Signs of Toxic Shock Syndrome

Toxic shock syndrome is a rare but serious condition that occurs when staph or strep bacteria (staphylococcus aureus or streptococcus pyogenes, respectively) enter a person’s body through an opening in their skin. They can then release toxins into the bloodstream, which damage tissue and stop organs from working.

“TSS is estimated to affect 3-6 people per 100,000 per year,” said Erin Clark, MD, an obstetrician-gynecologist with University of Utah Health. It’s estimated to cause 2-3 deaths per year.

Toxic Shock Syndrome Causes and Misconceptions
In past decades, high-absorbency tampons were blamed for the majority of cases; according to a 1983 report published by the Centers for Disease Control and Prevention (CDC), nearly 99% of menstruation-associated cases were a result of tampon use.

For any tampon-users reading this today, however, there is no need to swear off tampons forever. While it’s still true that your risk is higher if you wear one for extended periods of time, due to changes in how tampons are made and how long they’re used for, the number of tampon-related cases has dropped to 1 in 100,000 menstruating women (.001%).

But tampons aren’t the only way to get TSS. About half of TSS cases occur in menstruating women, the rest occur in men, children, and older women. Other risk factors may include:

• An open wound
• A history of intravenous drug use
• Recent surgery, childbirth, miscarriage or abortion
• Usage of menstrual cups, diaphragms, or contraceptive sponges
• Viral infections, such as the flu or chickenpox

Dawn Massabni, who lost her 19-year-old daughter to TSS in 2017, described in an interview with ABC Action News how quickly her daughter, Madalyn Massabni, fell sick on her last visit home. “I couldn’t understand how she got so sick, it all happened in 36 hours,” Massabni said. “She had a seizure in my arms and I never knew what a seizure looked like.” Madalyn died on her 19th birthday, and her mother is now working to educate young women in the hopes of saving lives.

TSS symptoms often appear suddenly, and can quickly escalate into a life-threatening condition if not treated immediately. Symptoms involve many systems and may look like the flu or other infections.

Possible signs and symptoms include:

• A sudden high fever (temperature at least 102°F)
• Chills
• A rapid drop in blood pressure (with lightheadedness or fainting)
• Vomiting or diarrhea
• Rash that is red and flat and that covers most of the areas of the body; often resembles a sunburn, particularly on your palms and soles
• Shedding of the skin in large sheets, especially over the palms and soles, seen one to two weeks after the onset of symptoms.
• Headaches
• Seizures
• Disorientation or confusion
• Weakness
• Fatigue
• Muscle aches
• Redness of the eyes, mouth and throat (and in the vagina in females)

If left untreated, complications associated with TSS include:

• Liver failure
• Kidney failure
• Heart failure
• Coagulopathy (bleeding disorders)

Because TSS is often misdiagnosed, it’s crucial to get medical attention quickly if you’re experiencing symptoms. Aimee Haller Follis, a 37-year-old mom who survived TSS, shared with Fox News about how what she thought was the flu ended up being TSS. “Initially, I thought I was just run down […]. But the fever got higher and higher and higher.” At the hospital, Follis became lethargic, dehydrated and visually impaired. Doctors couldn’t figure out the cause of her organ failure until hours later, when she was asked about her last menstrual cycle, and that’s when they found the infection in her cervix.

With proper and timely medical intervention, the majority of TSS cases can be treated successfully.

When to call a doctor
Contact your doctor immediately if you experience any of the above-mentioned symptoms. In addition, the CDC’s clinical criteria for TSS includes fever, rash, low blood pressure, and multisystem organ involvement. If you experience any of these symptoms, especially after using tampons or after a surgery or skin injury, contact your doctor immediately.

Treatment
Treatment, according to Healthline.com, includes stabilizing the patient with intravenous (IV) hydration of water, electrolytes, and glucose; antibiotics for 7 to 14 days; medication to stabilize blood pressure; gamma globulin injections to suppress inflammation and boost your body’s immune system; surgical removal of infected deep tissue; removal of any foreign objects such as a tampon or vaginal sponge, and draining pus or blood from the wound to clear any infection.

Prevent Toxic Shock Syndrome
Reduce your risk of contracting TSS by doing the following:

• Remove tampons after 4-8 hours (depending on package instructions)
• Avoid high-absorbency tampons if you don’t need them
• Avoid tampons made of rayon
• Use pads instead of tampons on low-flow days
• Store tampons away from heat and moisture (to avoid bacteria growth)
• Wash hands thoroughly before inserting a tampon
• Clean and bandage all skin wounds as quickly as possible
• Call a doctor if you experience fever, rash, low blood pressure, and multisystem organ involvement.