Toxic Shock Syndrome

Toxic shock syndrome (TSS) is caused by toxins released by certain strains of common bacteria. Although anyone can experience TSS, it occurs most often in healthy adults. The wound through which the bacteria gain entry is often minor or unnoticeable. Toxic shock syndrome has become linked with the use of tampons. TSS develops quickly and may be fatal. Still, this disease is fairly rare.

Toxins released by particular strains of extremely common families of bacteria called Staphylococcus, Streptococcus,and Clostridium cause TSS. These bacteria are everywhere, including on our mucous membranes such as the throat, mouth, nose, and vagina. Most strains are harmless, but some bacteria release a threatening toxin (poison) into the blood.

Sepsis is a body-wide response to infection caused by bacteria or other substances. Septic shock is a serious case of sepsis, where the body goes into shock (life-threatening low blood pressure). TSS is a special form of septic shock caused by the toxins of the Staphylococcus and Streptococcus bacteria.

Toxic shock syndrome can occur when women use tampons, especially "super-absorbent" ones. Toxic shock sprang to public attention in 1980, when over 700 women were infected around North America. Most of these women had recently switched to a new super-absorbent tampon. It's still not clear why this type of tampon increases the risk of TSS, but it may be related to a "drying" of the vagina. Women who leave a diaphragm in place for more than 24 hours are also at an increased risk of TSS.

Many cases of TSS aren't related to tampon use, but occur after surgery, accidental injury, or childbirth. Cases due to Streptococcus usually arise following surgery, but sometimes infections of the skin can result in TSS. Cases due to Clostridium more commonly occur after childbirth and medical abortions. Staphylococcus is generally responsible in tampon-related cases.

TSS symptoms come on suddenly. Symptoms can include:

• confusion
• extreme fatigue and weakness
• high fever of 39°C to 40.5°C (102°F to 105°F)
• headache
• red eyes
• severe diarrhea
• sore throat
• vomiting
• widespread red rash

In severe cases, the symptoms get rapidly worse over the next 24 to 48 hours. Huge amounts of fluid and vital minerals leak into tissues and are lost to the vital organs. The blood supply decreases and blood pressure drops. This can produce fainting and possibly coma. Breathing problems can occur, and the blood and organs may not receive enough oxygen. After 1 to 2 weeks, the skin may start to peel, especially on the palms of the hands and soles of the feet. Also, blood may not clot properly, which increases the risk of bleeding.

Many organs are severely threatened by the bacterial poison. The muscles, kidneys, liver, heart, and lungs can all be damaged by the infection, but can recover with treatment.

It's believed by experts that there are many mild cases of tampon-related toxic shock that never progress to the more drastic symptoms listed above. They go unreported or are mistaken for diseases like influenza and gastroenteritis.

Your doctor will ask you about your symptoms and perform a physical exam. Your doctor will also order blood tests and may send a blood or tissue sample to a laboratory to be checked for bacteria. Other tests such as an electrocardiogram (ECG), X-rays, computed tomography (CT), or magnetic resonance imaging (MRI) scans may be done.