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A doctor and patient discuss TSS

Understanding Toxic Shock Syndrome

Toxic shock syndrome (TSS) is a very rare condition resulting from particular bacterial infections. In fact, less than 350 cases were reported in the United States for 2015—but this makes it no less deadly for those who were infected.

Although TSS is generally associated with tampon use, the National Institute of Health reports that “today less than half of cases are linked to tampon[s].” Here’s a look at the symptoms, causes, diagnosis, and treatment of TSS.

Toxic Shock Syndrome Symptoms

The symptoms of TSS are very similar to those of a serious flu. A general feeling of being unwell and high fever with or without chills may develop quickly, indicating infection. Other obvious signs may be present, such as stomach upset (nausea, vomiting, or diarrhea), a headache, aching muscles, or an unusual redness in the eyes, mouth, and throat.

TSS may even cause seizures and a skin rash that looks like a sunburn but occurs primarily on the soles of the patient’s feet or palms of the hand. After one to two weeks, desquamation (or peeling) will occur at the site of the rash.

Symptoms that may be more subtle or less easy to detect from home include confusion, hypotension (low blood pressure), and eventually failure of the liver, kidneys, or other organs.

Toxic Shock Syndrome Causes

The bacteria generally responsible for TSS are staphylococcus aureus and A. streptococcus—infections more commonly known as staph and strep. The NIH states that strep generally causes “a similar problem, called toxic shock-like syndrome (TSLS)” rather than true TSS; the primary difference is an increased severity of necrosis (death) of soft tissue, like skin.

Using tampons is probably the most commonly recognized initiator of TSS. Particular brands of tampons or leaving one in the vagina for too long during menstruation are prime risk factors for menstruating women, but TSS can occur in anyone, of any gender or age.

The NIH lists a variety of other issues from which TSS may present, including “foreign bodies or packings (such as those used to stop nosebleeds) inside the body;” skin infections (particularly Staph infections), cuts, or burns; and undergoing surgery or childbirth. Other sources name bone or blood infections, abscess (a raised area of pus), pneumonia, and even viruses like the chickenpox (which create open wounds) as potential instigators. These issues can create conditions that allow the bacteria in question to invade the skin or body, resulting in life-threatening illness. 

Toxic Shock Syndrome Diagnosis

If you suspect you or a loved one has TSS, getting medical assistance as quickly as possible is essential. Diagnosis may take different forms, depending upon the individual’s situation, as there is not a specific TSS test available. The NIH lists the symptoms of fever, rash, hypotension, and dysfunction of at least three organs as key factors in determining the presence of TSS. TSS-causing bacteria can be detected through blood tests, urine tests, or taking a swab from the throat or external female reproductive organs.

If the condition is detected, additional tests are often necessary to evaluate the degree to which TSS has reached—i.e. if the condition has progressed to potential organ failure. The Mayo Clinic states “a CT scan, lumbar puncture or chest x-ray” may be necessary to achieve a clear view of the patient’s internal status. 

Toxic Shock Syndrome Treatment

Successful treatment of TSS nearly always requires a stay in the hospital. Initial steps include removing any foreign objects (like tampons) and cleaning or draining any infected locations (such as cuts or surgical sites).

Antibiotics may be administered intravenously to begin prompt destruction of the bacteria, along with fluids for dehydration and medication to return blood pressure to normal. Any affected organs should be treated to return their function to normal—for example, initiating dialysis for kidney issues.

More severe cases may require administering gamma globulin, a source of antibodies derived from blood plasma. Surgery is sometimes necessary to debride (remove) any necrotic tissue or remaining areas of infection. TSS should be treated as a medical emergency; seek help immediately to begin treatment as soon as possible. 

Last Updated: April 01, 2016