What is toxic shock syndrome?

Toxic shock syndrome (TSS) is a rare, often life-threatening illness that develops suddenly after an infection and can rapidly affect several different organ systems, including the lungs, kidneys, and liver. Since toxic shock syndrome progresses quickly, immediate medical treatment is needed.

What causes toxic shock syndrome?

Toxic shock syndrome is the rare result of infection by Streptococcus pyogenes (group A strep) or Staphylococcus aureus (staph) bacteria. These bacteria make toxins that cause TSS. These bacteria are common but usually don't cause problems. They can cause infections of the throat or skin that are easy to treat, such as strep throat or impetigo. In rare cases, the toxins enter the bloodstream and cause a severe immune reaction in people whose bodies can't fight these toxins. The body’s reaction causes the symptoms associated with TSS.¹

• Strep TSS most often occurs after childbirth, the flu (influenza), chickenpox, surgery, minor skin cuts or wounds, or injuries that cause bruising but may not break the skin.
• Staph TSS most often occurs after prolonged use of a tampon (menstrual TSS) or after a surgical procedure, such as nose surgery using packing bandages (nonmenstrual TSS).

What are the symptoms?

TSS symptoms develop quickly and can become life-threatening within 2 days. First signs of TSS usually include:

• Severe flu-like symptoms, such as muscle aches and pains, stomach cramps, a headache, or a sore throat.
• Sudden fever over 102°F (38.9°C).
• Vomiting and diarrhea.
• Signs of shock, including low blood pressure and rapid heartbeat, often with lightheadedness, fainting, nausea, vomiting, or restlessness and confusion.
• A rash that looks like a sunburn. The rash can be over several areas of your body or just in specific places such as the armpits or the groin.
• Severe pain at the site of an infection (if a wound or injury to the skin is involved).
• Redness in the nasal passages and inside the mouth.

Other TSS symptoms that may follow include:

• Conjunctivitis (pinkeye).
• Involvement of more than one organ system, most commonly the lungs and kidneys.
• Blood infection (sepsis) that affects the entire body.
• Skin tissue death (necrosis), which occurs early in the syndrome.
• Skin tissue shedding, which occurs during recovery.

Toxic shock symptoms vary slightly depending on the strep or staph bacteria involved.

How is toxic shock syndrome diagnosed?

Because it progresses so quickly, toxic shock syndrome is usually diagnosed and treated based on symptoms and signs of infection without waiting for laboratory results. Additional blood and tissue tests can help identify the type of bacterium causing the infection.

How is it treated?

Emergency treatment often requires intravenous fluid replacement and hospital intensive care, particularly when the body has gone into shock. Further treatment involves antibiotics to kill the bacteria involved, removing any source of infection, and treating any complications. If there are no major complications, most people recover completely in 1 to 2 weeks with antibiotic treatment.

If you think you have toxic shock syndrome, call your doctor immediately. If you have symptoms of shock, such as severe weakness, dizziness, or lightheadedness, immediately seek emergency medical care. Since TSS can cause life-threatening complications, you will most likely need treatment in a hospital where your condition can be closely monitored.

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