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Toxic Shock Syndrome Toxic Shock Syndrome
Toxic shock syndrome (TSS) is a very serious, life threatening condition. It is cause by the toxins that are produced by certain bacteria.... Toxic Shock Syndrome

by Kimberly Allen R.N.

Toxic shock syndrome (TSS) is a very serious, life threatening condition.  It is cause by the toxins that are produced by certain bacteria.  TSS has frequently been associated with tampon use by women that are menstruating.  However, it can affect anyone, male or female, at any age.  Most estimates are that approximately half of all cases of TSS are related to tampon use and the other half are related to other situations, like skin infections or as a complication after surgery.

Toxic shock usually starts with a common bacteria growing in a tampon, which then produces a toxin that attacks major organs.

There are 2 types of bacteria that have been linked to TSS, staphylococcus aureus and group A streptococcus.  The symptoms of TSS vary depending on the type of bacteria that is producing the toxins.  If staphylococcus aureus is the causing bacteria the symptoms will typically appear suddenly in people that seem healthy.  They will have a high fever, usually >102F, a lower blood pressure, confusion and malaise.  These symptoms can progress rapidly to coma and multiple organ failure.  There is also a characteristic rash that is frequently seen in the early stages of TSS that looks like a sunburn that can develop on any part of the body including the palms, soles of your feet and eyes. The rash peels off after 10-14 days in those that survive the initial infection.  On the other hand TSS that is caused by the streptococcal bacteria usually develop TSS from a pre-existing  skin infection.  The symptoms in this case usually begin at the site of the original infection with severe pain, increased redness, swelling of the area around the site and sometimes an increase in drainage that has a foul odor and green color.  These symptoms are usually followed quickly by the same symptoms of TSS caused by staphylococcus aureus with the exception of the rash.
Diagnosis of toxic shock  syndrome is based solely on criteria laid out by the CDC in 1981, those guidelines are;
1. Body temperature greater than 102.2F
2. Systolic blood pressure less than 90mmHg, the systolic is the top number in the blood pressure reading.
3. Diffuse rash,severe reddening of the skin especially on the palms and sole.
4. Involvement of 3 or more organ systems; GI- vomiting and diarrhea; renal failure- serum creatinine 2 times the normal, liver failure – AST and ALT 2 times normal; thrombocytopenia with platelet count below 100,00mm, CNS involvement with confusion.
If you feel you may have TSS it’s important to seek medical attention immediately.  TSS is a life threatening illness and any delay in treatment can mean the difference between life and death.  Initial treatment usually involves intravenous fluids to raise and stabilize your blood pressure, intravenous antibiotics to attack the infection, the antibiotic will depend on the bacteria causing the infection.  You will also receive oxygen to increase the levels in your bloodstream to help your body fight the infection.  Any tampons, wound packing or any other suspected source of the infection will be removed.  In some cases surgery to drain any abscesses and/or remove any dead tissue.
When I worked in home health I was caring for an older gentleman that I knew in the community.  He’d had abdominal surgery that required the opening to heal from the inside out requiring it to be packed twice a day with sterile gauze. I had been packing it for weeks and it was almost healed when I had to leave for a vacation (family wedding) that had been planned for over a year.  When I returned 2 weeks later expecting it to be completely healed, however when I saw him I found it was not.  In fact I was quite alarmed as even though there was only as very small superficial area that was not completely healed I noticed the area was red and there was some green drainage on the dressing.  I immediately called the surgeon on call.  His first question to me was ” has he eaten anything yet?” fortunately it was 6am and he had not had breakfast yet. The Dr wanted him brought to the hospital immediately, and when I told my patient and his wife my patient let me know in no uncertain terms he was not happy that I wouldn’t let him eat or drink anything, most especially coffee. The surgeon was waiting for him when he got to the hospital and he was taken to surgery immediately.  It turns out that one of the stitches that was supposed to dissolve didn’t and developed an abscess deep in the wound.
The best way to prevent toxic shock syndrome is to change tampons at least every 4-8 hours and try to alternate using tampons and sanitary napkins when possible.  If you’ve had surgery or have an open sore on your skin watch for symptoms of infection and report them to your Dr immediately.  Remember survival depends on early detection and treatment.

Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at