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Toxic shock syndrome

Staphylococcal toxic shock syndrome; Toxic shock-like syndrome; TSLS

Toxic shock syndrome is a serious disease that involves fever, shock, and problems with several body organs.

Causes

Toxic shock syndrome is caused by a toxin produced by some types of staphylococcus bacteria. A similar problem, called toxic shock-like syndrome (TSLS), can be caused by toxin from streptococcal bacteria. Not all staph or strep infections cause toxic shock syndrome.

The earliest cases of toxic shock syndrome involved women who used tampons during their menstrual periods. However, today less than one half of cases are linked to tampon use. Toxic shock syndrome can also occur with skin infections, burns, and after surgery. The condition can also affect children, postmenopausal women, and men.

Risk factors include:

  • Recent childbirth
  • Infection with Staphylococcus aureus (S aureus), commonly called a Staph infection
  • Foreign bodies or packings (such as those used to stop nosebleeds) inside the body
  • Menstrual period
  • Recent surgery
  • Tampon use (with higher risk if you leave one in for a long time)
  • Wound infection after surgery

Symptoms

Symptoms include:

  • Confusion
  • Diarrhea
  • General ill feeling
  • Headaches
  • High fever, sometimes accompanied by chills
  • Low blood pressure
  • Muscle aches
  • Nausea and vomiting
  • Organ failure (most often kidneys and liver)
  • Redness of eyes, mouth, throat
  • Seizures
  • Widespread red rash that looks like a sunburn -- skin peeling occurs 1 or 2 weeks after the rash, particularly on the palms of the hand or bottom of the feet

Exams and Tests

No single test can diagnose toxic shock syndrome.

The health care provider will look for the following factors:

  • Fever
  • Low blood pressure
  • Rash that peels after 1 to 2 weeks
  • Problems with the function of at least 3 organs

In some cases, blood cultures may be positive for growth of S aureus or Streptoccus pyognes.

Treatment

Treatment includes:

  • Removal of materials, such as tampons, vaginal sponges, or nasal packing
  • Drainage of infection sites (such as a surgical wound)

The goal of treatment is to maintain important body functions. This may include:

  • Antibiotics for any infection (may be given through an IV)
  • Dialysis (if severe kidney problems are present)
  • Fluids through a vein (IV)
  • Medicines to control blood pressure
  • Intravenous gamma globulin in severe cases
  • Staying in the hospital intensive care unit (ICU) for monitoring

Outlook (Prognosis)

Toxic shock syndrome may be deadly in up to 50% of cases. The condition may return in those who survive.

Possible Complications

Complications may include:

  • Organ damage including kidney, heart, and liver failure
  • Shock
  • Death

When to Contact a Medical Professional

Toxic shock syndrome is a medical emergency. Seek medical help right away if you develop a rash, fever, and feel ill, particularly during menstruation and tampon use or if you have had recent surgery.

Prevention

You can lower your risk for menstrual toxic shock syndrome by:

  • Avoiding highly absorbent tampons
  • Changing tampons frequently (at least every 8 hours)
  • Only using tampons once in awhile during menstruation

References

Gardella C, Eckert LO, Lentz GM. Genital tract infections: vulva, vagina, cervix, toxic shock syndrome, endometritis, and salpingitis. In:  Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 23.

Larioza J, Brown RB. Toxic shock syndrome. In: Kellerman RD, Bope ET, eds. Conn's Current Therapy 2018. Philadelphia, PA: Elsevier Saunders; 2018;624-628.

Que Y-A, Moreillon P. Staphyloccus aureus (including Staphylococal toxic shock syndrome). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 196.

  • Normal uterine anatomy (cut section)

    Normal uterine anatomy (cut section) - illustration

    The uterus is a muscular organ with thick walls, two upper openings to the fallopian tubes and an inferior opening to the vagina.

    Normal uterine anatomy (cut section)

    illustration

  • Bacteria

    Bacteria - illustration

    Bacterial infections can lead to the formation of pus, or to the spread of the bacteria in the blood.

    Bacteria

    illustration

    • Normal uterine anatomy (cut section)

      Normal uterine anatomy (cut section) - illustration

      The uterus is a muscular organ with thick walls, two upper openings to the fallopian tubes and an inferior opening to the vagina.

      Normal uterine anatomy (cut section)

      illustration

    • Bacteria

      Bacteria - illustration

      Bacterial infections can lead to the formation of pus, or to the spread of the bacteria in the blood.

      Bacteria

      illustration

     

    Review Date: 6/5/2018

    Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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