Toxic shock syndrome (TSS) is a serious but uncommon bacterial infection. TSS was originally linked to the use of tampons, but is now also known to be associated with the contraceptive sponge and diaphragm birth control methods. TSS has also resulted from wounds secondary to minor trauma or surgery incisions where bacteria have been able to enter the body and cause the infection.
The symptoms of TSS include sudden high fever, a faint feeling, watery diarrhea, headache, and muscle aches. If your child has these symptoms, call your doctor right away.
About Toxic Shock Syndrome
There are two types of this condition. The first, toxic shock syndrome, is caused by Staphylococcus aureus bacteria and has been associated with the use of tampons. (TSS was initially linked to a particular type of tampon, which has since been taken off the market.) Although the exact connection is still not clear, researchers suspect that certain types of high-absorbency tampons provided a moist, warm home where the bacteria could thrive.
TSS can affect anyone who has any type of staph infection, including pneumonia, abscess, skin or wound infection, a blood infection called septicemia, or a bone infection called osteomyelitis.
The second type of related infection, streptococcal toxic shock syndrome, or STSS, is caused by streptococcus bacteria. Most often STSS appears after streptococcus bacteria have invaded areas of injured skin, such as cuts and scrapes, surgical wounds, and even chickenpox blisters. It almost never follows a simple streptococcus throat infection (strep throat).
Toxic shock syndrome
Toxic shock syndrome from staphylococcus starts suddenly with vomiting, high fever (temperature at least 102º Fahrenheit [38.8º Celsius]), a rapid drop in blood pressure (with lightheadedness or fainting), watery diarrhea, headache, sore throat, and muscle aches.
Within 24 hours, a sunburn-like rash appears. There also may be bloodshot eyes and an unusual redness under the eyelids or inside the mouth (and vagina in females). After that, broken blood vessels may appear on the skin. Other symptoms may include: confusion or other mental changes; decreased urination; fatigue and weakness; thirst; weak and rapid pulse; pale, cool, moist skin; and rapid breathing.
Streptococcal toxic shock syndrome (STSS)
STSS can happen following a streptococcus infection in the body, most often a skin infection or an infected wound. Within 48 hours of infection, blood pressure drops dangerously low, and the person may have fever, dizziness, confusion, difficulty breathing, and a weak and rapid pulse. The skin may be pale, cool, and moist, and there may be a rash that sometimes peels later on. The area around an infected wound can become swollen, red, and have areas of severely damaged or dying flesh. The liver and kidneys may begin to fail, and bleeding problems may develop.
The bacteria that cause toxic shock syndrome can be carried on unwashed hands and prompt an infection anywhere on the body. So hand washing is extremely important.
Girls can reduce their risk of TSS by either avoiding tampons or alternating them with sanitary napkins. Girls who use only tampons should choose ones with the lowest absorbency that will handle menstrual flow and change the tampons frequently. Between menstrual periods, store tampons away from heat and moisture (where bacteria can grow) — for example, in a bedroom rather than in a bathroom closet.
Because staphylococcus bacteria are often carried on dirty hands, it's important for girls to to wash their hands thoroughly before and after inserting a tampon. If your daughter is just starting her menstrual period, she should know about taking these precautions. Any female who has recovered from TSS should check with her doctor before using tampons again.
The best defense against STSS is to clean and bandage all skin wounds as quickly as possible. Call your doctor immediately whenever a wound becomes red, swollen, or tender, or if a fever begins. Although STSS almost never follows strep throat, check with your doctor whenever your child has a sore throat with fever, particularly if your child's condition is worsening despite medical treatment.
Diagnosis and Treatment
Doctors typically diagnose TSS and STSS by doing a physical exam and conducting blood tests that assess a child's liver and kidney function. In toxic shock syndrome, doctors may want to rule out conditions like measles or Rocky Mountain spotted fever, which can produce similar symptoms. A doctor may also take samples of fluid from an abscess, boil, or infected wound to look for a possible source of staphylococcus or streptococcus infection.
Doctors typically treat TSS with antibiotics. If there is a pocket of infection, like an abscess, a doctor also may need to drain the infected area. A child who has TSS is monitored for signs of shock until the condition has stabilized and seems to be improving. Steroids are also sometimes used to treat severe cases of TSS.
As with TSS, doctors typically treat STSS with antibiotics and give intravenous fluids and medications to maintain normal blood pressure. Surgery is sometimes necessary to remove areas of dead skin and muscle around an infected wound.
When to Call the Doctor
Call your doctor immediately if your child has any of the following signs and symptoms:
- Signs of shock: Go to the emergency department immediately or call an ambulance if your child has cold hands and feet; a pulse that is fast and weak; confusion or other mental changes; pale, moist skin; shortness of breath; abnormally fast breathing; or a strong feeling of anxiety or fear.
- Signs of TSS: Look for fever; rash (especially a rash that looks like sunburn); nausea and vomiting; watery diarrhea; confusion or other mental changes; and decreased urination. If your daughter uses tampons, ask her to tell you immediately if she notices any unusual vaginal discharge, especially if it smells strange or bad. Most of the time that will be due to other causes, but no matter the cause, it still rates evaluation.
- Signs of STSS: Look for the symptoms of shock listed above, plus a fever; blotchy rash; and an area of infected skin that is red, swollen, and painful.
Once you realize that something is wrong, it's important to get medical attention right away. The sooner your child gets treatment, the quicker the recovery will be.
Reviewed by: Joel Klein, MD
Date reviewed: June 2008