What is toxic shock syndrome?

Causes and Symptoms

Toxic shock syndrome, an overwhelming and potentially life-threatening infection, is most commonly known for its association with tampon use in young women. Although this is still the most commonly affected population, toxic shock syndrome can affect nonmenstruating women and men as well.

Two distinct organisms can be responsible for toxic shock syndrome, each associated with a different constellation of symptoms. The bacteria
Staphylococcus aureus (staph) causes all cases of menstrual toxic shock syndrome, and some nonmenstrual cases as well. Nonmenstrual cases can arise from an infected surgical wound or infections elsewhere in the body. The bacteria Streptococcus pyogenes (strep) is responsible for nonmenstrual toxic shock syndrome only.

All patients with staph toxic shock syndrome have high fevers, light-headedness associated with low blood pressure, and a diffuse rash resembling a sunburn. The eyes, mouth, and vagina can become red and irritated, and several weeks following the initial illness, the skin on the palms and soles begins to slough. Other symptoms may include vomiting, diarrhea, muscle aches, jaundice, kidney failure, and confusion.

Strep toxic shock syndrome typically arises at a site of minor trauma to the skin, either an injury or a recent surgical wound. Severe pain at the site is the most common finding. The patient may have a fever, confusion, and low blood pressure. Severe swelling at the site of infection can lead to major damage to the skin and underlying tissues; this necrotizing fasciitis
(so-called flesh-eating bacteria) is a well-known manifestation of strep toxic shock syndrome.

Treatment and Therapy

Because of the severity of the illness, almost all patients with toxic shock syndrome require hospitalization. Intravenous fluids and other medications are administered to improve the blood pressure, and antibiotics are used to kill the bacteria and to decrease production of the toxins that they release.

In cases of menstrual toxic shock syndrome, removal of the tampon is critical. For infected surgical wounds, removal of bandages and packing is required, as well as occasional removal of infected tissue with surgery.

In cases of necrotizing fasciitis, surgical removal of infected tissue is necessary and may involve a loss of a significant amount of skin and underlying muscle.

Perspective and Prospects

The initial association of toxic shock syndrome with highly absorbent tampons in the 1980s led to a withdrawal of such products from the market. Consequently, the number of cases of menstrual toxic shock syndrome has significantly declined; however, extended tampon use remains a risk factor for toxic shock syndrome. Frequent tampon changes and tampon use only on the heaviest days of bleeding should reduce this risk. Women who have had menstrual toxic shock syndrome or other problems with staph infections should avoid tampon use.

Bibliography:

Beers, Mark H., et al., eds. The Merck Manual of Diagnosis and Therapy. 19th ed. Whitehouse Station, N.J.: Merck, 2011.

Icon Health. Toxic Shock Syndrome: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References. San Diego, Calif.: Icon Health, 2004.

Mandell, Gerald L., John E. Bennett, and Raphael Dolin, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. New York: Churchill Livingstone/Elsevier, 2010.

Parker, James N., and Philip M. Parker, eds. The Official Patient’s Sourcebook on Toxic Shock Syndrome. San Diego, Calif.: Icon Health, 2002.

Sheen, Barbara. Toxic Shock Syndrome. San Diego, Calif.: Lucent Books, 2006.

Vorvick, Linda J., Jatin M Vyas, and David Zieve. "Toxic Shock Syndrome." Medline Plus, August 15, 2012.

Wood, Debra. "Toxic Shock Syndrome." Health Library, November 26, 2012.