Using superabsorbent tampons or having an infection caused by Staphylococcus aureus or group A streptococci increases the risk of toxic shock syndrome.
The syndrome can be fatal, particularly when caused by streptococci.
Doctors diagnose toxic shock syndrome by doing a physical examination and by culturing and identifying the bacteria.
Changing tampons frequently and not using superabsorbent tampons can help reduce the risk of the syndrome.
Treatment includes cleaning of the infected area, removing infected tissue, and using antibiotics.
(See also Overview of Bacteria Overview of Bacteria Bacteria are microscopic, single-celled organisms. They are among the earliest known life forms on earth. There are thousands of different kinds of bacteria, and they live in every conceivable... read more .)
Causes of Toxic Shock Syndrome
Toxic shock syndrome results from toxins produced by two types of bacteria:
This syndrome may occur when Staphylococcus aureus infects tissue (for example, in a wound) or is simply growing on a tampon (especially the superabsorbent type) in the vagina. Exactly why superabsorbent tampons increase the risk of this syndrome is unknown. Leaving a diaphragm in the vagina for more than 24 hours increases the risk slightly.
Toxic shock syndrome caused by group A streptococci usually occurs in people who have infection of skin or of tissues under the skin. About half of people with this syndrome have a bloodstream infection ( bacteremia Bacteremia Bacteremia is the presence of bacteria in the bloodstream. Bacteremia may result from ordinary activities (such as vigorous toothbrushing), dental or medical procedures, or from infections ... read more ), and about half have necrotizing fasciitis Necrotizing Skin Infections Necrotizing skin infections, including necrotizing cellulitis and necrotizing fasciitis, are severe forms of cellulitis characterized by death of infected skin and tissues (necrosis). The infected... read more (a particularly serious streptococcal infection).
Toxic shock syndrome may also occur in the following situations:
When a surgical incision is infected, even when the infection seems minor
When the uterus becomes infected after delivery of a baby
After nose surgery if bandages are used to pack the nose
In otherwise healthy people who have a group A streptococcal tissue infection, usually of the skin
Symptoms of Toxic Shock Syndrome
Toxic shock syndrome symptoms and prognosis vary depending on whether staphylococci or streptococci are the cause.
With either organism, symptoms develop suddenly and worsen rapidly over a few days. Blood pressure falls to dangerously low levels, and several organs (such as the kidneys, liver, heart, and lungs) malfunction or stop functioning (called organ failure). People may have a high fever, a red and sore throat, red eyes, diarrhea, and muscle aches. Some become delirious. A rash that resembles sunburn covers the entire body, including the palms and soles. Then, the skin sometimes peels. Fluid accumulates in tissues, causing swelling (edema). Blood does not clot normally, making bleeding more likely and more severe.
In streptococcal toxic shock syndrome, the infected wound, if present, is painful. Gangrene may develop around the wound. This syndrome is more likely to cause fever, a general feeling of illness (malaise), and severe pain at the site of the infection. Difficulty breathing due to respiratory failure ( acute respiratory distress syndrome Acute Respiratory Distress Syndrome (ARDS) Acute respiratory distress syndrome is a type of respiratory (lung) failure resulting from many different disorders that cause fluid to accumulate in the lungs and oxygen levels in the blood... read more ) is common. Even with treatment, 20 to 60% of people die.
Staphylococcal toxic shock syndrome is often less serious. Fewer than 3% of people die. Skin peeling, particularly on the palms and soles, is more common. The skin usually starts peeling 3 to 7 days after symptoms start. If people survive, recovery is usually complete.
When the source is a tampon infected by staphylococci, toxic shock syndrome commonly recurs, usually within 4 months of the first episode, if women continue to use tampons. Occasionally, the syndrome recurs more than once. Each episode tends to be milder. To reduce the risk of recurrences, women who have had the syndrome should not use tampons or diaphragms.
Diagnosis of Toxic Shock Syndrome
A doctor's evaluation
Culture of samples of blood and infected tissue
The diagnosis of toxic shock syndrome is usually based on the symptoms and results of a physical examination and routine blood tests.
Samples of blood and infected tissue are also sent to a laboratory where bacteria can be grown (cultured).
Magnetic resonance imaging (MRI) or computed tomography (CT) may be done to locate sites of infection.
Blood tests are done regularly to monitor how well organs are functioning.
Prevention of Toxic Shock Syndrome
Women who use tampons can take several measures to prevent infection:
Not using superabsorbent tampons
Using the least absorbent tampons needed
Alternating use of tampons and pads
Changing tampons every 4 to 8 hours
Women who have had toxic shock syndrome due to staphylococci should probably not use tampons and cervical caps, plugs, or diaphragms.
Otherwise, there are no recommendations for preventing toxic shock syndrome.
Treatment of Toxic Shock Syndrome
Fluids given intravenously
Often drugs to increase blood pressure
Cleaning of the infected area (vagina or wound) and removing infected tissue
If toxic shock syndrome is suspected, people are hospitalized, usually in an intensive care unit (ICU) Types of units People who need specific types of care may be put in special care units. Intensive care units (ICUs) are for people who are seriously ill. These people include those who have had a sudden, general... read more .
Fluids that contain salts and often drugs to increase blood pressure to normal levels are given intravenously. Many people need help with breathing, usually with a mechanical ventilator Respiratory Failure and Acute Respiratory Distress Syndrome . Tampons, diaphragms, and other foreign objects are removed from the vagina promptly.
Antibiotics and, for severe cases, immune globulin (which can neutralize the toxin) are given intravenously. Immune globulin contains antibodies obtained from the blood of people with a normal immune system. Antibiotics are started immediately, before the bacteria are identified. Once the bacteria are identified, antibiotics are adjusted as needed.
Areas that could contain the bacteria, such as surgical wounds and the vagina, are flushed out with water (irrigated).
If wounds are infected, surgery may be needed to clean them out further, to remove infected tissue, or sometimes, if gangrene has developed, to remove a limb.