What are the signs and symptoms of toxic shock syndrome. How is toxic shock syndrome caused. Who is at risk for developing toxic shock syndrome. What are the potential complications of toxic shock syndrome. How can toxic shock syndrome be prevented.

Understanding Toxic Shock Syndrome: A Rare but Serious Condition

Toxic shock syndrome (TSS) is a rare and potentially life-threatening condition caused by certain bacterial toxins. It can affect anyone, regardless of age or gender, and requires immediate medical attention due to its rapid progression and severe complications.

The Bacterial Culprits Behind Toxic Shock Syndrome

Two main types of bacteria are responsible for causing toxic shock syndrome:

• Staphylococcus aureus (staph)
• Group A streptococcus (strep)

While these bacteria are commonly found on the skin and in the nose without causing harm, in rare cases, they can produce toxins that enter the bloodstream, triggering a severe immune reaction.

How do these bacteria cause toxic shock syndrome?

The toxins produced by staph or strep bacteria enter the bloodstream and cause a severe immune reaction. This reaction leads to the rapid onset of symptoms and can affect multiple organs, including the lungs, kidneys, and liver.

Recognizing the Symptoms of Toxic Shock Syndrome

Toxic shock syndrome symptoms develop suddenly and can worsen rapidly. Early recognition is crucial for prompt treatment. The most common signs and symptoms include:

• Sudden high fever (over 102°F or 39°C)
• Low blood pressure
• Vomiting or diarrhea
• A sunburn-like rash, particularly on the palms and soles
• Confusion or disorientation
• Muscle aches
• Redness of the eyes, mouth, and throat
• Seizures
• Severe headaches

Can toxic shock syndrome symptoms be mistaken for other conditions?

Yes, the initial symptoms of toxic shock syndrome can be similar to those of the flu or other infections. However, the rapid progression and severity of symptoms, along with the presence of a rash, are key indicators of TSS. If you experience these symptoms, especially after using tampons or if you have a skin or wound infection, seek medical attention immediately.

Risk Factors and Vulnerable Groups

While toxic shock syndrome can affect anyone, certain factors may increase the risk of developing this condition:

• Menstruating women using high-absorbency tampons
• Recent surgery patients
• People with skin wounds or burns
• Users of contraceptive sponges, diaphragms, or menstrual cups
• Individuals with viral infections like the flu or chickenpox

Are there specific age groups more susceptible to toxic shock syndrome?

Approximately half of the staphylococcal toxic shock syndrome cases occur in menstruating women. However, the condition can affect people of all ages, including older women, men, and children. Streptococcal toxic shock syndrome does not show a preference for any particular age group.

Potential Complications and Long-term Effects

Toxic shock syndrome can progress rapidly and lead to severe complications if left untreated. Some potential complications include:

1. Shock: A life-threatening condition characterized by a sudden drop in blood pressure and organ failure
2. Renal failure: Impairment of kidney function, which may require dialysis
3. Acute respiratory distress syndrome (ARDS): Severe breathing difficulties due to fluid buildup in the lungs
4. Liver failure: Impairment of liver function, which can lead to various systemic issues
5. Disseminated intravascular coagulation (DIC): A blood clotting disorder that can cause excessive bleeding

Can toxic shock syndrome recur in individuals who have previously experienced it?

Yes, toxic shock syndrome can recur. People who have had TSS once are at an increased risk of developing it again. If you have a history of TSS, it is crucial to take extra precautions and avoid using tampons or other internal menstrual products.

Diagnosis and Treatment Approaches

Diagnosing toxic shock syndrome requires a combination of clinical evaluation and laboratory tests. Healthcare providers will typically:

• Perform a physical examination
• Order blood and urine tests to check for signs of infection and organ function
• Take samples from any suspected infection sites for culture
• Conduct imaging tests, such as chest X-rays or CT scans, to assess organ involvement

Treatment for toxic shock syndrome is typically carried out in a hospital setting and may include:

1. Intravenous antibiotics to combat the bacterial infection
2. Intravenous fluids to maintain blood pressure and prevent dehydration
3. Medications to stabilize blood pressure
4. Dialysis in cases of kidney failure
5. Surgical removal of infected tissue, if necessary

How long does recovery from toxic shock syndrome typically take?

Recovery time from toxic shock syndrome can vary depending on the severity of the condition and the individual’s overall health. Some patients may recover within a few weeks, while others may require several months of rehabilitation. Long-term follow-up care is often necessary to monitor for potential complications or recurrence.

Prevention Strategies and Safe Practices

While it’s not always possible to prevent toxic shock syndrome, there are several measures you can take to reduce your risk:

• Use tampons with the lowest absorbency necessary for your menstrual flow
• Change tampons frequently, at least every 4-8 hours
• Alternate between tampons and sanitary pads during your period
• Avoid using tampons overnight; use pads instead
• Wash your hands thoroughly before and after inserting a tampon
• Keep cuts, burns, and other wounds clean and properly dressed
• Follow post-operative care instructions carefully after any surgical procedure

Have tampon manufacturers made changes to reduce the risk of toxic shock syndrome?

Yes, manufacturers of tampons sold in the United States have made significant changes to reduce the risk of toxic shock syndrome. They no longer use the materials or designs associated with a higher incidence of TSS. Additionally, the U.S. Food and Drug Administration (FDA) requires manufacturers to use standard measurements and labeling for absorbency and to print usage guidelines on tampon boxes.

Raising Awareness and Education

Educating the public about toxic shock syndrome is crucial for early recognition and prevention. Here are some ways to raise awareness:

• Include information about TSS in health education programs in schools
• Provide clear and accessible information about TSS on tampon packaging and in product inserts
• Encourage healthcare providers to discuss TSS risks with patients, especially those using internal menstrual products
• Promote proper wound care and hygiene practices in healthcare settings and the community
• Support research initiatives aimed at better understanding and preventing toxic shock syndrome

Are there any ongoing research efforts to improve the prevention and treatment of toxic shock syndrome?

Yes, researchers continue to study toxic shock syndrome to develop better prevention strategies and treatment options. Some areas of focus include:

• Developing new diagnostic tools for faster and more accurate detection of TSS
• Investigating potential vaccines against the toxins produced by staph and strep bacteria
• Exploring novel antibiotic treatments and immunotherapies
• Studying the genetic factors that may influence susceptibility to TSS

By advancing our understanding of toxic shock syndrome, we can hope to reduce its incidence and improve outcomes for those affected by this rare but serious condition.

Toxic shock syndrome – Symptoms and causes

Overview

Toxic shock syndrome is a rare, life-threatening complication of certain types of bacterial infections. Often toxic shock syndrome results from toxins produced by Staphylococcus aureus (staph) bacteria, but the condition may also be caused by toxins produced by group A streptococcus (strep) bacteria.

Toxic shock syndrome can affect anyone, including men, children and postmenopausal women. Risk factors for toxic shock syndrome include skin wounds, surgery, and the use of tampons and other devices, such as menstrual cups, contraceptive sponges or diaphragms.

Products & Services

Show more products from Mayo Clinic

Symptoms

Possible signs and symptoms of toxic shock syndrome include:

• A sudden high fever
• Low blood pressure
• Vomiting or diarrhea
• A rash resembling a sunburn, particularly on your palms and soles
• Confusion
• Muscle aches
• Redness of your eyes, mouth and throat
• Seizures
• Headaches

When to see a doctor

Call your doctor immediately if you have signs or symptoms of toxic shock syndrome. This is especially important if you’ve recently used tampons or if you have a skin or wound infection.

Causes

Most commonly, Staphylococcus aureus (staph) bacteria cause toxic shock syndrome. The syndrome can also be caused by group A streptococcus (strep) bacteria.

Risk factors

Toxic shock syndrome can affect anyone. About half the cases of toxic shock syndrome associated with staphylococci bacteria occur in women of menstruating age; the rest occur in older women, men and children. Streptococcal toxic shock syndrome occurs in people of all ages.

Toxic shock syndrome has been associated with:

• Having cuts or burns on your skin
• Having had recent surgery
• Using contraceptive sponges, diaphragms, superabsorbent tampons or menstrual cups
• Having a viral infection, such as the flu or chickenpox

Complications

Toxic shock syndrome can progress rapidly. Complications may include:

• Shock
• Renal failure
• Death

Prevention

Manufacturers of tampons sold in the United States no longer use the materials or designs that were associated with toxic shock syndrome. Also, the U.S. Food and Drug Administration requires manufacturers to use standard measurement and labeling for absorbency and to print guidelines on the boxes.

If you use tampons, read the labels and use the lowest absorbency tampon you can. Change tampons frequently, at least every four to eight hours. Alternate using tampons and sanitary napkins, and use minipads when your flow is light.

Toxic shock syndrome can recur. People who’ve had it once can get it again. If you’ve had toxic shock syndrome or a prior serious staph or strep infection, don’t use tampons.

Toxic Shock Syndrome | Michigan Medicine

Topic Overview

What is toxic shock syndrome?

Toxic shock syndrome (TSS) is a rare illness that happens suddenly after an infection. It quickly can harm several different organs, including the lungs, the kidneys, and the liver, and it can be deadly. Since toxic shock syndrome gets worse quickly, it requires medical treatment right away.

What causes toxic shock syndrome?

An infection caused by strep or staph bacteria can lead to toxic shock syndrome. These bacteria are common and usually don’t cause problems. But in rare cases, the toxins enter the bloodstream and cause a severe immune reaction. This reaction causes the symptoms of TSS.

• Toxic shock syndrome caused by strep most often occurs after childbirth, the flu (influenza), chickenpox, surgery, minor skin cuts or wounds, or injuries that cause bruising but may not break the skin.
• Toxic shock syndrome caused by staph most often occurs after a tampon is kept in too long (menstrual TSS) or after surgery (nonmenstrual TSS).

If you have had TSS, you are more likely to get it again.^{footnote 1}

What are the symptoms?

Toxic shock symptoms get worse quickly and can be deadly within 2 days. Symptoms include:

• Sudden fever over 102°F (39°C).
• Signs of shock, including low blood pressure and rapid heartbeat; nausea; vomiting; or fainting or feeling lightheaded, restless, or confused.
• A rash that looks like a sunburn. The rash can be on several areas of your body or just in certain places, such as the armpits or the groin.
• Severe pain in an infected wound or injury.

Other TSS symptoms may include:

• Severe flu-like symptoms, such as muscle aches and pains, stomach cramps, a headache, or a sore throat.
• Redness inside the nose and mouth.
• Pinkeye (conjunctivitis).
• Scaling, peeling skin, especially on the palms of the hands and soles of the feet.

Having sudden, severe symptoms is one of the most important clues that you may have toxic shock syndrome. If you think you have TSS, get medical care right away.

How is toxic shock syndrome diagnosed?

Doctors usually diagnose toxic shock syndrome based on your symptoms. Tests can help show whether staph or strep bacteria are causing the infection. Tests you may need include:

How is it treated?

Treatment for toxic shock syndrome almost always takes place in a hospital. Treatment includes:

• Removing the source of the infection or cleaning the wound.
• Treating complications, such as shock or liver, kidney, and lung failure.
• Using antibiotics and other medicines to fight the infection.

Sometimes surgery is needed if TSS developed after surgery or if the infection is destroying the skin and soft tissue (necrotizing fasciitis).

After having TSS, you may get better in 1 to 2 weeks. But it will take longer if you had major complications.

How can you prevent toxic shock syndrome?

You can take steps to prevent TSS:

• Keep all skin wounds clean to help prevent infection. This includes cuts, punctures, scrapes, burns, sores from shingles, insect or animal bites, and surgical wounds.
• Help keep children from scratching chickenpox sores by managing itching.
• Avoid using tampons and barrier contraceptives (such as diaphragms, cervical caps, or sponges) during the first 12 weeks after childbirth.
• Follow the directions on package inserts for tampons, diaphragms, and contraceptive sponges. Change your tampon at least every 4 to 8 hours, or use tampons for only part of the day. Don’t leave in your diaphragm or contraceptive sponge for more than 12 to 18 hours.
• If you have had menstrual TSS, do not use tampons, barrier contraceptives, or an intrauterine device (IUD).

References

Citations

1. Ainbinder SW, et al. (2007). Toxic shock syndrome section of Sexually transmitted diseases and pelvic infections. In AH DeCherney et al. , eds., Current Diagnosis and Treatment Obstetrics and Gynecology, 10th ed., pp. 689–691. New York: McGraw-Hill.

Other Works Consulted

• Centers for Disease Control and Prevention (2008). Group A Streptococcal (GAS) Disease. Available online: https://www.cdc.gov/groupastrep/index.html.
• Larioza J, Brown RB (2011). Toxic shock syndrome. In ET Bope et al., eds., Conn’s Current Therapy 2011, pp. 88–90. Philadelphia: Saunders.
• Stevens DL, et al. (2006). Successful treatment of staphylococcal toxic shock syndrome with linezolid: A case report and in vitro evaluation of the production of toxic shock syndrome toxin type 1 in the presence of antibiotics. Clinical Infectious Diseases, 42: 729–731.

Credits

Current as of:
September 23, 2020

Author: Healthwise Staff
Medical Review:
E. Gregory Thompson MD – Internal Medicine
Adam Husney MD – Family Medicine
Kathleen Romito MD – Family Medicine
Elizabeth T. Russo MD – Internal Medicine
Dennis L. Stevens MD, PhD – Internal Medicine, Infectious Disease

Current as of: September 23, 2020

Author:
Healthwise Staff

Medical Review:E. Gregory Thompson MD – Internal Medicine & Adam Husney MD – Family Medicine & Kathleen Romito MD – Family Medicine & Elizabeth T. Russo MD – Internal Medicine & Dennis L. Stevens MD, PhD – Internal Medicine, Infectious Disease

Ainbinder SW, et al. (2007). Toxic shock syndrome section of Sexually transmitted diseases and pelvic infections. In AH DeCherney et al., eds., Current Diagnosis and Treatment Obstetrics and Gynecology, 10th ed., pp. 689-691. New York: McGraw-Hill.

Toxic shock syndrome – NHS

Toxic shock syndrome (TSS) is a rare but life-threatening condition caused by bacteria getting into the body and releasing harmful toxins.

It’s often associated with tampon use in young women, but it can affect anyone of any age – including men and children.

TSS gets worse very quickly and can be fatal if not treated promptly. But if it’s diagnosed and treated early, most people make a full recovery.

Symptoms of toxic shock syndrome

The symptoms of toxic shock syndrome (TSS) start suddenly and get worse quickly. They include:

Sometimes you may also have a wound on your skin where the bacteria got into your body, but it may not look infected.

Important:
Coronavirus (COVID-19)

At the moment it can be hard to know what to do if you or your child is unwell. 

It’s important to trust your instincts and get medical help if you need it.

When to get medical advice

Toxic shock syndrome (TSS) is a medical emergency.

While these symptoms could be due to a different condition, it’s important to contact your GP, a local out-of-hours service, or NHS 111 as soon as possible if you have a combination of these symptoms.

It’s very unlikely that you have TSS, but these symptoms should not be ignored.

Go to your nearest A&E department or call 999 and ask for an ambulance immediately if you have severe symptoms or they are rapidly getting worse.

If you’re wearing a tampon, remove it straight away. Also tell your doctor if you’ve been using a tampon, recently had a burn or skin injury, or if you have a skin infection such as a boil.

If a doctor suspects you have TSS, you’ll be referred to hospital immediately.

Treatment for toxic shock syndrome

If you have toxic shock syndrome (TSS), you’ll be admitted to hospital and may need to be treated in an intensive care unit.

Treatment for TSS may involve:

• antibiotics to treat the infection
• in some cases, purified antibodies that have been taken out of donated blood, known as pooled immunoglobulin, may also be given to help your body fight the infection
• oxygen to help with breathing
• fluids to prevent dehydration and organ damage
• medicine to help control blood pressure
• dialysis if your kidneys stop functioning
• in severe cases, surgery may be needed to remove dead tissue. Rarely, it may be necessary to amputate the affected area

Most people will start to feel better within a few days, but it may take several weeks before you’re well enough to leave hospital.

Causes of toxic shock syndrome

Toxic shock syndrome (TSS) is caused by either staphylococcus or streptococcus bacteria.

These bacteria normally live on the skin and in the nose or mouth without causing harm, but if they get deeper into the body they can release toxins that damage tissue and stop organs working.

These things can increase your risk of getting TSS:

TSS is not spread from person to person. You do not develop immunity to it once you’ve had it, so you can get it more than once.

Preventing toxic shock syndrome

The following things can reduce your risk of toxic shock syndrome (TSS):

• treat wounds and burns quickly and get medical advice if you notice signs of an infection, such as swelling, redness and increasing pain
• always use a tampon with the lowest absorbency suitable for your period
• alternate between tampons and a sanitary towel or panty liner during your period
• wash your hands before and after inserting a tampon
• change tampons regularly – as often as directed on the pack (usually at least every 4 to 8 hours)
• never have more than one tampon in your vagina at a time
• when using a tampon at night, insert a fresh tampon before going to bed and remove it when you wake up
• remove a tampon at the end of your period
• when using female barrier contraception, follow the manufacturer’s instructions about how long you can leave it in

It’s a good idea to avoid using tampons or female barrier contraception if you’ve had TSS before.

Page last reviewed: 27 September 2019
Next review due: 27 September 2022

Toxic Shock Syndrome (for Teens)

What Is Toxic Shock Syndrome?

Toxic shock syndrome (TSS) is a rare but very serious infection. TSS is a medical emergency. So it’s important to know how to prevent it and what signs to watch for. With prompt treatment, it’s usually cured.

What Are the Signs & Symptoms of Toxic Shock Syndrome?

Toxic shock syndrome starts suddenly, often with

• a high fever (temperature at least 102°F [38.8°C])
• a rapid drop in blood pressure (with lightheadedness or fainting)
• diarrhea
• headache
• sunburn-like rash on any part of the body, including the palms of the hands and the soles of the feet
• muscle aches

Other signs include:

• vomiting
• confusion
• weakness
• tiredness
• peeing less than usual
• being thirsty

A person also might have bloodshot eyes and an unusual redness under the eyelids or inside the mouth (and in the vagina in females). The area around an infected wound can become swollen, red, and tender.

What Causes Toxic Shock Syndrome?

Toxic shock syndrome is caused by two types of

bacteria:

1. Staphylococcus aureus (often called staph)
2. Streptococcus pyogenes (often called strep)

Most cases are related to staph bacteria. When strep causes toxic shock syndrome, it’s usually because the bacteria got into areas of injured skin, such as cuts and scrapes, surgical wounds, and even chickenpox blisters.

Who Gets Toxic Shock Syndrome?

Originally, toxic shock syndrome was linked to the use of super-absorbent tampons. Research led to better tampons and better habits for using them, such as changing them often. The number of TSS cases dropped dramatically. Today about half of all TSS cases are related to menstruation.

Two birth control methods, the contraceptive sponge and the diaphragm, have been linked to TSS.

Toxic shock syndrome also can affect someone with any type of staph infection, including:

What Problems Can Happen?

If toxic shock syndrome isn’t treated:

• Organs such as the liver and kidneys may begin to fail.
• Problems such as seizures, bleeding, and heart failure can happen.

How Is Toxic Shock Syndrome Diagnosed?

If doctors think someone has toxic shock syndrome, they’ll start intravenous (IV) fluids and antibiotics as soon as possible, even before they’re sure the person has TSS.

To confirm a diagnosis, doctors take a sample from the likely site of the infection, such as the skin, nose, or vagina, to check for the bacteria. They also may take and test a blood sample. Other blood tests can help doctors:

• see how organs like the kidneys are working
• check for other diseases that might be causing the symptoms

How Is Toxic Shock Syndrome Treated?

Besides giving

antibioticsand IV fluids, as needed doctors will:

• remove tampons, contraceptive devices, or wound packing
• clean wounds
• drain a pocket of infection (an abscess)

People with TSS usually need to stay in the hospital, often in the intensive care unit (ICU), for several days. There, doctors can watch their blood pressure and breathing and check for signs of other problems, such as organ damage.

Can Toxic Shock Syndrome Be Prevented?

Washing hands well and often can help prevent the bacteria that cause toxic shock syndrome from spreading.

During their periods, girls can reduce their risk of TSS by:

• washing their hands well before and after inserting a tampon 
• not using tampons or alternating them with sanitary napkins
• if using tampons, choose ones with the lowest absorbency that will handle menstrual flow, and change the tampons often
• on low-flow days, using pads instead of tampons

Between menstrual periods, store tampons away from heat and moisture, where bacteria can grow (for example, in a bedroom rather than in a bathroom closet).

Any female who has had TSS should not use tampons.

Clean and bandage all skin wounds as quickly as possible. Call your doctor if a wound gets red, swollen, or tender, or if a fever begins.

When Should I Call the Doctor?

Symptoms of toxic shock syndrome come on suddenly. Call your doctor right away if you get a sudden high fever, feel faint, or have any other signs of TSS.

Toxic Shock Syndrome (TSS) – Basics & Causes

What is Toxic Shock Syndrome?

Toxic shock syndrome is a sudden, potentially fatal condition. It’s caused by the release of toxins from an overgrowth of bacteria called Staphylococcus aureus, or staph, which is found in many women’s bodies. Toxic shock syndrome affects menstruating women, especially those who use super-absorbent tampons. The body responds with a sharp drop in blood pressure that deprives organs of oxygen and can lead to death.

This disease made headlines in the late 1970s and early 1980s after the deaths of several young women who were using a brand of super-absorbent tampon that was later removed from the market.

Toxic shock syndrome is still mostly a disease of menstruating women who use tampons. But it has also been linked to the use of menstrual sponges, diaphragms, and cervical caps. A woman who has recently given birth also has a higher chance of getting toxic shock. And it can happen to men and women who have been exposed to staph bacteria while recovering from surgery, a burn, an open wound, or the use of a prosthetic device.

More than one-third of all cases of toxic shock involve women under 19, and up to 30% of women who have had the disease will get it again. If you have ever had toxic shock, you must look out for the symptoms so you can get immediate medical care.

People who die from toxic shock are killed by the body’s response to the toxins released by staph bacteria. Most people suffer hypotensive shock, in which the heart and lungs stop working.

Toxic Shock Syndrome Symptoms

Some signs and symptoms of toxic shock syndrome to look out for include:

• A high fever that spikes suddenly
• Low blood pressure
• Throwing up or frequent, watery stools
• A rash that looks like a sunburn, especially on your palms and bottoms of your feet
• Confusion
• Muscle aches
• Red eyes, mouth, and throat
• Seizures
• Headaches

If you’re menstruating and have a high fever with vomiting, especially if you‘ve been using tampons, you must get medical help right away. If you’re using a tampon, menstrual sponge, diaphragm, or cervical cap when you get ill, remove it immediately, even before calling your doctor.

Toxic Shock Syndrome Causes

Toxic shock syndrome is caused by a poison produced by Staphylococcus aureus bacteria. This bacteria is one of several staph bacteria that cause skin infections in burn patients and hospital patients who have had surgery.

Staph is normally — and harmlessly — present in the vagina. Doctors don’t know how staph causes toxic shock syndrome. But two conditions are necessary: First, the bacteria need an environment in which they can grow rapidly and release poisons. Then the poisons must get into the bloodstream.

A tampon saturated with blood is a supportive place for rapid growth of bacteria. It also seems to matter what the tampon is made of. Polyester foam provides a better environment for the growth of bacteria than either cotton or rayon fibers.

In some cases resulting from menstrual sponges, diaphragms, and cervical caps, the device had been in the vagina for a long time — more than 30 hours. In the case of sponges alone, pieces of the sponge remained in the vagina.

The way in which bacterial poisons enter the bloodstream may also be related to tampon use. Sliding a tampon into place could make microscopic tears in your vaginal walls, rupturing tiny blood vessels. Leaving a super-absorbent tampon in too long or using it when your flow is light can dry out your vagina. This makes tearing even more likely.

Researchers investigating toxic shock syndrome causes have ruled out feminine deodorant sprays and douches, underwear, and other clothing. The condition is also unrelated to your menstrual history, drug or alcohol use, cigarette smoking, swimming or bathing, or sexual activity.

Toxic Shock Syndrome Diagnosis

There are several ways that doctors test for toxic shock syndrome:

• Test blood and urine samples for a staph or strep infection.
• Take a swab of your vagina, cervix, or throat.
• Use a CT scan, lumbar puncture, or chest X-ray to show if toxic shock syndrome is affecting other organs in your body

Toxic Shock Syndrome Treatment

If you have toxic shock syndrome, you’ll most likely need to go to the hospital where you could receive:

• Antibiotics
• Medicine for low blood pressure
• Fluid to replace your body’s loss of water
• Other supportive care

Toxic Shock Syndrome | HealthLinkBC File 04

What is Toxic Shock Syndrome?

Toxic shock syndrome (TSS) is a rare, but serious illness that can often be life-threatening. TSS develops suddenly after certain types of bacteria enter the bloodstream and produce toxins (poisons). It can quickly affect several different organs including your liver, lungs and kidneys. Since TSS develops quickly, emergency medical help is needed as soon as possible.

Although TSS has been linked to tampon use by women, it can occur in children, men and people in all age groups. Only half of the cases of TSS are linked to menstruation.

If you think you have TSS, call 9-1-1 or go to the nearest emergency department right away.

What causes TSS?

TSS is caused by toxins made by some types of bacteria. The 2 bacteria that make toxins that can cause TSS are:

• Staphylococcus aureus (SA) (commonly known as staph)
• Group A Streptococcus (GAS)

For more information on group A Streptococcus, see HealthLinkBC File #106 Group A Streptococcal Infections.

Staphylococcus aureus are found in the nose or on the skin of up to 30 per cent of people. They are also found in the vagina of about 10 to 20 per cent of women. These bacteria are usually not harmful, and only cause mild nose, throat or skin infections.

In some cases, SA infections can result in TSS. SA makes several toxins and when the toxins enter your bloodstream you can have a severe reaction causing TSS. The toxins may enter your bloodstream through a wound to the skin, including a surgical wound. TSS can also occur in menstruating women using tampons or a menstrual cup. Most people, however, are not affected by the toxins because they have developed antibodies to them.

What are the symptoms of TSS?

Symptoms of TSS include flu-like symptoms such as fever, headache and muscle soreness. These symptoms will develop quickly and are severe. Other symptoms may include pain at the site of a wound, vomiting and diarrhea, signs of shock including low blood pressure and light-headedness, shortness of breath and sunburn-like rash.

In general, TSS symptoms can develop as soon as 12 hours after a surgical procedure. Symptoms usually develop in 3 to 5 days in women who are menstruating and using tampons.

If you experience the above symptoms after using tampons or after a surgery or skin injury, contact your health care provider immediately.

What should I do if I think I have TSS?

Toxic shock syndrome requires immediate emergency care in a hospital. Call 9-1-1 or go to the nearest emergency department right away if you think you have TSS.

If you experience any of the symptoms of TSS while using a tampon, remove the tampon and see your health care provider right away. Inform them that you were using a tampon when the symptoms started.

What is the treatment for TSS?

TSS cannot be treated at home. Hospital care is required for treating a staph infection and related complications caused by TSS, such as shock. You will be given antibiotics to kill the bacteria and stop further release of toxins.

If the source of infection involves a tampon, diaphragm or contraceptive sponge, it should be removed as soon as possible.

Who is at risk of TSS?

TSS from a staph infection can affect anyone; however, some people are at greater risk of TSS than others.

Risk factors for TSS include:

• Past history of SA toxic shock syndrome.
• Prolonged use of a tampon, especially the super absorbent type.
• Use of contraceptive sponges, diaphragms or intrauterine devices.
• Irritation and inflammation of the vagina, also known as vaginitis.
• A burn, skin infection or injury, including a wound from surgery. Those who develop a SA wound infection after surgery may be at greater risk of TSS.
• Recent respiratory infections, such as sinusitis, sore throat (pharyngitis), laryngitis, tonsillitis or pneumonia.

Although menstruating women using tampons are at higher risk of TSS, tampons do not cause TSS.

Can TSS be prevented?

TSS can be prevented by keeping all burns, wounds, scrapes and animal or insect bites clean.

Women who use tampons, menstrual cups, diaphragms, cervical caps or contraceptive sponges can prevent TSS by:

• Following the directions on package inserts.
• Washing your hands with soap before inserting or removing a tampon, menstrual cup, diaphragm or contraceptive sponge.
• Changing your tampon at least every 8 hours, or use tampons for only part of the day.
• Wearing tampons and sanitary pads at alternate times. For example, use pads at night and tampons during the day.
• Using tampons with the lowest absorbency that you need. The risk of TSS is higher with super absorbent tampons.
• Not leaving your diaphragm or contraceptive sponge in for more than 12 to 18 hours.

Toxic Shock Syndrome: Symptoms, Treatment, and Prevention

Toxic shock syndrome (TSS) is a rare but serious condition that’s caused when your immune system reacts to toxins produced by bacteria. TSS occurs when these toxins enter into your bloodstream, where your body’s reaction  can affect many systems in your body at once.

TSS can be life-threatening, but with the right treatment, it’s also curable. That means it’s important to know its signs and symptoms so you can spot it and treat it quickly.

What Are the Symptoms of TSS?

The symptoms are a lot like ones you might see from other kinds of infections: swelling, fever, redness, and a general feeling of being unwell.

TSS symptoms usually come on quickly, about 2 days after the bacteria infects you. The way TSS affects your body depends on the type of bacteria causing your condition.

Generally, TSS causes:

In order to figure out what kind of TSS you have, and to rule out other causes of infection or disease, your doctor will check for symptoms that are specific to certain types of bacteria. The bacteria that most commonly cause TSS are:

• Staphylococcus aureus
• Streptococcus pyogenes
• Clostridium sordellii (C. sordellii)

Staphylococcal TSS symptoms

Staphylococcal TSS happens most often in women. Sometimes, you can get it if you use superabsorbent tampons, and the bacteria gets trapped for too long in your vagina. You’re also more at risk if you have an infection after surgery, childbirth, or have burns or pus buildup in your body. This type of TSS causes:

You may also start to shed your skin in sheets, usually on the palms of your hands or soles of your feet, 1 to 2 weeks after your symptoms start.

Streptococcal TSS symptoms

This kind of TSS usually happens after you have chickenpox, a skin infection, or if you have a weak immune system. The first symptom is most often severe pain that comes on suddenly. Other symptoms include:

• Very low blood pressure
• Shock (not enough blood flow to the systems in your body)
• Bleeding problems
• Bruising
• Flat, red rash like a sunburn on most of your body
• Trouble breathing

You may also have sheets of skin shed off, like in staphylococcal TSS, but this doesn’t always happen.

C. sordellii TSS symptoms

Clostridium sordellii infection happens in the uterus. You can also get it from IV drug use. Its symptoms include:

Unlike the other most common types of TSS, such as staphylococcal TSS, C. sordellii does not usually cause a fever.

Call 911 if you or another person shows signs of shock, especially if you have used tampons, a diaphragm, or contraceptive sponge or if you have a skin wound or infection.

How Is TSS Diagnosed and Treated?

Because TSS can be life-threatening, you will probably need to get treatment in a hospital.

Doctors will do an exam and blood tests. They can keep an eye on your condition as they treat the TSS and its symptoms. You may have to stay there for a few days or longer, depending on how severe your case is.

Before choosing a treatment for you, your doctor will need to examine you to find out more about:

• Your age and medical history
• Your recent health history, including what might be causing your TSS
• What kind of symptoms you’re having
• How serious your symptoms are
• How you react to certain medications or treatments

Your doctor may have to run tests or collect tissue or blood samples in order to figure out the specific treatments that will work for you. You may need:

IV antibiotics. This is the most common way doctors treat TSS. Antibiotics will help stop the bacteria from growing in your system. They do not get rid of the toxins that have built up in your body. The type of antibiotic you get depends on which kind of bacteria is causing your TSS.

Immunoglobulin therapy. If your TSS is very severe, your doctor may try to treat it with immunoglobulin. It’s a part of blood plasma that has antibodies. You get it through an IV. Immunoglobulin therapy can help boost your body’s defense systems against infection.

You may also need treatment for the symptoms of TSS, such as:

Depending on what caused your TSS, your doctor may want to:

• Take out any tampons or other contraceptive devices
• Clean any wounds
• Drain pus from infected areas

If you have an infection that is very severe, you may have to have surgery to remove dead tissue and deep clean your wound to get rid of all of it.

How Do You Prevent TSS?

TSS is rare. You’re unlikely to get it if you’ve never had it. But once you get it, you’re at a higher risk of getting it again. You can take these steps to keep your chances as low as possible:

• If you get a wound, keep it clean, dry, and bandaged. Make sure to change your bandages regularly.
• Any time you see signs of infection in a wound — redness, swelling, pain, fever — tell your doctor as soon as possible so it can be treated.

Be careful when you use tampons, diaphragms, or contraceptive sponges. All three carry some risk of TSS. If you’ve had TSS before, or if you’ve had a serious bacterial infection, you’re at a greater risk of getting TSS, and shouldn’t use them at all.

Because of improved designs, the risk of getting TSS from tampons is much lower than it used to be. But it’s still important to practice good tampon hygiene. To use tampons safely and reduce your risk of TSS:

• Use the lowest absorbency tampon you can.
• Change your tampon frequently — every 4 to 6 hours or more, depending on your flow.
• Use pads on light flow days.
• Don’t use tampons when you don’t have your period.
• Keep your tampon box in a cool, dry place to keep bacteria from growing.
• Always wash your hands before putting a tampon in or taking one out.

Toxic Shock Syndrome | Leleka Maternity Hospital Blog | Media center

What is toxic shock syndrome (TSS)? This is a rare but very dangerous condition. TSS cannot be called a disease; it is intoxication of the body as a result of an acute bacterial infection. The infection is caused by staphylococci and streptococci. These bacteria can be present in small quantities in the body, usually in the nasopharynx, without affecting vital functions. But when factors appear that contribute to the rapid multiplication of these bacteria, their number grows rapidly, and toxic waste products become deadly.In about half of cases of TSS, women develop during their period.

Signs of toxic shock syndrome

The danger of TSS is that its symptoms initially do not differ from an acute respiratory viral infection. It is often confused with allergies and other diseases, and it is expected that after some time the problem will disappear by itself. Therefore, at the first suspicion, you need to check what kind of infection we are talking about. The first signs of TSS are as follows:

• high temperature, 39 degrees and above;
• dizziness, weakness;
• nausea, vomiting;
• delirium;
• low blood pressure;
• sometimes – redness of the throat.

With TSS, skin rash, sunburn-like redness, and then flaking may occur. This is a symptom that points to the real cause of the problem. However, peeling does not appear immediately, and you should not wait for it: every hour of delay creates additional health risks. With actively developing TSS, the liver and kidneys are very quickly affected, and other vital systems are involved. Therefore, it is important to check as early as possible whether the described signs are not a symptom of toxic shock.

Syndrome of toxic shock with menstruation

According to statistics, more than half of all victims of TSS are women who used tampons during their periods. The mechanism of the development of the symptom has not yet been reliably studied. Presumably, it develops in women in whose vagina colonies of dangerous bacteria already existed. It is sometimes possible that bacteria are absorbed into the tampon along with the pool water. One way or another, once in the nutrient medium – blood and mucous secretions that the tampon absorbs – bacteria multiply rapidly.The toxins they produce enter the bloodstream through the walls of the vagina, sometimes through microscopic scratches left by the tampon. The symptoms described above appear.

Other cases of toxic shock syndrome

In cases where TSS does not arise from a tampon, it is also caused by ingested staphylococci and streptococci. The infection enters the body through an open wound. It may be a small wound on the surface of the skin, but more often bacterial infection occurs after surgery, with insufficient or unskilled care.Reproduction of bacteria can occur, for example, in certain areas of tissues during their necrosis.

Treatment of toxic shock syndrome

If the tampon is changed every few hours, the TSS will not develop in time. But if symptoms similar to TSS suddenly appear, the tampon should be removed immediately, and a new one should not be used until the diagnosis is clarified – it is better to use a pad that absorbs secretions from outside the body.

It is imperative to replace the tampon after visiting the pool.

If the signs of TSS are pronounced and last for several days, after removing the tampon it is necessary to call an ambulance and hospitalize the patient. Once the diagnosis is confirmed, the patient will be prescribed a course of antibiotics and other supportive measures.

90,000 Toxic Shock Syndrome!

1. What is toxic shock syndrome?

Toxic shock syndrome is a sudden, life-threatening condition.Toxic shock syndrome occurs due to the release of toxic substances and an overgrowth of bacteria called Staphylococcus aureus , which many women have in their bodies.

Toxic shock syndrome is associated with menstruation in women, especially those who use tampons. The body reacts to toxic shock syndrome with a sharp and severe drop in blood pressure, which deprives the organs of oxygen. And this can lead to death.

A must for your reference!
Help with treatment and hospitalization!

2. Risk Factors

Although the TSS is most often associated with the use of tampons, the use of diaphragms and caps is a risk factor.Women who have recently given birth also have a higher risk of developing toxic shock syndrome. In addition, TSS occurs in both men and women with the development of staphylococcal bacteria during the recovery period after surgery, burns, open wounds, or the use of prostheses.

More than a third of all cases of toxic shock were diagnosed in women under the age of 19. And in 30% of women who have had this disease, it reappears. Therefore, if you have ever had toxic shock, it is very important to know its symptoms so that you can immediately seek medical help if necessary.

People who die from toxic shock die from the body’s reaction to the poisons released by the staphylococcus bacteria. Most have hypotensive shock, in which the heart and lungs stop working.

If you have a high fever with vomiting during your period (especially if you use tampons), you need to call an ambulance right away! If you are using a tampon, menstrual sponge, diaphragm, or cervical cap, remove it immediately without waiting for a doctor.

Visit our
Gynecology page

3. Causes of toxic shock syndrome

Toxic shock syndrome is caused by a poison produced by Staphylococcus aureus bacteria.This same bacteria often causes skin infections in burn patients and those who have undergone surgery.

Staphylococcus aureus is usually present in the vagina in women. And this, in general, is not a pathology. Why staphylococcus aureus causes toxic shock syndrome is still not clear. But for the development of toxic shock, two conditions are necessary. First, bacteria need an environment where they can grow rapidly and release poison. And secondly, the poison must enter the bloodstream.

A blood-soaked swab is a favorable environment for the rapid growth of bacteria.A special risk factor is if the tampon remains in the vagina for a very long time (more than 30 hours) or if, for some reason, part of the tampon, diaphragm or cap remains in the vagina.

The way in which bacterial poison enters the bloodstream can also be related to the use of a tampon. By placing a tampon in the vagina, microscopic scratches can be made on the walls of the vagina. Tiny blood vessels can also rupture. Superabsorbent tampons, especially if left in the vagina for too long, can cause vaginal dryness, which increases the likelihood of microinjury.

In general, there have been many theories about the causes of toxic shock syndrome. But research has ruled out the effects of women’s deodorants, the effects of underwear. TSS is also not associated with the features of the menstrual cycle in women, sexual activity, alcohol, drug use, smoking, swimming and bathing in water.

About our clinic
m.Chistye Prudy
Medinterkom Page!

Rapid diagnostics of streptococcus

December 14, 2018

No one is immune from infection. There are a huge number of pathogenic organisms, and the most common causative agents of infectious diseases are group A streptococci.These are round-shaped microorganisms that cause diseases such as:

• pharyngitis
• tonsillitis
• impetigo
• pyoderma
• paraproctitis
• vaginitis
• sepsis
• pneumonia
• endocarditis
• pericarditis
• osteomyelitis
• purulent arthritis
• myositis
• phlegmon
• omphalitis
• scarlet fever
• erysipelas
• toxic shock syndrome
• necrotizing fasciitis
• rheumatism
• acute glomerulonephritis

Symptoms

The clinical picture of the disease may differ depending on the age of the patient, the affected organ and the presence of concomitant diseases.In a child, the disease manifests itself more rapidly. A chill occurs first, followed by the following symptoms:

• nausea and vomiting
• green or yellow nasal discharge
• decreased appetite
• enlarged lymph nodes
• tickling and sore throat
• increase in body temperature to high rates.

Streptococcal infections are often very severe in adults.Patients have the same signs of the disease that are characteristic of children, but they are more pronounced.

Pregnant women and people with poor health need to be especially attentive to their health and the protection of the body from streptococcal infection.

Diagnostics

There are several ways to identify group A streptococcal infections. To determine the pathogen, the following medical studies are carried out.

• Bacteriological culture.The biomaterial taken from the patient (sputum, mucus, saliva, blood, urine) is examined for the release of a separate pathogen.
• Serological method. The amount of antibodies to the pathogen in the patient’s blood is detected.
• PCR method. The polymerase chain reaction is based on the identification of specific DNA fragments of streptococcus. The material for PCR testing is blood plasma, scraping from the oropharynx, flushing from the lungs, sputum, saliva. The method allows you to identify the pathogen at the earliest stage of the disease.

The fastest way to almost certainly determine if you have a streptococcal infection is the Rapid Test . It is carried out directly at the reception of a doctor (therapist or pediatrician) and allows you to identify the pathogen in the early stages.

Diagnostic time is about 10 minutes.

90,000 Publications in the media

Toxic shock syndrome is a severe pathological syndrome that develops when infected with staphylococcus strains, producers of TSST-1 (toxic shock syndrome toxin-1), less often enterotoxins B and C, as well as group A streptococcus.

Epidemiology. The syndrome was first reported in 1980 in women aged 15–25 years old who used sorbing tampons during menstruation (after the appearance of tampons with reduced sorbing properties and without polyacrylic fillers, the incidence of septic shock has sharply decreased). The syndrome can also develop after childbirth and as a complication after surgery (especially on the nasal cavity and paranasal sinuses).

Pathomorphology. Subepidermal sagittal skin dissection. Minimal inflammatory response in tissues. Decrease in the number of lymphocytes in the lymph nodes. Ulceration of the mucous membrane of the vagina and cervix.

Clinical presentation. Increased body temperature (38.8 ° C and above), vomiting, diarrhea, erythema and scarlet fever, more often on the palms and soles (followed by desquamation after 1–2 weeks), arterial hypotension, development of meningism, acute respiratory distress syndrome and shock.Periorbital edema, conjunctivitis are possible.

Research methods • Microbiological examination •• Isolation of culture Staphylococcus aureus from vagina or surgical wound (> 90%) •• Nasal or perineal discharge Staphylococcus aureus •• Isolation of Staphylococcus aureus •• Neutrophilia with an increase in the number of stab forms •• Lymphopenia •• Normocytic, normochromic anemia •• Thrombocytopenia •• Coagulopathy • Biochemical blood test •• Hypoalbuminemia •• Electrolyte imbalance •• Hypocalcemia •• Hypomagnesemia • • Hypocalcemia •• Increase in blood urea nitrogen •• Increase in serum creatinine •• Increase in calcitonin •• Increase in serum bilirubin •• Change in urine sediment.

Special studies • Absence of serum antibodies to TSST-1, SEA, SEB or SEC • Determination of TSST-1 or SEA-SEC in isolate Staphylococcus aureus .

Differential diagnosis • Scarlet fever • Drug reaction • Rocky mountain spotted fever • Leptospirosis • Kawasaki disease • Meningococcemia.

TREATMENT

Management tactics • Regime – stationary, intensive therapy; until the normalization of body temperature and blood pressure, constant monitoring of the patient is necessary • Removal of tampons from the vagina • Restoration of water balance • Drug therapy • If necessary – mechanical ventilation • Treatment of chronic foci of infections.

Drug therapy • Intravenous infusion of dopamine 400-800 mg / day lasting from 2-3 hours to 1-4 days • HA IV • Antibiotics •• Oxacillin 2-4 g / day every 6 hours •• If you are allergic to oxacillin – clindamycin 0.6-2.4 mg / day in 4 doses •• Vancomycin 500 mg every 6 hours • Immunoglobulin 0.4 mg / kg IV every 6 hours

Complications • ARF • Respiratory distress syndrome in adults • Alopecia • DIC • Ataxia, toxic encephalopathy • Memory impairment • Cardiomyopathy.

Current and forecast. Mortality rate – 3-9%. Relapses – 10-15% of cases.

Age features. Children and adolescents. It is sometimes seen as a complication of chickenpox.

Prevention. Elimination of the use of long-acting tampons during menstruation, especially with a high absorption capacity. Changing tampons frequently throughout the day should be recommended. Applying sanitary napkins at night. Timely treatment of infected wounds.

ICD-10 • A41.9 Septicemia, unspecified

Note. Streptococcal toxic shock syndrome, or streptococcal toxic syndrome, may be clinically indistinguishable from staphylococcal toxic shock.

90,000 why, after she lost her leg, did this girl sue the tampon manufacturer?

At 24, Lauren Wasser had a life. She was the child of two models and stood 5 feet 11 inches tall.A blonde with blue eyes and a bone structure that made her look like Santa Monica’s androgynous answer to Lara Stone. She turned down a basketball scholarship to pursue a modeling career, which began successfully when she was two months old, in ItalianVogue magazine alongside her mother. When she wasn’t modeling, she took improvisation lessons at the Groundlings, played basketball for fun, and cycled 30 miles every day. She had an apartment in Santa Monica and was part of LA’s dazzling social scene.

“Everything was based on appearance,” she says. “I was socialite , and didn’t even think about it.” Lauren had so many friends that when they gathered outside St. John’s Health Center a few weeks later to say goodbye to her, a line lined up around the entire hospital.

It all started on October 3, 2012, when, according to Lauren, she felt not very – almost as if she was starting a cold. She also had her period and ran to a nearby Ralph’s store for tampons from her favorite brand, Kotex Natural Balance.At first glance, the trip to the store had nothing to do with an incomprehensible disease that pierced her body. After all, by that time Lauren had already known from her own experience for 11 years what a period was, and “Kotex” was part of those days. Like most girls, her mother told her all about using tampons when she was 13 years old, showed her how to use the applicator, and told her to change the tampon every three to four hours. The rule was simple; that day, according to Lauren, she changed her tampons in the morning, afternoon and again in the evening.

Later that day, she decided to go to her friend’s birthday party at the Darkroom on Melrose Avenue. “I tried to behave normally,” she says, although she struggled to stay upright. “Everyone is like that – damn, you look terrible.” She drove back to Santa Monica, took off her clothes and fell into bed. All she wanted was to sleep.

The next thing she remembers is a blind cocker spaniel jumping onto her chest and barking aggressively. Someone banged on the door and shouted: “Police, police!”Lauren dragged herself to the door, and a policeman entered the apartment to inspect everything. Lauren’s mother, who had just undergone surgery, worried that Lauren had not been in touch for a long time, and called the police.

“I was not able to walk my dog, so there was piss and poop everywhere,” she says. She had no idea how long she was in bed. The policeman assessed the situation, told her to call her mother, and left.

Lauren somehow fed the dog a few carrots from the empty refrigerator, then called her mother, who asked if she could call an ambulance.“But I was so weak that I couldn’t make that decision on my own,” says Lauren. “I told her that I wanted to lie down and that I would call her back in the morning. And this is the last thing I remember. ” The next day, the mother sent her friend to her with a police officer. They found Lauren lying facedown on the bedroom floor.

She was rushed to St. John’s Hospital with a fever of 40 degrees ten minutes before she died, they were told. Her internal organs refused to work and she suffered a massive heart attack.The doctors could not stabilize her condition, and no one could understand what was happening until they called the infectious disease specialist who immediately asked, “Does she have a tampon?” The tampon was, and he was sent to the laboratory. There they confirmed toxic shock syndrome.

TSS, which got its name in 1978, is, in short, a complication of bacterial infections. Often staphylococcus is added to it ( Staphylococcus aureus ). This condition is not unique to women, but the link between infection and the use of tampons was noticed even during the exacerbation of concomitant TSS deaths in 1980.(One tampon is not enough to cause TSS. A person should already have Staphylococcus aureus in their body. About 20 percent of the population carries this bacterium.)

Tampons and similar items have been used by women during their periods for centuries, but their composition has changed over the past 50 years or so. Instead of natural components, such as cotton, synthetic components began to be used: viscose and plastic.Such materials are especially actively used by such tampon manufacturers as “Playtex”, “Tampax”, “Kotex”. These synthetic fabrics, together with the absorbent properties of tampons, can create ideal conditions for the bacteria that leads to TSS. When Proctor & Gamble introduced an extra absorbent tampon called Rely in the 1980s, TSS really boomed. According to a study by the Yale Journal of Biology and Medicine, the “carboxymethyl cellulose gel” in Rely swabs worked like agar in a petri dish, providing a viscous environment where bacteria could thrive. “

“This is the most excruciating pain I have ever experienced. I don’t know how to describe it to you. ”- Lauren Wasser

At the hospital, doctors told Lauren’s mother to pray and prepare a coffin for her. Lauren plunged into a medical coma. News of her hospitalization leaked to Facebook, and her friends and acquaintances lined up outside the hospital to pay their last respects to the girl.

Of course, Lauren doesn’t remember any of this. Not the Facebook posts “pray for Lauren,” not the nervous friends in her room, not even the moment when her long white hair, matted from her days in the hospital, was shaved off.All she remembers is when she woke up, 80 pounds of fluid was poured into her body, and she herself was disoriented and thought she was in Texas.

“I had a huge belly. Tubes stuck out from everywhere. I couldn’t speak, ”she says. Next to the bed was a tube of black toxins that were flushed out of her bloodstream. She looked out the window and saw several houses typical of the southwest. The body was bloated and seemed completely out of place. “I thought I was overeating,” she says.”I had no idea what was going on.”

Much worse than the disorientation was a burning sensation in the arms and legs, which did not go away no matter what. The infection turned into gangrene. Three years later, when she tells me her story in a Los Angeles cafe, Lauren still has no words to describe how she felt. “This is the most excruciating pain I have ever experienced. I don’t know how to describe it to you, ”she says. She was transferred to UCLA Medical Center to receive hyperbaric oxygen therapy.There she was placed in a pressure chamber to force blood to flow to her legs.

While Lauren was waiting for treatment, there was a moment when she was left alone in the room. Her mother and godfather went out for a while, and she was sitting in a large chair. There was a curtain, and behind the curtain was a woman talking to someone on the phone. Lauren could hear the conversation. The woman insisted that something was urgent, that something had to happen as soon as possible. And then she said, “We have a 24-year-old girl here who will need to amputate her right leg below the knee.”

“I thought Oh, God, she’s talking about me,” , says Lauren. “ My leg will be cut off “.

While Lauren was in the hospital, her mother started a complicated lawsuit involving Kimberly-Clark Corporation, a manufacturer and distributor of Kotex Natural Balance tampons, and grocery stores Kroger and Ralph’s selling Kotex Natural Balance as defendants. It is not certain that Kotex tampons carry more TSS risks than other well-known brands, but they are named in the case because that is the brand that Lauren used.The family’s legal team hopes to end the use of synthetic materials in tampon production in general. The complaint says that all the defendants “through negligence, inadvertently, recklessly, but to some extent are responsible” for the hospitalization of Lauren with TSS. (A spokesperson for Kimberly-Clark declined to comment for this article because the company “does not comment on the current lawsuit.”)

Lawyer Lauren Hunter J. Shkolnik is used to seeing the dark side of products that most people consider safe.For example, he was involved in a case involving an ingredient in a cough syrup that caused people to suffer strokes. “I wish I could tell you that Lauren’s case shocked me, but it’s not,” he says. “The tampons have not changed since the day when there was an epidemic of TSS. All they did was put up the caption: “You could get toxic shock.” The material hasn’t changed for decades. ” To avoid anger from the Food and Drug Administration, the companies simply print a warning on the tampon packaging, he said.He calls it a “escape-jail-card”.

There has been a requirement to put such a warning on tampon packages since the 80s, but Shkolnik believes that the warning on Lauren’s tampon package is not clear enough, especially when it comes to whether or not to remove the tampon at night. Here’s the wording: “Change your tampon every four to eight hours, including at night.” The family thinks this instruction is not clear. They are going to argue that “at night” can mean more than eight hours, especially when it comes to a young girl who can easily sleep nine to ten hours on weekends.“Tampon companies have to say, ‘Don’t sleep with him. Use a spacer, ”says Shkolnik.

Of course, most women remember the Toxic Shock Syndrome warning on all tampon packages, and while they probably don’t get it every time they use a tampon, they know there is a question. The packaging says:

The tampon is considered a companion of toxic shock syndrome. TSS is a rare but serious condition that can lead to death.Read and save this information. Use a maximum of eight hours.

The student admits that the existence of this warning from the Food and Drug Administration will be the most difficult part of the case. “Part of our job is to show the jury that this is not a warning on the packaging, but that for 20 years they have had materials that could make tampons safer, but they decided not to use them. They call these tampons “natural,” although in fact, these man-made materials make them dangerous.Their marketing makes women think that they are made from natural cotton, but this is not so, there is no cotton in them, and if there was, the possibility of developing toxic shock would be reduced to almost zero. ”

Dr. Philip M. Thierno, professor of microbiology and pathology at New York University School of Medicine, has done significant independent research into the relationship between tampons and toxic shock syndrome. He agrees that cotton would be a safer option. “Most tampon manufacturers make tampons from different types of rayon and cotton or from pure rayon, and in both cases, the tampons provide the optimal physical and chemical conditions for the TSST-1 toxin to appear if the toxigenic strain Staphylococcus aureus is part of the normal the vaginal flora of a woman, ”he says.“Toxic shock syndrome can occur if a woman does not have antibodies to the toxin or not enough antibodies. So synthetic tampon ingredients are a problem, while 100% cotton tampons are less risk, if any. ”

In the hospital, Lauren faced a nightmare situation: she had to sign papers authorizing the amputation of her right leg below the knee. “Both of my legs started to shrink,” she says. “I had to act quickly.”The heel and toes of her left foot were severely injured, and the doctors thought the left leg would have to be amputated, but Lauren fought to keep it. “I knew the odds were 50/50,” she said. “We did two skin grafts, which miraculously and thanks to God were the only salvation for my foot. Today I have no fingers. The heel has finally healed, but it is very sensitive, there is no fatty tissue on it. ”

Because Lauren is still young, her body produces calcium in an attempt to repair her injured foot, which ironically increases the damage.“I walk on rocks,” she says. She is often operated on and still lives in pain for three years. The doctors told her that she might have to go through another amputation later, when she was 50 or so.

“It took me a while to figure out if I was just as respectable and attractive.” – Lauren Wasser

“I wanted to kill myself when I got home,” she says. “I was that girl , and now suddenly I don’t have a leg, I’m in a wheelchair, I have half a foot, I can’t even go to the toilet.I am in bed, I cannot move, and I had the feeling that the four walls were my prison. ” Sometimes she jumps out of bed, deceived by phantom limb syndrome, and immediately falls to the floor. The only thing that kept her from hurting herself was the thought of her little brother, who was 14 at the time. “I didn’t want him to come home and find that I had given up,” she says.

Lauren says it took her a long time to come to terms with her new identity.“I was crying on a small stool in the shower, and a wheelchair was waiting for me,” she says. “This is such a game. All your life you live and think: “I am an athlete” or “I am a beautiful girl”, and then something happened that I could not control. It took me a while to figure out if I was the same respectable and attractive. ”

She was assisted by her photographer friend Jennifer Rovero, who took hundreds of photographs while Lauren was recovering, treating the process as a form of therapy.Taking pictures in the city, they developed a habit of asking young girls if they had heard of toxic shock syndrome and if they believed it existed. Most say no.

Lauren hopes to appear before Congress with Representative Carolyn Maloney this fall. A congresswoman from New York is trying to push through the Robin Danielson Act, named after a woman who died of TSS in 1998. The act “will be the beginning of a program to investigate the risks of dioxin, synthetic materials, chemical fragrances and other components in feminine hygiene products.”He was blocked nine times already without even letting the issue be brought to a vote.

For clarity, transparency, not banning tampons, is what Lauren, her lawyers, and Maloney want. Tampons are convenient, and when you need to hide bleeding during your period, they make sense.

But to this day, Lauren can’t watch advertisements for tampons – girls frolicking on the beach or shining on the playground in clean white shorts – because they don’t usually warn of toxic shock syndrome.“I can’t be on camera, I don’t really want to wear a swimsuit, I couldn’t jump into the ocean if I wanted to,” she says. “This product fucked me.”

She wants tampons, like cigarettes, to have a larger and clearer warning of their potential risks. “You know cigarettes can kill you, so when you smoke, it’s your choice,” she says. “If I knew about TSS, I would never use tampons.” And she will never use them again.

Lauren and her friend never take photographs of her prosthesis and instead focus on her face. But today they show me their latest shots. In these photographs, Lauren’s eyes are heavily made up in black, and she is standing on her feet. Her prosthesis is wearing NewBalances. She took the stance of the model playing the ball. It’s been three years since a black tank of toxins stood next to her hospital bed, as she was in a hyperbaric chamber, and a denture salesman came to her hospital room to present something she had never thought of before.Today, she may even joke about the situation, calling her leg “small foot” and “small foot”, respectively.

I ask if she plays basketball, and I think about the lives that have split into before and after, and I wonder if there is some kind of freedom, some way to bring parts of myself through this line. “If you play, you always play,” she replies.

Follow Tori Telfer on Twitter.

Killer tampon. What is toxic shock syndrome and how to avoid it?

Toxic shock syndrome (TSS) is a rare but extremely dangerous infection.Scientists from the National Institutes of Health in the United States have found that the fatal problem is about 50%. Representatives of all genders and ages are susceptible to it, however, women are most often at risk during menstruation if they use a tool such as a hygienic tampon.

TSS is an extremely dangerous medical condition provoked by certain bacterial infections. It develops when bacteria enter the body, which most often occurs through various damage to the skin, such as scratches and cuts.

Scientists cannot name the exact reasons why a tampon leads to the development of TSS, however, with prolonged use, they become an optimal environment for the active reproduction of dangerous microorganisms. In addition, doctors believe that the fibers of the hygiene product leave scratches on the mucous membrane inside the vagina, allowing bacteria to enter the bloodstream without hindrance.

Symptoms of TSS can vary, but usually come on very quickly. You should be on your guard if the temperature suddenly rises and a sunburn-like rash appears on the palms and soles.In some cases, diarrhea and vomiting occur, the mucous membranes of the eyes turn red, there may be headaches and muscle pains, and blood pressure also decreases. The danger is that often such manifestations are perceived as flu symptoms, but if they are observed after using a tampon, it is better to immediately consult a doctor, since treatment is possible only after hospitalization. In difficult cases, patients are faced with shock, after which, as a rule, the kidneys fail, losing the ability to filter waste in the blood.If you do not take up treatment quickly, TSS can end with heart and kidney failure.

How to prevent?

It is important to choose the right tampons, choosing those with the least absorbency. The hygiene product should be changed regularly, at least once every 4-8 hours, even if the last days of menstruation are on and the discharge is not so abundant. At night, it is better to refuse tampons altogether, since during this time bacteria can spread to a dangerous extent.It is optimal at night to use gaskets that are no less comfortable, but safer for long-term operation.

Other ways to avoid TSS include regular hygiene and prompt treatment of any wounds and scratches.

(PDF) The case of T oxic shock syndrom in a pa TienT wiTh scarleT fever

BULLETIN OF MODERNCLINICALMEDICINE2013Volume6, Issue333

CLINICAL RADIATION

progressive hypotension, renal failure

(oligoanuria, increased blood levels of creatine

tinin and urea, hemoglobinuria), DIC syndrome,

acute respiratory distress syndrome (RDS).

It is believed that laboratory signs of lesions on

checks with streptococcal septic shock appear

early and often precede arterial hypotension

[2, 5]. TSS caused by GABHS exceeds septic shock

of any other etiology in terms of the severity of the clinical picture

, the rate of increase in hypotension and organ damage

, and the mortality rate [5]. In contrast to the similar

in a number of manifestations of staphylococcal toxic

shock, SSTS almost always proceeds with the phenomena of

bacteremia.

Below we present our own observations of the syndrome

of toxic shock in a patient with scarlet fever.

Patient O., 7 years old, was admitted to the Regional Clinical Hospital of the Ministry of Health of the Republic of Tatarstan through the line

“air ambulance” in an extremely serious condition

from the infectious diseases hospital in Naberezhnye Chelny. Tya –

the condition was due to general toxic

manifestations and multiple organ failure. At the transfer

, the child was on mechanical ventilation.

Anamnesis: a child from the 1st pregnancy,

kavsha against the background of colpitis, the first urgent delivery at

at the 40th week of gestation.Body weight at birth 3280 g,

length 52 cm. The child’s psychophysical development in

in subsequent years corresponded to age. Aller-

gological history is not burdened. Of the transferred

diseases – ARVI, chickenpox, tracheobronchitis.

Heredity is not burdened.

Medical history. She fell ill acutely on 09/14/12:

the body temperature increased to 38 ° C, on the skin of the face,

of the arms and legs, the torso, a small-point rash

appeared on a hyperemic background, which became brighter the next

day.There was repeated vomiting of

gastric contents, intense pain in the throat –

le when swallowing, a rise in body temperature to 39 ° C.

Took panadol, against the background of which

was noted a short-term decrease in temperature. On the same day

she was examined at the infectious diseases hospital in the city of Na-

Berezhnye Chelny. In addition to fever and rash, practically

changes in the pharynx were found throughout the body in the form of

bright hyperemia of the tonsils, which were enlarged

to the II degree, purulent superimpositions took place in the gaps.From the epidemiological history: 3-4 days

before the disease was in contact with a schoolgirl,

of whom was diagnosed with “lacunar angina”.

Based on clinical and epidemiological data

, a diagnosis of scarlet fever was made and

recommended outpatient treatment – amoxicillin, suprastin,

rinsing the oropharynx with furatsilin solution. However,

there was no improvement in the patient’s condition.On

the 4th day of illness, a profuse miliary rash appeared,

complaints of sore throat persisted, the tongue was described as

“crimson”, periodically there was a rise in body temperature up to 39 ° C, weakness, no appetite,

there were no urination disorders.

On the 5th day of illness, the patient’s condition sharply worsened

– fever up to 40 ° C, vomiting appeared

“coffee grounds”, an ambulance team was called

, which delivered the patient to an infectious hospital. …Naberezhnye Chelny, where she stayed for

for the next 3 days. Upon hospitalization, the patient’s condition

was assessed as severe, due to the manifestations of

intoxication, profuse rash and hemorrhagic syndrome

. The patient is lethargic, inhibited, but conscious, meningeal signs are negative. On the skin

of the trunk and limbs there is a profuse, mainly

miliary rash, as well as elements of hemorrhagic

petechial rashes mainly on the flexor-

surfaces of the hands.Breathing was carried out over all

fields of the lungs, no wheezing was heard. Heart sounds

are rhythmic, muffled. The abdomen is rounded, not

swollen, deep palpable, painless.

The liver is enlarged and protrudes from under the edge of the costal arch

by 4 cm. The spleen is enlarged by 1 cm. There was a

decrease in urine output.

In the general blood test – pronounced leukocytosis,

accelerated ESR, thrombocytopenia. In the biochemical

blood test – hypoproteinemia (the level of total protein

– 51 g / L), an increase in the CRP level to 25 mg / L,

transaminase activity up to 200 U, urea levels

(16 mmol / L) and creatinine (380 μmol / L), impairment of hemostasis indices in the form of thrombocytopenia

(40 × 109 / L), an increase in blood coagulation time

(up to 10 min according to Sukharev) and a decrease in the prothrombin index

(up to 35% ).

On the 6th day of illness, the patient’s condition worsened –

elk, there was an increase in signs of renal non-

sufficiency (anuria), manifestations of DIC syndrome (according to

gastric tube discharge of the “coffee grounds” type,

increase in hemorrhagic rash , bleeding from

injection sites), circulatory disorders (marble –

skin integument, acrocyanosis, pulse of weak

filling and tension, arterial hypotension,

BP 80/40 mm Hg.Art.). There was a picture of dynamically developing

RDS (tachypnea up to 24 per minute, shortness of breath

of a mixed nature, decreased oxygen saturation of hemoglo-

bin oxygen up to 85%), in connection with which the patient was transferred to mechanical ventilation

.

Treatment included infusions of glucose

saline solutions, antibacterial therapy (cef

Triaxone), dexamethasone, dopamine, hemostatic

therapy (transfusion of erythrocyte mass and blood sugar), administration of dicinone

.

Due to the severity of the condition on the 7th day of illness, the child

for further treatment was transferred to the DRKB

Kazan with a diagnosis of scarlet fever, toxic form.

Multiple organ failure. DIC syndrome. Septi-

shock. Acute renal failure ”.

From 20.09.12 to 06.10.12 the patient was in the

intensive care unit of the DRKB. The severity of the condition at hospitalization was due to the picture

of acute renal failure (oliguric

period), DIC syndrome, intoxication.An examination was carried out on

, which revealed in the KLA an accelerated

ESR up to 35 mm / h, signs of moderate anemia of

severity (hemoglobin level 86 g / l), in a biochemical blood test – an increase in CRP levels,

ASL-O (713.0 ED / ml), procalcitonin (33.4 ng / ml),

urea and creatinine. In the general analysis of urine –

proteinuria, leukocyturia and erythrocyturia. On the ECG:

sinus tachycardia with a heart rate of 136 per min, the position of

of the electrical axis of the heart is normal.Ultrasound of the heart:

1st degree mitral valve prolapse with mild

regurgitation. Insufficiency of the mitral valve

1st degree. Insufficiency of the tricuspid valve –

pan of the 2nd degree. False chord of the left ventricle. In the

inoculation, fungi of the genus Candida were isolated from the pharynx. Culture of

sputum from the trachea did not give growth of microflora.