Toxic shock syndrome

Answer 1

Definition

Toxic shock syndrome is a severe disease that involves fever, shock, and problems with the function of several body organs.

Alternative Names

Staphylococcal toxic shock syndrome

Causes, incidence, and risk factors

Toxic shock syndrome is caused by a toxin produced by certain types of Staphylococcus bacteria. A similar syndrome, called toxic shock-like syndrome (TSLS), can be caused by Streptococcal bacteria.

Although the earliest described cases of toxic shock syndrome involved women who were using tampons during their periods (menstruation), just slightly over half of current cases are associated with such events. Toxic shock syndrome can also occur in children, postmenopausal women, and men.

Risk factors include:

• Childbirth
• Current Staphylococcus aureus (S. aureus) infection
• Foreign bodies or packings (such as those used to stop nosebleeds)
• Menstruation
• Surgery
• Tampon use (particularly if you leave on in for a long time)
• Use of barrier contraceptives such as a diaphragm or vaginal sponge

Symptoms

• Confusion
• Diarrhea
• General ill-feeling
• Headaches
• 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
• 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

Signs and tests

No single test can diagnose toxic shock syndrome. The diagnosis is based on several criteria: fever, low blood pressure, a rash that peels after 1-2 weeks, and problems with the function of at least three organs. In some cases, blood cultures may be positive for growth of S. aureus.

Treatment

Any foreign materials, such as tampons, vaginal sponges, or nasal packing, will be removed. Sites of infection (such as a surgical wound) will be drained.

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)
• Methods to control blood pressure

Expectations (prognosis)

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

Complications

• Severe organ dysfunction
  • Kidney failure
  • Heart failure
  • Liver failure
• Shock

Calling your health care provider

Toxic shock syndrome is a medical emergency. You must seek immediate attention if you develop fever or rash, particularly during menstruation and tampon use, or if you have had recent surgery.

Prevention

Menstrual toxic shock syndrome can be prevented by avoiding the use of highly absorbent tampons. You can reduce your risk by changing tampons more frequently and using tampons only once in a while (not regularly) during menstruation.

References

Hans D, Kelly E, Wilhelmson K, Katz ED. Rapidly Fatal Infections. Emerg Med Clin North Am. 2008 May;26(2):259-79, vii.

Todd JK. Toxic Shock Syndrome. In: Long SS, Pickering LK, Prober CG, eds. Principles and Practice of Pediatric Infectious Diseases. 2nd ed. Philadelphia, Pa: Churchill Livingstone; 2003:chap 13.

Answer 2

Definition

Toxic shock syndrome is a severe disease that involves fever, shock, and problems with the function of several body organs.

Alternative Names

Staphylococcal toxic shock syndrome

Causes, incidence, and risk factors

Toxic shock syndrome is caused by a toxin produced by certain types of Staphylococcus bacteria. A similar syndrome, called toxic shock-like syndrome (TSLS), can be caused by Streptococcal bacteria.

Although the earliest cases of toxic shock syndrome involved women who were using tampons during their periods (menstruation), today less than half of current cases are associated with such events. 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:

• Childbirth
• Staphylococcus aureus (S. aureus) infection, commonly called a Staph infection
• Foreign bodies or packings (such as those used to stop nosebleeds)
• Menstruation
• Surgery
• Tampon use (particularly if you leave on in for a long time)
• Use of barrier contraceptives such as a diaphragm or vaginal sponge
• Wound infection after surgery

Symptoms

• Confusion
• Diarrhea
• General ill-feeling
• Headaches
• 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
• 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

Signs and tests

No single test can diagnose toxic shock syndrome.

The diagnosis is based on several criteria: fever, low blood pressure, a rash that peels after 1-2 weeks, and problems with the function of at least three organs.

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

Treatment

Any foreign materials, such as tampons, vaginal sponges, or nasal packing, will be removed. Sites of infection (such as a surgical wound) will be drained.

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)
• Methods to control blood pressure
• Intravenous gamma globulin may help in severe cases

Expectations (prognosis)

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

Complications

• Severe organ dysfunction
  • Kidney failure
  • Heart failure
  • Liver failure
• Shock

Calling your health care provider

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

Prevention

Menstrual toxic shock syndrome can be prevented by avoiding the use of highly absorbent tampons. You can reduce your risk by changing tampons more frequently and using tampons only once in a while (not regularly) during menstruation.

References

Ferguson AJ. Gram-positive toxic shock syndromes. Lancet Infect Dis. 2009 May;9(5):281-90.

Que Y, Moreillon Ph. Staphylococcus aureus (including staphylococcal toxic shock). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 195.

Reviewed By

Review Date: 09/11/2010

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.