Toxic Shock Syndrome (TSS)

What is toxic shock syndrome?

Toxic shock syndrome (TSS) is an illness that produces symptoms in many systems of the body. Certain bacterial infections release toxins into the bloodstream. These toxins can spread to many body organs. This can cause severe damage and illness.

What causes toxic shock syndrome?

The bacteria listed below are the main causes of TSS.

Staphylococcus aureus (S. aureus)

These bacteria may normally exist on the surface of a person's body and may not cause infection. But if there is a cut, burn, or other injury, they may enter the wound and cause a localized or spreading infection. The germ may make a toxin in the bloodstream. Certain strains of S. aureus are more likely than others to cause skin and spreading infections. And a person can pick up a new, more dangerous strain. S. aureus strains can be spread by direct contact with infected people, clothes, or objects in the environment. TSS from S. aureus was identified in the late 1970s and early 1980s when menstruating people used highly absorbent tampons that became infected with S. aureus during use. Because of changes in how tampons are made, this type of TSS has declined.

Streptococcus pyogenes (S. pyogenes)

TSS from S. pyogenes is most commonly seen in children and older adults. This type of TSS may happen from a cut, injury, or other local infection. It also can occur as a secondary infection, such as in people who have recently had chickenpox, bacterial cellulitis (infection of the skin and underlying tissue), or have a weak immune system. Other people at risk are those with diabetes, chronic lung disease, or heart disease.

Clostridium sordellii (C. sordellii)

These bacteria normally exist in the vagina and don't cause infection. They may enter the uterus during normal menstruation, childbirth, or gynecological procedures, such as abortion. Intravenous drug use can also lead to C. sordellii infections.

Who is at risk for toxic shock syndrome?

You may be at risk for TSS if you:

Let tampons, contraceptive sponges, diaphragms, or other devices remain in your vagina for a prolonged period, particularly if you have had TSS in the past
Have surgical wounds
Have a local infection in the skin or deep tissue
Inject illegal drugs
Have recently given birth or have had a miscarriage or abortion

What are the symptoms of toxic shock syndrome?

Symptoms of TSS involve many systems. They may look like other infections. Each person is different, but symptoms of TSS can start quickly and include:

High fever, often at least 102°F (38.9°C)
Chills
Red eyes (conjunctivitis)
Headache
Fatigue
Rash that is red and flat and that covers most of the body
Shedding of the skin in large sheets, especially over the palms and soles, which is seen 1 to 2 weeks after the onset of symptoms
Low blood pressure
Vomiting
Diarrhea
Severe muscle aches and pain
Severe pain at the site of a soft tissue infection
Increased blood flow to the mouth, eyes, and vagina, making them appear red
Decreased urine output and sediment in urine
Decreased liver function
Bruising due to low blood platelet count
Disorientation and confusion
High white blood cell count in the blood

How is toxic shock syndrome diagnosed?

Ruling out similar illnesses such as drug reactions or Rocky Mountain spotted fever is critical in diagnosing TSS. Tests you may need are:

Blood and wound cultures. These tests find and identify microorganisms.
Blood tests. These tests measure blood clotting and bleeding times, cell counts, electrolytes, and liver function, among others.
Urine tests
Lumbar puncture. During this procedure, a needle is inserted between the vertebrae of the spine to draw spinal fluid and check for bacteria.

How is toxic shock syndrome treated?

Treatment for TSS may include:

Hospital stay
IV (intravenous) antibiotics and possibly immune globulin (antibody therapy)
IV fluid to treat shock and prevent organ damage
Heart medicines in people with very low blood pressure
Dialysis in people who develop kidney failure
Blood products
Supplemental oxygen or mechanical ventilation to assist with breathing
Deep surgical cleaning of an infected wound

What are possible complications of toxic shock syndrome?

TSS can result in amputations of fingers, toes, or limbs, or even death.

Can toxic shock syndrome be prevented?

Because reinfection is common, don't use tampons if you have had tampon-related TSS. You can also prevent TSS with correct and thorough wound care.

When should I call my healthcare provider?

TSS may start like other infections. But it can quickly progress to a life-threatening disease. If a mild illness quickly becomes severe with whole-body symptoms, seek care right away.

Key points about toxic shock syndrome

Toxic shock syndrome is a serious illness. It's a cluster of symptoms that involve many systems of the body.
It can be caused by Staphylococcus aureus, Streptococcus pyogenes, or Clostridium sordellii.
Early symptoms are similar to other infections. But they can progress quickly to become life-threatening.
TSS can be life-threatening and needs medical care right away.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your healthcare provider if you have questions, especially after office hours or on weekends and holidays.

Online Medical Reviewer: Barry Zingman MD
Online Medical Reviewer: Raymond Turley Jr PA-C
Online Medical Reviewer: Stacey Wojcik MBA BSN RN

Date Last Reviewed: 8/1/2023

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