Toxic shock syndrome

Overview

Toxic shock syndrome is a rare, life-threatening complication of certain types of bacterial infections. Often toxic shock syndrome results from toxins produced by Staphylococcus aureus (staph) bacteria, but the condition may also be caused by toxins produced by group A streptococcus (strep) bacteria.

Toxic shock syndrome can affect anyone, including men, children and postmenopausal women. Risk factors for toxic shock syndrome include skin wounds, surgery, and the use of tampons and other devices, such as menstrual cups, contraceptive sponges or diaphragms.

Symptoms

Possible signs and symptoms of toxic shock syndrome include:

• A sudden high fever
• Low blood pressure
• Vomiting or diarrhea
• A rash resembling a sunburn, particularly on your palms and soles
• Confusion
• Muscle aches
• Redness of your eyes, mouth and throat
• Seizures
• Headaches

When to see a doctor

Call your doctor immediately if you have signs or symptoms of toxic shock syndrome. This is especially important if you've recently used tampons or if you have a skin or wound infection.

Causes

Most commonly, Staphylococcus aureus (staph) bacteria cause toxic shock syndrome. The syndrome can also be caused by group A streptococcus (strep) bacteria.

Risk factors

Toxic shock syndrome can affect anyone. About half the cases of toxic shock syndrome associated with staphylococci bacteria occur in women of menstruating age; the rest occur in older women, men and children. Streptococcal toxic shock syndrome occurs in people of all ages.

Toxic shock syndrome has been associated with:

• Having cuts or burns on your skin
• Having had recent surgery
• Using contraceptive sponges, diaphragms, superabsorbent tampons or menstrual cups
• Having a viral infection, such as the flu or chickenpox

Complications

Toxic shock syndrome can progress rapidly. Complications may include:

• Shock
• Renal failure
• Death

Prevention

Manufacturers of tampons sold in the United States no longer use the materials or designs that were associated with toxic shock syndrome. Also, the U.S. Food and Drug Administration requires manufacturers to use standard measurement and labeling for absorbency and to print guidelines on the boxes.

If you use tampons, read the labels and use the lowest absorbency tampon you can. Change tampons frequently, at least every four to eight hours. Alternate using tampons and sanitary napkins, and use minipads when your flow is light.

Toxic shock syndrome can recur. People who've had it once can get it again. If you've had toxic shock syndrome or a prior serious staph or strep infection, don't use tampons.

Diagnosis

There's no one test for toxic shock syndrome. You may need to provide blood and urine samples to test for the presence of a staph or strep infection. Your vagina, cervix and throat may be swabbed for samples to be analyzed in a lab.

Because toxic shock syndrome can affect multiple organs, your doctor may order other tests, such as a CT scan, lumbar puncture or chest X-ray, to assess the extent of your illness.

Treatment

If you develop toxic shock syndrome, you'll likely be hospitalized. In the hospital, you'll:

• Be treated with antibiotics while doctors seek the infection source
• Receive medication to stabilize your blood pressure if it's low and fluids to treat dehydration
• Receive supportive care to treat other signs and symptoms

The toxins produced by the staph or strep bacteria and accompanying hypotension may result in kidney failure. If your kidneys fail, you may need dialysis.

Surgery

Surgery may be necessary to remove nonliving tissue from the site of infection or to drain the infection.

Preparing for your appointment

Toxic shock syndrome usually is diagnosed in an emergency setting. However, if you're concerned about your risk of toxic shock syndrome, see your doctor to check your risk factors and talk about prevention. Here's some information to help you prepare for your appointment.

What you can do

• Be aware of any pre-appointment restrictions. When you make the appointment, find out if there's anything you need to do in advance, such as restrict your diet.
• Write down your symptoms, even those that seem unrelated to the reason for your appointment.
• Write down key personal information, including major stresses or recent life changes.
• If you menstruate, write down the date your last period started.
• Make a list of all medications, vitamins or supplements you're taking.
• Bring a family member or friend along, if possible. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.

Preparing a list of questions for your doctor will help you make the most of your time together. For toxic shock syndrome, some basic questions to ask your doctor include:

• What is likely causing my symptoms or condition?
• What are other possible causes for my symptoms or condition?
• What tests do I need?
• What is the best course of action?
• What are the alternatives to the primary approach you're suggesting?
• I have these other health conditions. How can I best manage them together?
• Are there restrictions that I need to follow?
• Should I see a specialist?
• Is there a generic alternative to the medicine you're prescribing?
• Are there brochures or other printed material that I can take with me? What websites do you recommend?

Don't hesitate to ask other questions, as well.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

• When did your symptoms begin?
• Have your symptoms been continuous or occasional?
• How severe are your symptoms?
• Do you use superabsorbent tampons?
• What type of birth control do you use?
• What, if anything, seems to improve your symptoms?
• What, if anything, appears to worsen your symptoms?