Toxic Shock Syndrome: All You Need To Know

Toxic shock syndrome, or TSS, is a life-threatening condition of a bacterial infection that an individual can suffer from. It is caused by the bacteria Streptococcus pyogenes or Staphylococcus aureus. These bacteria enter the bloodstream and produce exotoxins that can cause infections. The toxin released by Streptococcus pyogenes is called TSS Toxin-1 and the infection is called Streptococcal Toxic Shock Syndrome, or STSS. The infection caused by Staphylococcus aureus is just called TSS.


TSS was first observed in children in the year 1927 and again in 1978 (this is the year when the name "Toxic Shock Syndrome" was first introduced), but it is mostly linked to super-absorbent tampons use in menstruating women.

What is Toxic Shock Syndrome

Most of these cases affect women, but 25% that are non-menstruation related are observed in men and children with skin lesions. After the association of this infection with the tampons, all the super-absorbent tampons, diaphragms and sponges were removed from the market. Though not more than 3 in 100,000 are affected, it still poses a very serious risk to human lives.

With the increase in demand of tampons in women, a kind of tampons were introduced in the US market that could hold 20 times its own weight of menstrual fluid. They were said to "bloom" into a cup inside the vagina to hold all the fluid and prevent any leakage.

Carboxymethylcellulose, or CMC, was compressed along with beads of polyester to achieve this sort of an absorption capacity. This led to an outbreak of TSS in the menstruating women. It was also concluded that the higher the absorbency of the tampon, the higher were the risks of acquiring TSS.


Streptococcus pyogenes or Staphylococcus aureus, as we know, are the causes to TSS; Staphylococcus aureus being the more common one when associated with tampons. The other ways of getting this infection could be from a cut, a wound or any other opening in the skin.

The toxins that are released by the bacterial strains activate the T-cells of the immune system to release cytokines. Cytokines are small proteins that play an important role in cell signaling. Their release affects the cells around them, causing a response. In this case, the response is shock and tissue damage.

M protein is a virulence factor that is present on the filaments of the bacteria of the Streptococcus family mainly. When this is present, the chances of infection are higher. This is because the M protein protects the bacteria from being affected by the antibodies produced to destroy them.

Signs And Symptoms:

The symptoms of TSS and STSS include:

1. High fever
2. Low blood pressure
3. Rashes
4. Skin peeling
5. Mastitis
6. Fatigue
7. Weakness
8. Muscle pain
9. Frequent headaches
10. Seizures

These are the most common signs and symptoms, based on which your doctor might treat you.

The More Severe Symptoms Include:

1. Pneumonia
2. Coma
3. Stupor
4. Multiple organ failure - heart, lungs, liver or kidney

The body enters a phase of shock because of the foreign matter that is released into the blood by the bacteria. The immune responses of the body might or might not help, depending on the severity of the infection. In some cases, death was reported within 48 hours of infection.

Diagnosis And Treatment:

People with even the slightest signs of this type of an infection should be kept under observation to prevent any serious things from occurring. The diagnosis would include the doctor checking the temperature, blood pressure, desquamation or any organ inflammation on a regular basis. In some cases, the patient needs to be admitted to the Intensive Care Unit, or the ICU, to be provided with support.

The treatment considers the following parameters:

1. Surgical cleaning of deep-set wounds
2. Antibiotics of type IV
3. Cardiac health management
4. Constant supply of oxygen
5. Surgery in severe cases
6. Removal of the toxin


The most basic prevention type would be by immediately addressing any signs of an infection in any part of the body, be it external or internal. The women who use tampons, diaphragms or sponges should be advised to keep changing these every few hours once, no matter their capacity. The people who have already been diagnosed with TSS before are also at higher risks of recurrences.

Though this is not a very common disease, the name suggests how fatal it can be. So, prevention would be a better idea than a cure. Therefore, being hygienic and more alert about your body will help.

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