Toxic Shock Syndrome

What Is Toxic Shock Syndrome?

Toxic shock syndrome (TSS) is a rare but very serious infection. TSS is a medical emergency. So it's important to know how to prevent it and what signs to watch for. With prompt treatment, it's usually cured.

What Are the Signs & Symptoms of Toxic Shock Syndrome?

Toxic shock syndrome starts suddenly, often with

• a high fever (temperature at least 102°F [38.8°C])
• a rapid drop in blood pressure (with lightheadedness or fainting)
• diarrhea
• headache
• sunburn-like rash on any part of the body, including the palms of the hands and the soles of the feet
• muscle aches

Other signs include:

• vomiting
• confusion
• weakness
• tiredness
• peeing less than usual
• being thirsty

A person also might have bloodshot eyes and an unusual redness under the eyelids or inside the mouth (and in the vagina in females). The area around an infected wound can become swollen, red, and tender.

What Causes Toxic Shock Syndrome?

Toxic shock syndrome is caused by two types of bacteria :

1. Staphylococcus aureus (often called staph)
2. Streptococcus pyogenes (often called strep)

Most cases are related to staph bacteria. When strep causes toxic shock syndrome, it's usually because the bacteria got into areas of injured skin, such as cuts and scrapes, surgical wounds, and even chickenpox blisters.

Who Gets Toxic Shock Syndrome?

Originally, toxic shock syndrome was linked to the use of super-absorbent tampons. Research led to better tampons and better habits for using them, such as changing them often. The number of TSS cases dropped dramatically. Today about half of all TSS cases are related to menstruation.

The contraceptive sponge and the diaphragm, two types of birth control, have been linked to TSS. 

Toxic shock syndrome also can affect someone with any type of staph infection, including:

• pneumonia
• an abscess
• a skin infection
• an infected wound
• the blood infection septicemia
• the bone infection osteomyelitis

What Problems Can Happen?

If toxic shock syndrome isn't treated:

• Organs such as the liver and kidneys may begin to fail.
• Problems such as seizures, bleeding, and heart failure can happen.

How Is Toxic Shock Syndrome Diagnosed?

If doctors think someone has toxic shock syndrome, they'll start intravenous (IV) fluids and antibiotics as soon as possible, even before they're sure the person has TSS.

To confirm a diagnosis, doctors take a sample from the likely site of the infection, such as the skin, nose, or vagina, to check for the bacteria. They also may take and test a blood sample. Other blood tests can help doctors:

• see how organs like the kidneys are working
• check for other diseases that might be causing the symptoms

How Is Toxic Shock Syndrome Treated?

Besides giving antibiotics and IV fluids, as needed doctors will:

• remove tampons, contraceptive devices, or wound packing
• clean wounds
• drain a pocket of infection (an abscess)

People with TSS usually need to stay in the hospital, often in the intensive care unit (ICU), for several days. There, doctors can watch their blood pressure and breathing and check for signs of other problems, such as organ damage.

Can Toxic Shock Syndrome Be Prevented?

Washing hands well and often can help prevent the bacteria that cause toxic shock syndrome from spreading.

During their periods, girls can reduce their risk of TSS by:

• washing their hands well before and after inserting a tampon 
• not using tampons or alternating them with sanitary napkins
• if using tampons, choose ones with the lowest absorbency that will handle menstrual flow, and change the tampons often
• on low-flow days, using pads instead of tampons

Between menstrual periods, store tampons away from heat and moisture, where bacteria can grow (for example, in a bedroom rather than in a bathroom closet).

Any female who has had TSS should not use tampons.

Clean and bandage all skin wounds as quickly as possible. Call your doctor if a wound gets red, swollen, or tender, or if a fever begins.

When Should I Call the Doctor?

Symptoms of toxic shock syndrome come on suddenly. Call your doctor right away if your child gets a sudden high fever, feels faint, or has other signs of TSS.