Toxic shock syndrome

Toxic shock syndrome

Description, Causes and Risk Factors:

Abbreviation: TSS.

TSS is a toxin-mediated multisystem disease precipitated by infection with either Staphylococcus aureus or group A Streptococcus (GAS), also called Streptococcus pyogenes.

Risk factors

    Extremes of age.

  • Diabetes.

  • EtOH.

  • Drug abuse.


  • Immunodeficiency.

  • Rarely develops from symptomatic pharyngitis.

  • Those who use vaginal tampons, contraceptive diaphragms or vaginal contraceptive sponges.

  • Women who have recently given birth or had an abortion.

  • Men and women who have an infection with S. aureus are also known to be at risk for developing toxic shock syndrome.

The bacterium that causes TSS, Staphylococcus aureus, can be spread easily from person to person. TSS is not spread from person to person. Thorough handwashing is an important activity to prevent the spread of Staphylococcus aureus and other germs.

Most menstrual TSS can be prevented by avoiding the use of highly absorbent vaginal tampons. The risk may be reduced by using tampons intermittently during each menstrual cycle and by using less absorbent tampons. Users of diaphragms and contraceptive sponges should follow instructions which advise these not be left in place for more than 30 hours.

You can reduce your chances of getting TSS by changing your tampon frequently, at least every four to eight hours. Consider using the lowest absorbency tampon you can, and try to alternate using tampons and sanitary napkins whenever possible. Avoid using tampons at all when your flow is very light; use minipads instead.


    High fevers.

  • Chills.

  • Redness of eyes, mouth, and throat.

  • Myalgia.

  • Severe hypotension.

  • Headache.

  • Nonfocal neurologic abnormalities.

  • Diffuse erythroderma.

  • Mucous membrane hyperemia.

  • Pharyngitis.

  • Vomiting and diarrhea.


Differential Diagnosis: Leptospirosis, Rubeola, Rocky Mountain spotted fever, meningococcemia, Streptococcal or staphylococcal scarlet fever, and typhoid fever.

No single test can diagnose TSS. The diagnosis is based on several criteria: Fever, low blood pressure, a rash that peels after one to two weeks, and problems with the function of at least three organs. In some cases, blood cultures may be positive for growth of S. aureus. You may need to provide blood and urine samples to test for the presence of a staph or strep infection. Samples from your vagina, cervix and throat may be taken for laboratory analysis by using cotton swabs.

Chest Radiographs: Patients who develop multiorgan dysfunction will have bilateral airspaceinfiltrates consistent with acute respiratory distress syndrome.


TSS has a rapid, dramatic, and fulminant onset. Quick recognition of the syndrome is important for enabling appropriate and prompt treatment. Immediate and aggressive management of hypovolemic shock caused by capillary leakage, vasodilatation, and fluid loss is essential in staphylococcal TSS. To ensure adequate perfusion of vital organs, fluid replacement with large volumes of crystalloid solutions (isotonic sodium chloride, lactated Ringer's) or colloidal solutions is important and is considered the mainstay of treatment. Patients may require 8 to 20 L of fluid during the first 24 hours to maintain blood pressure. Placement of a central venous pressure line or a pulmonary arterial catheter is recommended for hemodynamic monitoring.

Note:The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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