Toxic Shock Syndrome

Introduction
Toxic shock syndrome, or TSS, is a rare, potentially life-threatening disorder. It occurs when toxins made by certain types of bacteria are released into the bloodstream.

What is going on in the body?

Toxic shock syndrome was first described in children in 1978. Experts quickly realized it happened more often among women who used superabsorbent tampons during their periods. TSS is triggered by toxins made by Staphylococcus aureus bacteria. The toxins cause a high fever and can damage the kidneys, liver, and heart.
Experts believe that tampons may block bacteria within the vagina. The moist, humid environment allows them to grow and produce high levels of toxins. Tampons can cause very small cuts in the vagina during insertion. These small cuts allow bacteria and their toxins to enter the bloodstream. About 70% of TSS cases have been related to certain brands of highly absorbent tampons that are no longer made.

What are the causes and risks of the disease?

Following is a list of certain factors that increase a woman's chances of getting TSS:

being between the ages of 12 and 30

having recently delivered a baby

having recently had surgery

leaving a diaphragm or cervical cap in the vagina for more than 36 hours

wearing the same tampon for longer than 8 hours        

What are the signs and symptoms of the disease?

TSS usually starts suddenly and develops quickly. The symptoms may include the following:

confusion

diarrhea

dizziness or fainting

a fever of 102 degrees Fahrenheit or higher

headaches

pelvic pain

sore throat

a sunburn-like rash anywhere on the body, but usually on the soles of the feet and palms of the hand

vomiting

How is the disease diagnosed?

Diagnosis of TSS begins with a history and physical exam, including a pelvic exam. The healthcare provider may order the following tests:

blood cultures

complete blood count, which is also called a CBC

kidney function tests

liver function tests

spinal tap

throat cultures

urinalysis

vaginal culture for Staphylococcus aureus     

What can be done to prevent the disease?

A woman can lower her risk for TSS by taking these steps:
Changes in the design of tampons have occurred because of concern over toxic shock syndrome. Changing tampons frequently should nearly eliminate the risk of tampon-related toxic shock syndrome.

What are the long-term effects of the disease?

If severe shock has occurred and led to kidney, liver, lung, or heart damage, long-term consequences may require treatment or cause permanent disability. The three major causes of death related to severe TSS are as follows:

Alternate tampons with pads every other day during the heaviest flow.

Avoid or minimize the use of superabsorbent tampons.

Change tampons at least every 6 to 8 hours.

Use pads while sleeping.

disseminated intravascular coagulation, or DIC, which causes uncontrollable bleeding

irreversible shock

severe lung damage  

What are the treatments for the disease?

A successful outcome depends on aggressive therapy. A severe TSS infection may require the following:

What are the side effects of the treatments?

Medications and blood transfusions may cause allergic reactions.

What happens after treatment for the disease?

Roughly 30% of women who develop TSS get it again. It is most likely to recur during the first three periods a woman has after treatment. The second bout may be more or less severe than the initial one. Recurrences are less common if a woman gets treatment to eliminate Staphylococcus bacteria during the initial infection. A woman should avoid tampons and sexual intercourse until the healthcare provider says otherwise.

antibiotics given through the vein

blood transfusions

corticosteroids

electrolyte or salt replacements

fluids and medications through the vein to maintain blood pressure

use of a ventilator if the lungs are damaged