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Toxic Shock Syndrome

Toxic shock syndrome (TSS) made the news in the late 1970s and early 80s when it was found that many women who developed TSS had used certain brands of super-absorbent tampons. These were later taken off the market. However, although TSS is rare, it is still a problem associated with infections, such as cellulitispneumonia 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.

Sometimes incorrectly called blood poisoning, sepsis is the body’s often deadly response to infection . Sepsis kills and disables millions and requires early suspicion and, treatment for survival. Sepsis and septic shock can result from an infection anywhere in the body, such as pneumonia, influenza, or urinary tract infections. Like strokes or heart attacks, sepsis is a medical emergency that requires rapid diagnosis and treatment. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with life-changing effects, such as post-traumatic stress disorder (PTSD), chronic pain and fatigue, organ dysfunction (organs don’t work properly) and/or amputations.

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

Preventing toxic shock syndrome

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 may be given 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 are having trouble breathing properly, you may be intubated (a tube placed in your trachea) and attached to a ventilator, or breathing machine.
  • Surgery: If necessary, a surgeon will operate to remove infected or gangrenous tissue that is causing the TSS.

If you suspect sepsis, call 9-1-1 or go to a hospital and tell your medical professional, “I AM CONCERNED ABOUT SEPSIS.” 

The information here is also available as a Sepsis Information Guide, which is a downloadable format for easier printing.

Would you like to share your story about sepsis or read about others who have had sepsis? Please visit Faces of Sepsis, where you will find hundreds of stories from survivors and tributes to those who died from sepsis.

Updated June 10, 2021.