Toxic shock syndrome (TSS) is the name given to a bacterial infection that is not common, but very serious. Originally believed to be caused by the use of tampons, it is now recognized as a problem associated with contraceptive sponge and diaphragm birth control methods. Apart from that, other causes of toxic shock syndrome include wounds, resulting from minor trauma or surgery incisions, which allow the bacteria to enter the body and cause the infection. Amongst the initial symptoms of TSS are sudden high fever, a faint feeling, watery diarrhea, headache and muscle aches.
Types of Toxic Shock Syndrome
There are basically two conditions that result from toxic shock syndrome. The first one is caused by Staphylococcus aureus bacteria and results from excessive use of tampons. It is believed that certain tampons provide a moist, warm area to the bacteria, where they thrive very easily. The second one is called streptococcal toxic shock syndrome (STSS) and is caused by streptococcus bacteria. In majority of the cases, STSS appears through the invasion of injured skin, such as cuts, scrapes, chickenpox blisters and surgical wounds, by streptococcus bacteria.
Incidence Of Toxic Shock Syndrome
The main three routes through which toxic shock syndrome (TSS) can occur include skin (e.g., cuts, surgery, burns), vagina (prolonged tampon exposure), and pharynx. However, the occurrence of the infection is quite rare, even after people are exposed to or colonized with toxin-producing strains of S. aureus or S. pyogenes. This is because majority of the people in this world have protective antibodies against the toxins that are responsible for TSS.
As to the reason why these antibodies are present in the body, even when a person has not been exposed to the bacteria, there is no established theory. Rather, it is speculated that the presence of the two strains of the bacteria in normal flora, minor cuts and the like have contributed to this natural immunization. Whatever be the reason, the incidence of this infection remains to be quite low, though not non-existent.
Symptoms
The following symptoms are seen in case of Toxic shock syndrome:
- Vomiting
- High fever (102° F or higher)
- Rapid drop in blood pressure
- Lightheadedness or fainting
- Watery diarrhea
- Headache
- Sore throat
- Muscle aches
- Sunburn-like rash (within 24 hours)
- Bloodshot eyes
- Redness under the eyelids
- Redness inside the mouth
- Redness inside the vagina
- Broken blood vessels, on the skin
- Confusion or other mental changes
- Decreased urination
- Thirst
- Weak and rapid pulse
- Pale, cool, moist skin
- Rapid breathing
Diagnosis
The diagnosis of toxic shock syndrome is based on the criteria given by CDC (Centers for Disease Control and Prevention), which was modified in 1981. It goes as well:
- Body temperature greater than 38.9 °C (102.02 °F)
- Systolic blood pressure less than 90 mmHg
- Diffuse rash, intense erythroderma, blanching ("boiled lobster") with subsequent desquamation, especially of the palms and soles
- Involvement of three or more organ systems:
- Gastrointestinal (vomiting, diarrhea)
- Mucous membrane hyperemia (vaginal, oral, conjunctival)
- Renal failure (serum creatinine greater than 2x normal)
- Hepatic inflammation (AST, ALT greater than 2x normal)
- Thrombocytopenia (platelet count less than 100,000 / mm³)
- CNS involvement (confusion without any focal neurological findings)