Toxic Shock Syndrome

Toxic shock syndrome is an illness in which toxin (poison)-producing Staphylococcus aureus bacteria enter the bloodstream. The toxin produced by the bacteria affects the skin and organs of the body. Toxic shock syndrome first attracted notice in the U.S. in 1979, when 55 cases and seven deaths were reported. All were in young, otherwise healthy women. In 1980 there were 813 cases of toxic shock syndrome, including 38 deaths. In these women, toxic shock was associated with the use of a particular brand of tampon. (It was subsequently taken off the market.)

Since then, toxic shock syndrome (TSS) and a similar disease, streptococcal toxic shocklike syndrome (STSS), have occurred after surgery, with wounds, and with skin infections. These “nonmenstrual” forms of TSS are more common than the “menstrual” form in the U.S., due to widespread public education about the association of TSS in women with prolonged use of a tampon.

Symptoms
Toxic shock syndrome and STSS have similar symptoms, which usually include:

• Fever
• Widespread rash
• Low blood pressure
• Problems with several organs in the body, such as heart, liver, kidneys, or lungs.

The palms and soles of the feet may become red and eventually peel. There may be muscle tenderness, pain, and/or weakness. As TSS progresses, the liver may be damaged, the kidneys may fail, and respiratory distress may develop. Some individuals may become critically ill and die.

Diagnosis
The symptoms of TSS are clues to its diagnosis. Blood samples can be cultured for bacteria (positive in 5-10% of TSS and about 50% of STSS). Other tests may be done to check for organ damage.

Treatment
The treatment of TSS and STSS includes antibiotics, blood pressure medications, and treatment of skin infections or wound abscesses. Additional treatments will depend on which organs have been affected. Despite treatment approximately 5-15% of individuals will not survive. Prompt diagnosis and treatment are key to reducing the severity of TSS.

Information for this article was taken from:
- Levin, R.M., & Manders, S.M. (2004). Toxic shock syndrome. eMedicine, accessed at http://www.emedicine.com/derm/topic425.htm
- Centers for Disease Control and Prevention. Toxic Shock Syndrome in the United States: Surveillance Update