TOXIC SHOCK SYNDROME

General Information

DEFINITION--A form of blood poisoning caused by poisons (toxins) released by staphylococcal bacteria. Menstrual toxic shock involves the female reproductive system and respiratory system. Nonmenstrual toxic shock can affect both sexes.

BODY PARTS INVOLVED--Reproductive system (females); respiratory system; soft tissues of the body.

SEX OR AGE MOST AFFECTED--All ages and both sexes, but most common in women of childbearing age (up to 15% of cases occur in males).

SIGNS & SYMPTOMS

• Sudden, high fever in a previously healthy person.
• Vomiting and watery diarrhea.
• Rash that resembles sunburn.
• Low blood pressure.
• Thirst.
• Rapid pulse.
• Feeling of impending doom.
• Mental changes, such as confusion.
• Extreme fatigue and weakness.
• Headache.
• Sore throat.

CAUSES--Some strains of staphylococcal bacteria produce toxins that enter the bloodstream, causing sudden symptoms. Most serious cases have come from staphylococci in the vagina of women using tampons. Toxic shock syndrome can also arise from wounds or infections in the throat, skin, lungs or bone.

RISK INCREASES WITH

• Continuous or prolonged use of highly absorbable tampons during menstrual periods.
• Staphylococcal infections.
• Postpartum women.
• Postoperative patients, particularly after nasal surgery.
• Severe burns, boils or abscesses.

HOW TO PREVENT

Seek early medical care for any wound that appears infected. > Females:

Change tampons frequently, and alternate them at night with sanitary napkins. Don't use superabsorbent tampons. Use those made of cotton. Don't use tampons if you have a skin infection, especially near the genitals. Wash hands thoroughly before inserting tampons. Staphylococci are commonly found on hands.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Laboratory blood studies and mucosal cultures.

APPROPRIATE HEALTH CARE

• Doctor's treatment.
• Immediate hospitalization for intravenous fluids to administer antibiotics and correct fluid and electrolyte loss and dehydration. Also to manage kidney or cardiac problems and provide mechanical breathing support if needed.
• Tampons, diaphragms or other foreign bodies are removed at once.

POSSIBLE COMPLICATIONS

• Severe shock.
• Kidney failure.
• Congestive heart failure.
• Respiratory distress.
• Loss of hair and nails.
• Recurrence of TSS.
• Mortality may be as high as 15% in severe cases.

PROBABLE OUTCOME--Most patients recover with early diagnosis and prompt hospital treatment, but some cases are fatal. Skin of the palms and soles often peels during recovery.

How To Treat

GENERAL MEASURES----The family should maintain an optimistic outlook, stay in close contact with the patient's doctor and help by making their visits with the patient brief and as supportive as possible.

MEDICATION--Your doctor may prescribe:

• Antibiotics, usually intravenous, for infection.
• Intravenous fluids and electrolytes.

ACTIVITY--Resume your normal activities as soon as symptoms improve.

DIET--No special diet after recovery. Intravenous nourishment is usually necessary during hospitalization.

Call Your Doctor If

• You have symptoms of toxic shock syndrome. Call immediately! Shock develops rapidly.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.