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Toxic shock syndrome
Toxic shock syndrome is a serious disease that involves fever, shock, and problems with several body organs.
Staphylococcal toxic shock syndrome
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 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 periods (menstruation). However, today less than 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 (particularly if you leave one in for a long time)
- Wound infection after surgery
- General ill-feeling
- High fever, sometimes accompanied by chills
- Low blood pressure
- Muscle aches
- Nausea and vomiting
- Organ failure (usually kidneys and liver)
- Redness of eyes, mouth, throat
- 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:
- Low blood pressure
- Rash that peels after 1 - 2 weeks
- Problems with the function of at least three organs
In some cases, blood cultures may be positive for growth of S. aureus.
- 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
Toxic shock syndrome may be deadly in up to 50% of cases. The condition may return in those that survive.
- Organ damage including kidney, heart, and liver failure
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.
You can lower your risk of menstrual toxic shock syndrome by:
- Avoiding highly absorbent tampons
- Changing tampons frequently
- Only using tampons once in awhile during menstruation
Eckert LO, Lentz GM. Infections of the lower genital tract: vulva, vagina, cervix, toxic shock syndrome, endometritis, and salpingitis. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 23.
Reviewed By: Cynthia D. White, MD, Fellow American College of Obstetricians and Gynecologists, Group Health Cooperative, Bellevue, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.