Toxic Shock Syndrome

An infection caused by strep or staph bacteria can lead to toxic shock syndrome (TSS). These bacteria are common and usually don't cause problems. But in rare cases, the toxins enter the bloodstream and cause a severe immune reaction. This reaction causes the symptoms of TSS.

• Toxic shock syndrome caused by strep most often occurs after childbirth, the flu (influenza), chickenpox, surgery, minor skin cuts or wounds, or injuries that cause bruising but may not break the skin.
• Toxic shock syndrome caused by staph most often occurs after a tampon is kept in too long (menstrual TSS) or after surgery (nonmenstrual TSS).

Toxic shock syndrome (TSS) symptoms get worse quickly and can be deadly within 2 days. Symptoms include:

• Sudden fever over 102 F (39 C).
• Signs of shock, including low blood pressure and rapid heartbeat; nausea; vomiting; or fainting or feeling lightheaded, restless, or confused.
• A rash that looks like a sunburn. The rash can be on several areas of your body or just in certain places, such as the armpits or the groin.
• Severe pain in an infected wound or injury.

Other TSS symptoms may include:

• Severe flu-like symptoms, such as muscle aches, stomach cramps, a headache, or a sore throat.
• Redness inside the nose and mouth.
• Pinkeye (conjunctivitis).
• Scaling, peeling skin, especially on the palms of the hands and soles of the feet.
• Having sudden, severe symptoms is one of the most important clues that you may have toxic shock syndrome. If you think you have TSS, get medical care right away.

Doctors usually diagnose toxic shock syndrome based on your symptoms. Tests can help show whether staph or strep bacteria are causing the infection. Tests you may need include:

• Blood tests.
• Tests on body fluids or tissues.
• A chest X-ray, to look for signs of damage to the lungs.
• Tests to rule out other infections, such as an infection of the blood (sepsis), Rocky Mountain spotted fever, leptospirosis, and typhoid fever.

You can take steps to prevent toxic shock syndrome (TSS):

• Keep all skin wounds clean to help prevent infection. This includes cuts, punctures, scrapes, burns, sores from shingles, insect or animal bites, and surgical wounds.
• Help keep children from scratching chickenpox sores by managing itching.
• After childbirth, talk to your doctor before you use tampons or some barrier forms of birth control.
• Follow the directions on package inserts for tampons, diaphragms, and contraceptive sponges.
• If you have had menstrual TSS, do not use tampons or barrier contraceptives.

Treatment for toxic shock syndrome almost always takes place in a hospital. Treatment includes

• Removing the source of the infection or cleaning the wound.
• Treating complications, such as shock or liver, kidney, and lung failure.
• Using antibiotics and other medicines to fight the infection.

Sometimes surgery is needed if TSS developed after surgery or if the infection is destroying the skin and soft tissue (necrotizing fasciitis).

After having TSS, you may get better in 1 to 2 weeks. But it will take longer if you had major complications.

Call 911 anytime you think you may need emergency care. For example, call if:

You passed out (lost consciousness).

• Call your doctor now or seek immediate medical care if:
• You have a new or worse rash.
• You have a new or higher fever.
• You are dizzy or lightheaded, or you feel like you might faint.
• You are short of breath.

Watch closely for changes in your health, and be sure to contact your doctor if:

• You do not get better as expected.