Understanding Toxic Shock Syndrome and the Dangers

About Toxic Shock Syndrome

Toxic shock syndrome (TSS) is a rare complication of a bacterial infection. Previously it was associated with the use of tampons and contraceptive sponges. The most common underlying cause of toxic shock syndrome is a Staphylococcal infection, however, infection by streptococci may also lead to toxic shock syndrome. Although it is more commonly reported in menstruating women, this condition is also seen in men, children and women of postmenopausal age group.

Common risk factors associated with toxic shock syndrome are infection following surgery and wound infection. Symptoms of toxic shock syndrome usually develop abruptly and mainly characterized by high fever, sloughing of skin and excessive fall in blood pressure. Immediate hospitalization and antibiotic therapy along with other supportive measures are the cornerstones of treatment of toxic shock syndrome. Death is possible in severe cases that are left untreated.

Signs and Symptoms

The symptoms of toxic shock syndrome vary slightly in different patients depending upon the underlying bacteria.

  • TSS due to staphylococcal infection is characterized by :
    – Sudden high fever
    – Low blood pressure
    – Generalized body ache
    – Headache
    – Vomiting
    – Flushing of all the mucosa of the body including vaginal, oral and conjunctival mucosa
    – Confusion
    – Attacks of epileptic fits
    These symptoms rapidly aggravate leading to stupor, coma and ultimately failure of multiple organs resulting in death. One important characteristic feature associated with staphylococcal toxic shock syndrome is the appearance of typical sunburn like a rash involving lips, mouth, palms and soles. The overlying skin in the affected area starts to slough off in 10 to 14 days.
  • TSS due to a streptococcal infection produces similar symptoms as in staphylococcal toxic shock syndrome, however, there are certain differences like these patients have a pre-existing skin lesions caused by Streptococcus pyogenes.

Symptoms of toxic shock syndrome deteriorate very rapidly. Therefore immediate medical attention is required or it can lead to multi-organ failure and death. Toxic shock syndrome has found to recur in patients with a prior history of the disease.

Causes of Toxic Shock Syndrome

Toxic shock syndrome occurs due to infection by staphylococcus or streptococcus although not all staphylococcal or streptococcal infections lead to toxic shock syndrome. Both this bacteria produces toxin superantigen which is responsible for the symptoms. Common risk factors are :

  • Recent childbirth.
  • Using a single tampon without changing for prolonged period during menstruation.
  • Using diaphragm or contraceptive sponges.
  • Iinfection of surgical or skin wounds by staphylococcus or streptococcus.

Tampons and contraceptive sponges left for prolonged period usually acts as the breeding ground for bacteria and lead to symptoms of toxic shock syndrome.

Treatment of Toxic Shock Syndrome

Patients diagnosed with suffering from toxic shock syndrome are to be hospitalized immediately. They are managed by immediate removal of foreign object like tampons, contraceptive sponges or wound packing from the body if any. Specific treatment measures include :

  • Intravenous administration of fluid to stabilize blood pressure.
  • High dose of intravenous antibiotics.
  • Moist oxygen inhalation.
  • Drainage of pus if there is any collection.

Management of other symptoms like dialysis if kidney function is impaired. In severe cases intravenous immunoglobulins are sometimes given to fight off infection.


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