Toxic Shock Syndrome (TSS)

What is toxic shock syndrome?

Toxic shock syndrome (TSS) is a cluster of symptoms that involve many systems of the body. Certain bacterial infections release toxins into the bloodstream. These toxins can spread to many body organs. This can cause severe damage and illness.

What causes toxic shock syndrome?

The bacteria listed below commonly cause TSS.

Staphylococcus aureus (S. aureus)

These bacteria may normally exist on the surface of a person's body and may not cause infection. But if there is a cut, burn, or other injury, they may enter the wound and cause a localized or spreading infection. The germ may make a toxin in the bloodstream. Certain strains of S. aureus are more likely than others to cause skin and spreading infections. And a person can pick up a new, more dangerous strain. S. aureus strains can be spread by direct contact with infected people, clothes, or objects in the environment. TSS from S. aureus was identified in the late 1970s and early 1980s when menstruating women used highly absorbent tampons. Because of changes in how tampons are made, this type of TSS has declined.

Streptococcus pyogenes (S. pyogenes)

TSS from S. pyogenes is most commonly seen in children and older adults. This type of TSS may happen from a cut, injury, or other localized infection. It also can occur as a secondary infection, such as in people who have recently had chickenpox, bacterial cellulitis (infection of the skin and underlying tissue), or have a weak immune system. Other people at risk are those with diabetes, chronic lung disease, or heart disease.

Clostridium sordellii (C. sordellii)

These bacteria normally exist in the vagina and don't cause infection. They may enter the uterus during normal menstruation, childbirth, or gynecological procedures, such as abortion. Intravenous drug use can also cause C. sordellii infections.

Who is at risk for toxic shock syndrome?

You may be at risk for TSS if you:

  • Used super-absorbent tampons in the past

  • Have surgical wounds

  • Have a local infection in the skin or deep tissue

  • Used intravenous drugs in the past

  • Have recently given birth or have had a miscarriage or abortion

What are the symptoms of toxic shock syndrome?

Symptoms of TSS involve many systems. They may look like other infections. While each person may have different symptoms, these are the most common ones:

  • Fever higher than 102°F (38.9°C)

  • Chills

  • Red eyes (conjunctivitis)

  • Headache

  • Fatigue

  • Rash that is red and flat and that covers most of the body

  • Shedding of the skin in large sheets, especially over the palms and soles, which is seen 1 to 2 weeks after the onset of symptoms

  • Low blood pressure

  • Vomiting

  • Diarrhea

  • Severe muscle aches and pain

  • Increased blood flow to the mouth, eyes, and vagina, making them appear red

  • Decreased urine output and sediment in urine

  • Decreased liver function

  • Bruising due to low blood platelet count

  • Disorientation and confusion

  • High white blood cell count in the blood

How is toxic shock syndrome diagnosed?

Ruling out similar illnesses (such as Rocky Mountain spotted fever) is critical in diagnosing TSS. Tests you may need are:

  • Blood and wound cultures. These tests find and identify microorganisms.

  • Blood tests. These tests measure blood clotting and bleeding times, cell counts, electrolytes, and liver function, among others.

  • Urine tests.

  • Lumbar puncture. During this procedure, a needle is inserted between the vertebrae of the spine to draw spinal fluid and check for bacteria.

How is toxic shock syndrome treated?

Your healthcare provider will figure out the best treatment for you based on:

  • How old you are

  • Your overall health and past health

  • How sick you are

  • How well you can handle specific medicines, procedures, or therapies

  • How long the condition is expected to last

  • Your opinion or preference

Treatment for TSS may include:

  • Intravenous (through a vein) antibiotics

  • Intravenous fluid to treat shock and prevent organ damage

  • Heart medicines in people with very low blood pressure

  • Dialysis in people who develop kidney failure

  • Blood products

  • Supplemental oxygen or mechanical ventilation to assist with breathing

  • Deep surgical cleaning of an infected wound

What are possible complications of toxic shock syndrome?

TSS can result in amputations of fingers, toes, or limbs, or even death.

Can toxic shock syndrome be prevented?

Because reinfection is common, menstruating girls and women should not use tampons if they have had tampon-related TSS. You can also prevent TSS with proper and thorough wound care

When should I call my healthcare provider?

TSS may start like other infections. But it can quickly progress to a seriously life-threatening disease. If a mild illness quickly becomes severe with whole-body symptoms, seek care right away.

Key points about toxic shock syndrome

  • Toxic shock syndrome is a serious illness. It's a cluster of symptoms that involve many systems of the body.

  • It can be caused by Staphylococcus aureus, Streptococcus pyogenes, or Clostridium sordellii.

  • Early symptoms are similar to other infections. But they can progress quickly to become life-threatening.

  • TSS can be life-threatening and requires medical care right away.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.

  • Before your visit, write down questions you want answered.

  • Bring someone with you to help you ask questions and remember what your provider tells you.

  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.

  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.

  • Ask if your condition can be treated in other ways.

  • Know why a test or procedure is recommended and what the results could mean.

  • Know what to expect if you do not take the medicine or have the test or procedure.

  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.

  • Know how you can contact your provider if you have questions.