Toxic Shock Syndrome

What Is It?

Toxic shock syndrome is a rare, life-threatening illness triggered by certain bacteria (group A streptococcal and Staphylococcus aureus). In toxic shock syndrome, toxins (poisons) produced by the bacteria cause a severe drop in blood pressure (hypotension) and organ failure. In some patients, these bacteria enter the body through an obvious break in the skin, such as a wound or puncture. Other cases are related to the use of tampons. Sometimes, however, toxic shock develops after a relatively mild injury, such as a bruise or muscle strain, or no cause is identified at all.

Symptoms

The majority (80 percent) of patients with group A streptococcal toxic shock syndrome have symptoms of a soft-tissue infection (pain, redness, warmth, swelling) in an area just below the skin or in a muscle. Patients with staphylococcal toxic shock syndrome may have a staphylococcal infection anywhere in the body and the site of infection may not be immediately apparent.

Symptoms of toxic shock include:

• Flu-like symptoms such as fever, chills, muscle aches, nausea, vomiting and diarrhea
• Hypotension (low blood pressure) with a weak and rapid pulse
• A red rash that covers the whole body, sometimes followed by peeling skin (the rash may be difficult to see in dark-skinned individuals)
• Decreased urine output
• Confusion, disorientation or other mental changes
• Swelling in the hands, feet and ankles
• Severe breathing difficulties

Diagnosis

Because a patient with toxic shock syndrome may be too ill to answer questions, a family member or friend may need to tell the doctor about the patient's medical history and symptoms. In general, the doctor will ask whether the patient has had any recent wounds or surgical procedures or has complained about a rash or a skin infection.

To help establish the diagnosis, the doctor will thoroughly examine you, including your vital signs (blood pressure, heart rate, temperature), and your heart, lungs, abdomen, skin, muscles and neurological system. Your doctor also will order the following blood tests to evaluate the severity of the illness, and to determine if the problem is caused by toxic shock syndrome or another process:

• Blood tests to measure levels of white blood cells, red blood cells and platelets
• Blood tests to evaluate how well the blood clots
• Blood chemistry tests to measure kidney function (blood urea nitrogen, or BUN, and creatinine) and liver function (liver enzymes and total bilirubin)
• Urinalysis
• Tests to check blood samples, wound discharge or other body fluids for bacterial growth (cultures) to test for the presence of GAS or staphylococcal bacteria; chest X-ray and a test for blood gases in patients with severe breathing difficulties

Expected Duration

Shock and other life-threatening symptoms of toxic shock syndrome can develop very suddenly. Once symptoms begin, death can follow quickly if the patient is not taken to a hospital immediately. Among hospitalized patients, the length of illness varies. Many patients require prolonged hospital treatment for kidney failure, liver failure or for severe respiratory problems that require mechanical ventilation (in which a machine breathes for the patient).

Prevention

There are no specific guidelines to prevent toxic shock syndrome. You may be able to reduce your risk of developing tissue infections by promptly cleaning and treating even small skin wounds. Staphylococcal toxic shock that is related to tampon use can be avoided by changing tampons frequently.

Treatment

Patients with toxic shock syndrome are hospitalized and treated with the following:

• Intravenous (into a vein) fluids and certain medicines to raise blood pressure and improve blood flow to vital organs
• Antibiotics to eliminate the bacteria that are causing the infection
• Surgical removal of destroyed tissue or, when necessary, amputation, in cases of toxic shock syndrome caused by group A streptococci that occurs in conjunction with devastating infections of the soft tissues
• Mechanical ventilation, dialysis or other supportive measurements if vital organs fail
• Experimental treatments, such as IV gamma globulin

When To Call A Professional

Toxic shock syndrome is a medical emergency. Call your doctor immediately whenever someone develops the symptoms listed above. Also, contact your doctor if a wound, puncture or bruise becomes red, warm, swollen and painful.

Prognosis

The prognosis is variable. Many people recover completely while others may die even with prompt treatment in the hospital.

Additional Info

National Center for Infectious Diseases

Office of Health Communication

Centers for Disease Control and Prevention

Mailstop C-14

1600 Clifton Rd., NE

Atlanta, GA 30333

Toll-Free: (888) 232-3228

http://www.cdc.gov/ncidod/

Centers for Disease Control and Prevention (CDC)

1600 Clifton Rd., NE

Atlanta, GA 30333

Phone: (404) 639-3534

Toll-Free: (800) 311-3435

http://www.cdc.gov/