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 May 14, 2005
Toxic Shock Syndrome
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Toxic Shock Syndrome (TSS) is a potentially fatal, flu-like disease caused by a toxin produced by a common strain of bacteria (staphylococci) that spreads to the bloodstream.


TSS is a condition that occurs in association with infections caused by the staphylococcus bacterium. This organism is normally found on the skin and in the vagina and it does not produce a harmful effect. On occasion, however, it can cause skin infections and even abscess formation. In severe cases, the toxin produced by the bacteria is absorbed into the blood stream and causes TSS. Fatality rates can be as high as 15 percent.


The illness occurs most frequently in young menstruating women (90 percent), but does occur in men, children, and non-menstruating women of all ages. Nonmenstrual causes of TSS are now about as common as menstrual cases. Menstruating women who use tampons face a greater risk of becoming ill with TSS than women who do not. Studies have shown that tampons, especially super-absorbent tampons, may produce conditions in the vagina which enable the bacteria to grow and produce the toxin. Other cases of TSS have developed from abscesses in association with surgical wound infections, abrasions, infected burns, and shingles.


Typically, the syndrome begins abruptly with a fever (frequently above 102F), accompanied by headache, sore throat, vomiting, diarrhea, abdominal cramping, bloodshot eyes, fainting and generalized muscle aching. A red rash all over the body may appear during the first few days of the illness and is often followed days later by peeling skin, usually on the palms and soles. In women who use tampons and develop TSS, the symptoms nearly always develop within 5 days of the start of a menstrual period. In severe cases of TSS, the patient may go into shock (a reaction to severe injury which may include a rapid pulse, pale appearance, clammy skin and sometimes unconsciousness). Prompt diagnosis and treatment are essential.


In addition to a medical history and physical exam, your physician may recommend bacterial cultures of any wounds and blood tests.


Treatment for TSS depends on the severity of the case. In all suspected cases, caution should be exercised since the illness may progress from mild to life-threatening within a matter of hours. If an abscess is present or a tampon in place, it should be removed. Antibiotics are used to treat the infection. Most patients recover within 7 to 14 days. Some cases require hospitalization and may even require treatment in intensive care facilities. Shock is treated by the administration of intravenous fluids, which helps the body maintain steady blood pressure. When toxic shock stems from a localized infection, such as an abscess or cellulitis, surgery is indicated to drain the abscess or debride devitalized tissues. Recurrences are common among those women who developed the syndrome during menstruation. Since it is difficult to completely eradicate the staphylococcus organism from the vagina, up to one-third of these patients have a recurrence of the illness within six months. These recurrences have most frequently occurred during a menstrual period. For this reason, women who have had TSS are advised not to use tampons for several months following the illness. The recurrent illness is usually not as severe as the initial episode.


Do any tests need to be done to diagnose and to determine severity? How serious is the condition? What type of treatment will you be recommending? Will hospitalization be required? Will any medications be prescribed? What are the side effects? Will fluid replacement be necessary? And if so, what is given?

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