toxic shock syndrome arise from streptococcus infections.
A mother has criticised hospital doctors after her seven-year-old son died from toxic shock syndrome following a minor scald.
Streptococcal toxic shock syndrome and staphylococcal toxic shock syndrome are both characterized by the sudden onset of shock and organ failure, often associated with skin and soft tissue damage [4,5].