What Causes Toxic Shock Syndrome?

Toxic shock syndrome (TSS) is a life-threatening condition caused by certain bacterial infections that require immediate medical attention. Please continue reading to find out what causes toxic shock syndrome as well as the risk factors, symptoms, and treatment.

What is toxic shock syndrome (TSS)?

TSS is a severe, potentially life-threatening complication of bacterial infections. It refers to a collection of symptoms involving multiple body organs. TSS occurs when toxins from certain bacteria that cause infectious diseases enter the bloodstream. The toxin produced by these bacteria spreads throughout the body and causes damage, resulting in toxic shock syndrome symptoms and multi-organ failure.

How do people get toxic shock syndrome?

Three main types of bacterial infections are known to cause toxic shock syndrome:

Staphylococcus aureus

Staphylococcus aureus is one of the normal bacteria in the body and is not considered contagious. Most people have antibodies to this pathogen and do not get staphylococcal infections. However, staphylococcus aureus can spread through contact with an infected individual and cause illness in people who do not have antibodies. An infectious disease with S. aureus can also occur from injured skin (an infected wound or skin infection), burns, surgical site infections, sinusitis, pneumonia, and osteomyelitis (bone infections) where the bacteria enter the bloodstream from these sites, leading to staphylococcal TSS.

Staphylococcal toxic shock syndrome was first diagnosed in the late 1970s in women who used super-absorbent tampons during their menstrual periods. The incidence of menstrual toxic shock syndrome due to staph infection has declined since then due to a change in the way tampons are manufactured.

Streptococcus pyogenes

Streptococcal toxic shock syndrome typically affects children and elderly people. Other risk factors for this type of bacterial infection include diabetes, a weakened immune system, and chronic lung or heart disease. TSS due to a strep infection can also occur secondary to bacterial cellulitis or chickenpox.

Clostridium sordellii

These are normal vaginal bacteria that do not cause infections. However, these bacteria sometimes move up to the uterine cavity when a woman is menstruating or during childbirth and gynecological procedures. The use of intravenous drugs can also lead to infections with this bacteria.

What is the most common cause of toxic shock syndrome?

Toxic shock syndrome was originally associated with the use of highly absorbent tampons in menstruating women. These types of tampons were taken off the market, and the incidence of tampon-induced TSS has since declined. Nonetheless, TSS most often occurs in the setting of menstruation, despite super absorbent tampons being discontinued.

However, TSS can also occur without the use of tampons, for example, due to a soft tissue infection, post-surgical wound infection, burns, retained foreign body such as nasal packing, or dialysis catheters. Therefore, doctors always consider other causes of TSS unrelated to tampon use, both in menstruating women who wear tampons as well as people who do not use tampons.

Why do tampons cause toxic shock syndrome?

It is unclear exactly how tampon use causes toxic shock syndrome. One theory is that the presence of blood-soaked tampons in the vagina allows overgrowth of bacteria.

Can all tampons give you TSS?

All tampons do not cause toxic shock syndrome. Although inserting tampons is a factor in many cases of toxic shock syndrome, this condition can also occur in non-menstruating women, menstruating women who do not use tampons, men, and children.

What are the risk factors for toxic shock syndrome (TSS)?

Inserting tampons, especially high-absorbency tampons, is a major risk factor for TSS. Besides tampon use, common sources of TSS are skin infections. Other risk factors include the use of diaphragms and contraceptive sponges, recent surgery, and recent obstetric events such as deliveries, miscarriages, or abortions. In addition, infants and elderly individuals are at risk of developing streptococcal TSS. Also, TSS is more common in cold weather and developing countries.

How do you know if you're going into toxic shock?

Toxic shock syndrome is characterized by high fever, low blood pressure, rapid heart rate, and a sunburn-like rash. Other toxic shock syndrome symptoms may include fatigue, feeling unwell, nausea, vomiting, headaches, body aches, sore throat, shedding of large areas of skin, decreased urine output, bruising, difficulty breathing, disorientation, and confusion.

How is toxic shock syndrome diagnosed?

Doctors use a range of tests, including blood tests, urine tests, blood cultures, and lumbar puncture, to rule out other conditions and confirm a diagnosis of toxic shock syndrome.

How is toxic shock syndrome treated?

TSS is a medical emergency. Prompt treatment of toxic shock syndrome in the intensive care unit is critical. The exact treatment plan depends on the patient’s age, health status, severity of TSS symptoms, and specific organ damage, but usually includes IV fluids, antibiotics, transfusion of blood products, medications to increase blood pressure, oxygen or mechanical ventilation, dialysis for kidney failure, and deep surgical cleaning of skin wounds that are infected.

How to prevent toxic shock syndrome (TSS)?

You can lower your risk of toxic shock syndrome by using sanitary napkins to catch blood flow (menstrual flow) and minimizing the use of tampons and other foreign bodies in the vagina, such as diaphragms, sponges, and menstrual cups. Girls and women with a history of TSS should not use tampons because the risk of re-infection is high. It is also important to obtain prompt care for infected skin wounds and surgical wounds to lower your risk of toxic shock syndrome (TSS).

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