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Toxic Shock Syndrome

(TSS)

Definition

Toxic shock syndrome (TSS) is a group of symptoms throughout the body. This illness can progress rapidly. It can lead to a failure of multiple body systems. Toxic shock syndrome can be fatal.
There are 2 types of TSS:

Causes

TSS is caused by toxins released from specific bacteria.
Bacteria infects the body through cuts or sores. The bacteria can create toxins as it grows. These toxins are harmful to many of your body's systems. The damage to your body is what causes the range of symptoms.
Immune System
Immune system white blood cell
The immune system creates antibodies to fight bacteria.
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TSS was originally associated with tampon use. It was common in women who used a particular type of highly absorbent tampons. As a result, these tampons were removed from the market. The number of TSS infections due to tampons has since significantly decreased.

Risk Factors

Factors that increase your risk of TSS include:

Symptoms

A person with TSS often appears very ill. Symptoms usually come on suddenly. Fever, chills, and body aches may start up to 4 days before other symptoms develop such as:
Symptoms of severe TSS include:
The infection can lead to severe complications such as:

Diagnosis

A physical and pelvic exam will be done. The diagnosis is most often based on fever, rash, low blood pressure, and problems affecting multiple body systems.
Your bodily fluids and tissues may be tested. This can be done with:

Treatment

The goal of treatment is to support life and reverse the process of organ decline. You may need to be monitored in the intensive care unit.
Treatment includes:

Cleaning and Draining the Infection Site

The wound will be opened. Sterile saline will be poured over the wound to clean the area. Any packing from a previous procedure will be removed.
If a birth control device is in the vagina, it will be taken out. If the TSS is menstrual type, the vagina may be flushed with saline.

Supportive Care

To support your body while you heal:
  • IV fluids will be given to replace lost fluids.
  • Your breathing may need to be supported by mechanical ventilation. It may be needed if your lungs are affected or you are too tired to breathe well on your own.
  • Dialysis may be needed with kidney failure. Dialysis takes over the job of the kidneys.
  • Medication may be given to:
    • Raise blood pressure
    • Lower fever
  • Antibiotics may be given. They do not cure TSS but can help to manage the condition.
  • IV immunoglobulin may be given to support the immune system.

Prevention

You can decrease your risk of menstrual-associated TSS with the following steps:
Most other forms of the disease are not currently preventable.

RESOURCES

American Congress of Obstetricians and Gynecologists http://www.acog.org

Centers for Disease Control and Prevention http://www.cdc.gov

CANADIAN RESOURCES

The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org

Women's Health Matters http://www.womenshealthmatters.ca

References

Imöhl M, van der Linden M, Reinert RR, Ritter K. Invasive group A streptococcal disease and association with varicella in Germany, 1996-2009. FEMS Immunol Med Microbiol. 2011;62(1):101-109.

Tampons and asbestos, dioxin and toxic shock syndrome. Food and Drug Administration website. Available at: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/PatientAlerts/ucm070003.htm. Updated March 20, 2013. Accessed January 22, 2015.

Toxic shock syndrome. Nemours Kids Health website. Available at: http://kidshealth.org/parent/infections/bacterial%5Fviral/toxic%5Fshock.html. Updated June 2014. Accessed January 22, 2015.

Tyner HL, Schlievert PM, Baddour LM. Beta-hemolytic streptococcal erythroderma syndrome: a clinical and pathogenic analysis. Am J Med Sci. 2011;342(4):343-344.

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