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Toxic Shock Syndrome (TSS)

November 17, 2010

What causes TSS?

Toxic shock syndrome (TSS) is a life-threatening condition caused by toxins produced by certain types of infecting bacteria. The condition has been most often associated with the use of tampons in menstruating women. In 1980, an outbreak of TSS was linked to the use of one brand of superabsorbent tampons. Although this outbreak was linked to toxins produced by the Staphylococcus aureus bacteria, TSS can also be caused by toxins from the group A Streptococcus bacteria. The condition is sometimes subdivided and referred to as staphylococcal TSS and streptococcal TSS.

Although this disease has been frequently linked to the use of tampons in menstruating women, it can affect people of any gender and any age. About half of the reported cases have been linked to the use of tampons in menstruating women, while the remaining cases are due to other situations. Tampons, especially when left in place for a long period of time, are thought to provide a breeding ground for the bacteria that subsequently release toxins to cause TSS. When not linked to tampon use, TSS can occur as a complication of surgery or skin infections.

What are the risk factors for TSS?

In the U.S., the incidence is approximately 1/100,000 women 15-44 years of age, with the overall incidence estimated at about twice that number.

Risk factors are the use of tampons (especially when left in place for an extended time period) and barrier contraceptive devices in women, surgery (especially nasal surgery), the use of wound packings (such as nasal packings), and postoperative wound infection.

What are the signs and symptoms of TSS?

Patients may experience a few days of mild flu-like symptoms before the TSS develops, but TSS itself is characterized by the rapid onset of specific symptoms, including high fever, nausea, vomiting, diarrhea, low blood pressure, and widespread skin rash. This will usually progress to a worsening of low blood pressure, dizziness, confusion, peeling of the skin of the palms and soles of the feet (which develops after one to two weeks of rash), headaches, and occasionally seizures. Ultimately, multiorgan failure may develop, and this leads to death in approximately 5 % of all those affected.

How is TSS diagnosed?

There is no one specific test that establishes the diagnosis of TSS. The diagnosis of TSS is difficult until the characteristic symptoms evolve and a source for the infection is identified. Besides a thorough physical examination (which includes a pelvic examination in women), blood tests will usually be ordered and might include a white blood cell count (to look for signs of infection), blood cultures (evaluating for possible bacteria in the bloodstream) and evaluation of kidney and liver function. Blood tests to exclude other diseases may also be ordered.

Chest X-rays or CT scans of the abdomen or pelvis can be ordered to evaluate the internal organs, depending on the results of the initial evaluation.

What is the treatment for TSS?

If you suspect that you have TSS, you should immediately seek medical care or go to an emergency department for evaluation. Foreign material such as tampons, contraceptive devices, or wound packings must be immediately removed. Treatment may involve a combination of the following:

  • intravenous (IV) fluids to stabilize the blood pressure, possibly in combination with medications to raise blood pressure;
  • IV antibiotics to fight the source of the infection;
  • oxygen administration;
  • removal of tampons, nasal packings, or other suspected sources of the infection;
  • surgical interventions to drain the source of the infection in cases of an abscess and remove necrotic tissue (dead tissues); and
  • dialysis if kidney failure develops.

Other therapies

  • IV immunoglobulin has been reported to be beneficial in severe cases of TSS.
  • Neither hyperbaric oxygen therapy (oxygen given at higher than normal amounts and pressures) nor high-dose corticosteroid treatments have shown any beneficial outcomes in patients with TSS.

TSS At A Glance

  • Toxic shock syndrome is a serious, life-threatening illness caused by toxins released by two specific types of bacteria, group A Streptococcus and S. aureus.
  • Although most commonly associated with tampon use in menstruating females, it can also occur in the setting of postsurgical wound infections as well as skin and other infections.
  • There is no one specific test that establishes the diagnosis of TSS.
  • TSS requires emergency care, including intravenous fluid and antibiotics.


From → menstruation

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