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Toxic Shock Syndrome - Symptoms And It's Treatment

Alternative names :- TSS; Staphylococcal toxic shock syndrome

Toxic shock syndrome featured in general public news in the early 1980s when an epidemic occurred. It was linked to the prolonged use of highly absorbent tampons in menstruating women. Since then manufacturers have made changes to tampon production and the number of cases of tampon-induced toxic shock syndrome has dropped significantly.

Toxic shock syndrome (TSS) is an acute bacterial infection caused by toxin-producing, penicillin-resistant strains of Staphylococcus aureus, such as TSS toxin-1 and staphylococcal enterotoxins B and C. The disease primarily affects menstruating women under age 30, especially teenagers, and is associated with continuous use of tampons during menses. Five percent of all cases are fatal.

What causes Toxic shock syndrome?

TSS has been linked to the use of tampons and intra vaginal contraceptive devices, such as the diaphragm and the sponge. Although tampons and intravaginal contraceptive devices are clearly implicated in TSS, their exact role is uncertain. Theoretically, they may contribute to development of TSS by:

  • introducing S. aureusinto the vagina during insertion (insertion with fingers instead of the supplied applicator increases the risk)
  • using high-absorbency tampons causes irritation and vaginal dryness, thereby increasing toxin production (occurs especially with rayon tampons)
  • traumatizing the vaginal mucosa during insertion, thus leading to infection
  • providing a favorable environment for the growth of S. aureus.

Although TSS is more closely related to the use of high-absorbency tampons, all tampons are associated with TSS risk. Fortunately, the incidence of TSS has declined significantly since its peak in the mid-l980s, probably due to advances in the way the FDA regulates tampon materials and absorbency as well as withdrawal from the market of those products most associated with TSS. When TSS isn't related to menstruation, it seems to be linked to other S. aureus infections, such as from skin abscesses, osteomyelitis, and post surgical infections.

Signs and symptoms of Toxic shock syndrome

At first, signs and symptoms of TSS may mimic the signs and symptoms of the flu, making diagnosis difficult. Typically, TSS produces sudden onset of intense muscle pains, fever over 104° F (40° C), chills, vomiting, diarrhea, headache, decreased level of consciousness, rigors, conjunctival hyperemia, and vaginal hyperemia and discharge. These symptoms usually occur during or shortly after menstruation. Severe hypotension occurs with hypovolemic shock. Within a few hours of onset, a deep red rash develops - especially on the palms and soles - and later desquamates. Major complications include persistent neuropsychological abnormalities, mild renal failure, rash, and cyanotic arms and legs. Disseminated intravascular coagulation (DIC) and acute respiratory distress syndrome (ARDS) may also occur.

The mortality rate of toxic shock syndrome is approximately 5-15%, and recurrences have been reported in as many as 30-40% of cases. Mortality rates of STSS are more than 5 times higher than in toxic shock syndrome.
Diagnosis tests information

Diagnosis is based on clinical findings and the presence of at least three of the following:

  • GI effects, including vomiting and profuse diarrhea
  • muscular effects, with severe myalgias or a fivefold or greater increase in creatine kinase levels
  • mucous membrane effects such as frank hyperemia
  • renal involvement with elevated blood urea nitrogen or creatinine levels (at least twice the normal levels)
  • liver involvement with elevated bilirubin, aspartate aminotransferase, or alanine aminotransferase levels (at least twice the normal levels)
  • blood involvement with signs of thrombocytopenia and a platelet count of less than 100,000/mm3
  • central nervous system effects, such as disorientation without focal signs.

In addition, isolation of S. aureus from vaginal discharge or lesions helps support the diagnosis. Negative results on blood tests for Rocky Mountain spotted fever, leptospirosis, and measles help rule out these disorders.

Treatment of Toxic shock syndrome

Treatment consists of I.V antistaphylococcal antibiotics that are betalactamase resistant, such as oxacillin and nafcillin. To treat shock and prevent organ damage, expect to replace fluids with saline solution and colloids. Pulmonary, cardiac, and renal support may also be required.

Special considerations and Prevention

Monitor the patient's vital signs frequently.

  • Administer antibiotics slowly and adhere to a strict administration schedule. Be sure to watch for signs of penicillin allergy.
  • Menstrual TSS can be prevented by avoiding the use of highly absorbent tampons
  • Obtain specimens of vaginal and cervical secretions for culture of S. aureus.
  • Remove any tampons from the patient's body immediately.

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