Toxic shock syndrome (TSS)

Toxic shock syndrome (TSS) is a serious condition that causes sudden fever, vomiting, watery diarrhea and muscle pain. If not treated promptly, toxic shock syndrome may cause very low blood pressure or shock. In some cases, TSS may be fatal.


Causes/associated factors
A toxin produced by the bacteria Staphylococcus aureus and group A streptococcus is typically responsible for toxic shock syndrome. The condition can affect men, women and children.
The bacteria may enter the bloodstream through a skin infection, an infected surgical wound, or an infection that develops after childbirth or an abortion. Vaginal sponges and diaphragms used for birth control are sometimes associated with TSS. The condition may also occur after pneumonia or sinusitis, especially if the sinus cavity is packed with gauze.

An association between toxic shock syndrome and tampon use was recognized in the early 1980s. How the Staphylococcus aureus bacteria enters the bloodstream in women who are menstruating is still not well understood, however. The bacteria may enter the bloodstream if the vagina is injured when a tampon is inserted. Or, a super-absorbent tampon may block the vagina for too long, allowing bacteria to back up into the pelvic organs and enter the abdominal cavity. The incidence of toxic shock syndrome in women who are menstruating has steadily declined since highly absorbent tampons were removed from the market in the early '80s and women became more educated about the proper use of tampons. Today, about half of all TSS cases occur in women who are menstruating.

In one-third of all cases, no source of infection is found.


Signs/symptoms
Symptoms of TSS develop suddenly and may include:
fever of 102°F or higher
vomiting
profuse, watery diarrhea
headache
sore throat
weakness
muscle pain
confusion
redness in vaginal, throat and eye tissues
a red rash resembling a sunburn
rapid heart rate
Within 48 to 72 hours, the person may go into shock, a condition in which the body doesn't maintain adequate blood flow. Common symptoms of shock include rapid pulse, low blood pressure and pale, clammy skin.


Diagnosis
Diagnosis is based on your medical history and a physical exam. Extensive blood testing will help the doctor determine which organs are affected. Samples of urine and vaginal secretions may also be tested. In some cases, a chest X-ray and electrocardiogram (a recording of the electrical activity of the heart) may also be necessary. Your doctor may order other tests based on your individual condition.

Treatment
First, any tampons or other possible sources of infection will be removed. Then, you may be given antibiotics, intravenous fluids and possibly other therapies based on the severity of the infection. Medications may be needed to stabilize blood pressure. If you have an infected wound, the dead tissue may need to be surgically removed.

Complications
Toxic shock syndrome can lead to:
kidney failure
congestive heart failure
respiratory distress
temporary loss of hair and nails
gangrene (tissue death) in an extremity
neuromuscular damage (relating to the nervous system)
liver failure
Recurrent episodes of toxic shock syndrome are possible. In some cases, toxic shock syndrome may be fatal.


Pregnancy-specific information
The risk of toxic shock syndrome increases after childbirth or abortion. Consult your doctor if you experience symptoms of TSS after either of these circumstances.

Senior-specific information
Toxic shock syndrome is more common in those under age 50. However, certain chronic diseases most common among older adults, including diabetes and chronic heart or lung disease, can increase the risk of TSS.

Prevention
When TSS was first identified, it was most common in women who used tampons. Although only about half of all current cases are related to tampons, it's wise to use them with caution. Because Staphylococcus aureus is often found on hands, wash your hands before inserting a tampon, diaphragm or vaginal sponge. Do not wear the same tampon for more than eight hours at a time, and avoid the super-absorbent variety. It may also help to alternate between pads and tampons during your period and use pads overnight. Use diaphragms and vaginal sponges only as directed -- never leave them in longer than suggested by the manufacturer.
Recurrences are most common within the first three months after the initial episode. Do not use tampons at all during this time. If you have a history of tampon-related toxic shock syndrome, talk to your doctor before using tampons at any point.