Toxic shock syndrome is caused by a toxin produced by certain types of Staphylococcus bacteria.  A similar syndrome, called toxic shock-like syndrome (TSLS), can be caused by Streptococcal bacteria.  Although the earliest described cases of toxic shock syndrome involved women who were using tampons during menstruation, just slightly over half of current cases are associated with such events.  Toxic shock syndrome can also occur in children, postmenopausal women and men.  Risk factors for the syndrome include childbirth, current Staphylococcus aureus (S. aureus) infection, foreign bodies or packings (such as those used to stop nosebleeds), menstruation, surgery, tampon use (particularly if you leave on in for a long time) and use of barrier contraceptives such as a diaphragm or vaginal sponge.

          Symptoms of this syndrome include confusion, diarrhea, a general ill-feeling, headaches, a high fever, sometimes accompanied by chills, low blood pressure, muscle aches, nausea and vomiting, organ failure (usually kidneys and liver), redness of the eyes, mouth and throat, seizures and a widespread red rash that looks like a sunburn – skin peeling occurs 1 or 2 weeks after the rash, particularly on the palms of the hand or bottom of the feet.  No single test can diagnose toxic shock syndrome.  The diagnosis is based on several criteria: fever, low blood pressure, a rash that peels after 1-2 weeks and problems with the function of at least three organs.  In some cases, blood cultures may be positive for the growth of S. aureus.

          Toxic shock syndrome is a medical emergency.  You must seek immediate attention if you develop fever or rash, particularly during menstruation and tampon use, or if you have had recent surgery.  This is an extremely dangerous situation – toxic shock syndrome may be deadly in up to 50% of cases.  The condition may return in those that survive.  Complications can include severe organ dysfunction such as kidney failure, heart failure or liver failure.  People with TSS typically need to stay in the hospital, often in the intensive care unit, for several days to closely monitor blood pressure, respiratory status, and to look for signs of other problems, such as organ damage.  TSS is a very rare illness that’s usually not fatal IF recognized and treated promptly.  If doctors suspect TSS, they will probably start intravenous (IV) fluids and antibiotics as soon as possible. They may take a sample from the suspected site of the infection, such as the skin, nose, or vagina, to check it for TSS.  They may also take a blood sample.  Other blood tests can help monitor how various organs like the kidneys are working and check for other diseases that may be causing the symptoms.

          The risk of getting TSS is already low. But you can reduce it still further by simply following some common-sense precautions: Clean and bandage any skin wounds.  Change bandages regularly, rather than keeping them on for several days.  Check wounds for signs of infection.  If a wound gets red, swollen, painful, or tender, or if you develop a fever, call your doctor right away.  If you’re a girl whose period has started, the best way to avoid TSS is to use sanitary napkins instead of tampons.  For girls who prefer to use tampons, select the ones with the lowest absorbency that can handle your menstrual flow and change them frequently.  You can also alternate the use of tampons with sanitary napkins.  If you’ve already had an episode of TSS or have been infected with S. aureus, don’t use tampons or contraceptive devices that have been associated with TSS (such as diaphragms and contraceptive sponges).

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