- Toxic shock syndrome (TSS) facts
- What is toxic shock syndrome?
- What causes toxic shock syndrome?
- What are risk factors for toxic shock syndrome?
- What are toxic shock syndrome symptoms and signs?
- How do physicians diagnose toxic shock syndrome?
- What is the treatment for toxic shock syndrome?
- What is the prognosis of toxic shock syndrome?
- Is it possible to prevent toxic shock syndrome?
Toxic shock syndrome (TSS) facts
- Toxic shock syndrome (TSS) is a severe illness associated with infections.
- Toxic shock syndrome is caused by exotoxin(s) secreted by Streptococcus or Staphylococcus.
- Risk factors include use of tampons, deep wound infections, and any immunosuppressive health problems.
- TSS signs and symptoms include:
- Diagnosis is usually made by clinical criteria such as the signs and symptoms listed above.
- Treatment depends on the individual's condition; usually intravenous fluids and IV antibiotics are required -- some patients may require additional support (respiratory support, dialysis, and intensive care).
- Early diagnosis with effective treatment can yield a good prognosis; development of organ damage usually worsens the patient's prognosis.
- The incidence of toxic shock syndrome can be reduced by avoiding the use of superabsorbent tampons and other devices placed in the vagina; other methods include excellent wound care and/or early treatment of deep wounds.
What is toxic shock syndrome?
Toxic shock syndrome is a severe illness associated with group A Streptococcus (GAS or Streptococcus pyogenes); this bacterium produces a toxin termed TSS toxin-1 (TSST-, or phage-group-1 streptococcal toxic shock syndrome). TSS was first described in 1978 in children, but subsequent reports identified TSS outbreaks in women who use tampons. Although first thought to be additionally associated with menstruation, over the past years, less than half of TTS cases have been menstruation-related. Although most cases of TTS occur in women who menstruate, about 25% of infections occur in men. TSS is also associated with Staphylococcus infections; some strains of these bacteria produce exotoxins very similar to TSST-1.
What causes toxic shock syndrome?
The cause of toxic shock syndrome (TSS) is one of several closely related exotoxins secreted by bacteria that are infecting the person. The toxins (also termed superantigens) activate T cells of the immune system to produce chemicals known as cytokines that subsequently cause shock and tissue damage. The superantigens have a unique way of interacting with the immune system. Although there are several closely related exotoxins, about 80% of individuals with TSS have an illness caused by TSST-1 or a similar exotoxin. Other exotoxins such as those produced by enterococci A, C, D, E, and H cause most of the remaining 20% of infections.
M protein, a filamentous protein on the cell membrane of group A Streptococcus bacteria enhances the likelihood of the bacterial strain being more likely to cause disease. Bacterial strains that lack M protein are less lethal because M protein can protect bacteria from host immune defenses. In addition, M protein apparently enhances cell damage and inflammation caused by exotoxins.
What are risk factors for toxic shock syndrome?
Risk factors for TSS include a history of using high-absorbency tampons, surgical wounds, history of using a diaphragm or contraceptive sponge, having a localized deep skin infection, abortion, burns, and immunosuppression (for example, as seen with diabetes, chronic lung or heart disease, or in elderly patients). Not recognizing TTS symptoms while using a tampon can be a serious mistake. For example, Sara Manitoski, a 16-year-old who was on an overnight school trip, complained of stomach cramps before she went to bed. The following morning, she was found unresponsive. She ultimately died, and the autopsy revealed that she died from TTS.
What are toxic shock syndrome symptoms and signs?
TSS symptoms and signs a resemble those found in other infections; however, the most common symptoms of TSS are as follows:
- Fever higher than 38.9 C (102 F)
- Low blood pressure (about <90 systolic); lightheadedness
- Decreased kidney function
- Disturbances in blood clotting (platelets less than or equal to 100,000/mm3)
- Liver involvement (twice the upper limit of normal for liver enzyme measurements)
- Acute respiratory distress
- A sunburn-like red rash that's flat and/or shedding of the skin (erythroderma)
- Damage and death of soft tissues, such as necrotizing fasciitis, myositis, or gangrene due to flesh-eating bacterial infections
- Muscle aches
Skin shedding may occur on the palms and soles of the feet about one or two weeks after the initial infection begins.
Some doctors classify TSS cases by stages -- others do not. However, early symptoms such as a high fever and a falling blood pressure (shock-like symptoms) may occur before later stages of organ damage appear. Early symptoms are flu-like and can be confused with those of other diseases, like norovirus or other viral and bacterial infections, especially in young women.
How do physicians diagnose toxic shock syndrome?
In general, after the history and physical, if the patient has low blood pressure and multiorgan involvement characterized by two of the above listed symptoms of organ dysfunction (renal, lung, liver, skin, or blood), the clinical diagnosis of TSS is made, according to CDC criteria. A confirmation of the diagnosis is done by isolation of one of the causative bacteria; the bacteria should be identified as capable of producing exotoxin that either is, or functions like, TSST-1.
What is the treatment for toxic shock syndrome?
The treatment for TSS varies from patient to patient; however, the following treatments are fairly common. Patients with TSS usually will be treated with two or more of the following treatments:
- Intravenous fluids to treat shock
- IV antibiotics
- Deep surgical cleaning of any infected wounds
- Cardiac medications to help treat low blood pressure
- Oxygen and/or mechanical ventilation as needed
- Blood products if needed
- Dialysis for patients with kidney failure
- Hospitalization in an intensive-care unit
What is the prognosis of toxic shock syndrome?
Patients with TSS who are diagnosed early and given appropriate treatment often have a good prognosis. Early treatment can help prevent life-threatening complications such as renal failure, respiratory failure, and coagulation disorders. However, the mortality (death) rate is about 5%-15%, and patients who develop complications have a poorer prognosis than those who do not. Patients who develop TSS are at risk for reinfection.
Is it possible to prevent toxic shock syndrome?
It is possible to reduce the chances of developing TSS. Menstruating females should minimize use of items like tampons, diaphragms, and sponges. Women should change tampons frequently and avoid super-absorbent tampons. For example, polyester, carboxymethylcellulose, and polyacrylate rayon, which increase tampon absorbency, have been removed from tampons because they were associated with increased TSS toxin production. Anyone diagnosed with TSS has a higher risk of reinfection. Women diagnosed with TSS should avoid tampon use in the future. Your ob-gyn doctor may provide additional recommendations. Early treatment of wounds, especially deep wounds, can help prevent TSS.
Hajjeh, R.A., Reingold A.L., Weil A., et al. "Toxic Shock Syndrome in the United States: Surveillance Update, 1979–1996." Emerging Infectious Diseases 5.6 (1999) :807-810. doi:10.3201/eid0506.990611.
United States. Center for Disease Control and Prevention. "Toxic Shock Syndrome: A Lasting Legacy." Oct. 11, 2017. <https://www.cdc.gov/od/science/wewerethere/toxicshock/index.html>.
Venkataraman, Ramesh. "Toxic Shock Syndrome." Medscape.com. May 7, 2018. <http://emedicine.medscape.com/article/169177-overview>.
Top Toxic Shock Syndrome (TSS) Related Articles
Aches, Pain, FeverAlthough a fever technically is any body temperature above the normal of 98.6 F (37 C), in practice, a person is usually not considered to have a significant fever until the temperature is above 100.4 F (38 C). Fever is part of the body's own disease-fighting arsenal; rising body temperatures apparently are capable of killing off many disease-producing organisms.
Barrier Methods of Birth Control
Many barrier methods of birth control are available for a man or woman, for example, the sponge, female and male condoms, diaphram, spermicides, male condoms, female condoms, contraceptive sponge, diaphragm, and cervical cap. Side effects, and efficacy (in preventing pregnancy) depends on the type of birth control used.
Burn types are based on their severity: first-degree burns, second-degree burns, and third-degree burns. First-degree burns are similar to a painful sunburn. The damage is more severe with second-degree burns, leading to blistering and more intense pain. The skin turns white and loses sensation with third degree burns. Burn treatment depends upon the burn location, total burn area, and intensity of the burn.
CAT ScanA CT scan is an X-ray procedure that combines many X-ray images with the aid of a computer to generate cross-sectional and three-dimensional images of internal organs and structures of the body. A CT scan is a low-risk procedure. Contrast material may be injected into a vein or the spinal fluid to enhance the scan.
Chest X-rayChest X-Ray is a type of X-Ray commonly used to detect abnormalities in the lungs. A chest X-ray can also detect some abnormalitites in the heart, aorta, and the bones of the thoracic area. A chest X-ray can be used to define abnormalities of the lungs such as:
- excessive fluid (fluid overload or pulmonary edema),
- fluid around the lung (pleural effusion),
- and cancers.
DialysisDialysis is a procedure that performs many of the normal duties of the kidneys, like filtering waste products from the blood, when the kidneys no longer work adequately. There are two types of dialysis: Hemodialysis uses a filter to remove waste products and water from the body; and peritoneal dialysis removes excess waste and fluid with a fluid that is placed into the patient's stomach cavity through a special plastic tube.
DiarrheaDiarrhea is a change is the frequency and looseness of bowel movements. Symptoms associated with diarrhea are cramping, abdominal pain, and the sensation of rectal urgency. Causes of diarrhea include viral, bacterial, or parasite infection, gastroenteritis, food poisoning, and drugs. Absorbents and anti-motility medications are used to treat diarrhea.
Low Blood Pressure
Low blood pressure, also referred to as hypotension, is blood pressure that is so low that it causes symptoms or signs due to the low flow of blood through the arteries and veins. Some of the symptoms of low blood pressure include light-headedness, dizziness, and fainting if not enough blood is getting to the brain.
Diseases and medications can also cause low blood pressure. When the flow of blood is too low to deliver enough oxygen and nutrients to vital organs such as the brain, heart, and kidneys; the organs do not function normally and may be permanently damaged.
RashThe word "rash" means an outbreak of red bumps on the body. The way people use this term, "a rash" can refer to many different skin conditions. The most common of these are scaly patches of skin and red, itchy bumps or patches all over the place.
Staphylococcus or staph is a group of bacteria that can cause a multitude of diseases. Staph infections can cause illness directly by infection or indirectly by the toxins they produce. Symptoms and signs of a staph infection include redness, swelling, pain, and drainage of pus. Minor skin infections are treated with an antibiotic ointment, while more serious infections are treated with intravenous antibiotics.
Staph Infection SlideshowDo you know what a staph infection is? Learn about the causes, symptoms, and treatment of staph infections (Staphylococcus aureus), and how this group of bacteria can cause a multitude diseases ranging from mild to potentially fatal.