Sepsis and Toxic Shock Syndrome

Toxic shock syndrome (TSS) made the news in the late 1970s and early 1980s when it was found that many people who developed TSS had used certain brands of super-absorbent tampons. These were later taken off the market. However, although TSS is rare, it’s still a problem associated with infections, such as cellulitis, pneumonia, or osteomyelitis.

Toxic shock syndrome occurs when certain bacteria release toxins into the body. Although TSS can be caused by group A streptococcus (strep) bacteria, it is usually caused by Staphylococcus aureus (staph) bacteria. These can lead to sepsis and septic shock.

Sepsis is a life-threatening emergency that happens when your body’s response to an infection damages vital organs and, often, causes death. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment.

Suggested Citation:
Sepsis Alliance. Sepsis and Toxic Shock Syndrome. 2024. https://www.sepsis.org/sepsisand/toxic-shock/

Updated June 18, 2024.

 

More About Toxic Shock Syndrome

Symptoms

The symptoms of TSS start very suddenly:

  • High fever: 102 degrees Fahrenheit (38.8 degrees Celsius) or higher
  • Fainting
  • Rapid drop in blood pressure
  • Confusion
  • Diarrhea
  • Fatigue
  • Headache
  • Low urine output
  • Overall muscle pain
  • Red eyes
  • Seizures
  • Sunburn-like rash, especially on the palms of the hands and soles of the feet
  • Thirst
  • Vomiting
  • Weakness
Risk Factors

Anyone can develop TSS, but some people may be at higher risk, such as those who:

  • Have cuts or wounds on the skin, or have had surgery
  • Have a viral infections, such as chicken pox
  • Use contraceptive sponges, diaphragms, or super-absorbent tampons
  • Recently had a child, miscarriage, or abortion
  • Have had TSS before
Prevention

Toxic shock syndrome is not always preventable, but you can take some steps to reduce your risk of developing it.

  • Keep cuts, wounds, and incisions as clean as possible, perhaps using antibacterial ointments, as directed by your doctor.
  • Watch all cuts, wounds, and incisions for signs of infection (increasing pain, redness around the wound, pus or other discharge from the wound).
  • Change tampons frequently and use the lowest absorbency possible.
  • Use menstrual pads instead of tampons for light flow days.
  • Remove diaphragms and contraceptive sponges as quickly as possible.
Diagnosis and Treatment

Because the symptoms for TSS occur so quickly, it’s vital that they be recognized, and TSS diagnosed and treated as quickly as possible. Blood tests will be done to find out what type of bacteria caused the TSS. Other tests, such as swabs from parts of your body that could be infected, urine tests, CT scans, and lumbar punctures may also be done.

The treatment for TSS is the same as for septic shock. If the cause of the infection is removable (tampon, wound packing, etc.), this will be done right away. The doctors will order intravenous (IV) fluids and antibiotics to start fighting the infection right away. Other treatments may include:

  • Medications for blood pressure: If your blood pressure is too low, you might need medications to bring it back up.
  • Dialysis: If your kidneys have stopped working, you may need dialysis until your kidneys can do their job again.
  • Oxygen: You may have an oxygen mask that delivers oxygen to help you breathe better.
  • Ventilator: If you have trouble breathing, you may need intubation (a tube placed in your trachea) and a ventilator, or breathing machine.
  • Surgery: If necessary, a surgeon will operate to remove infected or gangrenous tissue that is causing the TSS.

Related Resources

TSS
Information Guide

TSS

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Kelsi Godfrey

Thursday, March 23rd 2023 I gave birth to my fourth son. Everything went well and it was a normal delivery. Friday, March 24 I started experiencing shortness of breath, but all of my vitals were fine. Then on Saturday, March 25 2023 everything went downhill FAST so luckily I was still at the hospital. My heart rate started going up and blood pressure dropping. I was then intubated. By late afternoon/early evening, my doctors found my uterus was infected and determined I had streptococcal toxic shock syndrome that caused severe septic shock. (Sepsis and Pregnancy & Childbirth, Sepsis and Toxic ... Read Full Story

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Amanda Symns Brooks

The night I gave birth to my son I started feeling very weird. I had uncontrollable shaking and I could not get warm. I spent hours in the shower even running the hot water out. The nurses and my OBGYN would not listen to my concerns saying it was just my hormones. I was discharged home and continued to get worse over the week. (Sepsis and Pregnancy & Childbirth) I was at the local clinic on a Friday with a 60/40 blood pressure and was still sent home. I returned the next day to the ER with a temp of ... Read Full Story

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Kelli Shaw

I’ve been a TSS survivor for only a few months and have been looking to find a community of survivors that understands. (Sepsis and Toxic Shock Syndrome) I’d love to share my story in hopes of finding that connection and closure. I’m a 33-year-old wife and mother of 3. Our family has a busy lifestyle and I’m also a business owner. Back on November 17th (2023) I had a laparoscopic hysterectomy. After having my third, I was having lots of uterine pain and heavy bleeding that wasn’t solved with an IUD and hated using period products and tampons. One night ... Read Full Story

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Elizabeth B.

I was diagnosed with sepsis along with Strep A and toxic shock two days after giving birth to my beautiful daughter. (Sepsis and Group A Streptococcus, Sepsis and Toxic Shock Syndrome, Sepsis and Pregnancy & Childbirth) I was sent to the ER in Dallas, Texas, where I was intubated and in a medically induced coma for 8 days. I had an infection in my vagina that came from birth, resulting in five surgeries later to finally contain the infection. I was on continuous dialysis for 5 days and 3 days of intermittent dialysis. Due to the pressers I was on ... Read Full Story

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Misty Wilcox

In 2019 I had gastric bypass surgery to lose weight. I am not someone that jumps in without all the facts. I did all the research, asked people that I knew had the surgery so I felt comfortable on the day of my surgery, April 30, 2019. (Sepsis and Surgery) As soon as I woke from the anesthesia I knew something was wrong. I had a weird tingling in both my legs but I shook it off, though it was because my body had been something big and of course, there would be some effects. I went home after 2 ... Read Full Story

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Other Topics

Pneumonia

Pneumonia is an infection in one or both lungs, most commonly caused by bacteria, a virus, or fungus.

Cellulitis

Cellulitis is a type of infection that affects the skin and the tissue underneath, and can lead to sepsis when untreated.

MRSA

Methicillin-resistant Staphylococcus aureus is a staph infection that is immune to many types of antibiotics.

Group A Streptococcus

Group A Streptococcus is a bacterium that can cause many different infections which can lead to sepsis.

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