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.
The majority (80%) 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:
- Flulike 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
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 tests to determine if the problem is caused by toxic shock syndrome or another process, and to evaluate the severity of your illness:
- 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)
- Tests to check blood samples, wound discharge or other body fluids for the presence of group A streptococcal or staphylococcal bacteria
In addition, people with severe breathing difficulties will need a chest X-ray and a test for blood oxygen content.
Shock and other life-threatening symptoms of toxic shock syndrome can develop 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).
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.
Patients with toxic shock syndrome are hospitalized and treated with:
- Intravenous fluids and certain medicines to raise blood pressure and improve blood flow to vital organs
- Antibiotics to eliminate the bacteria causing the infection and releasing the toxin
Mechanical ventilation, dialysis or other supportive measures may be necessary if vital organs fail.
In some cases of toxic shock syndrome caused by group A streptococci, when there is extensive infection of soft tissues, surgical removal of destroyed tissue may be necessary.
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 or painful.
The prognosis is variable. Many people recover completely while others may die even with prompt treatment in the hospital.
Centers for Disease Control and Prevention (CDC)
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