The World of Pregnancy

How Do You Know If You Have Toxic Shock Syndrome?

Toxic shock syndrome (TSS) is a rare, life-threatening condition that often occurs suddenly after an infection and can rapidly affect various organs, including the lungs, kidneys and liver. It progresses very rapidly, requiring immediate medical treatment.How Do You Know If You Have Toxic Shock Syndrome


The toxins produced by streptococcal or staphylococcal that determine the occurrence of this syndrome are usually common, but harmless. Most of the time, this bacteria causes mild throat infections, such as streptococcal tonsillitis, or skin infections, like impetigo. However, in rare cases, the toxins produced by the bacteria end up in the bloodstream and cause a severe, rapid progressive immune reaction.

The immune reaction leading to TSS is usually linked to a deficiency of antibodies against the streptococcal or staphylococcal toxin. These antibodies are less likely to occur in young adults than adults.

Epidemics of TSS occur in the hospital and nursing homes, where people live in a tight community.

How Do You Know If You Have Toxic Shock Syndrome?

The rapid development of the symptoms is among the most important signs for TSS.

Symptoms of septic shock syndrome vary in severity, depending on the streptococcus or staphylococcus involved.

General Symptoms of Septic Shock Syndrome

They include:

  • Flu-like symptoms, like muscle pain, abdominal cramps, headache, sore throat. These symptoms are common in a lot of affections, but the TSS symptoms are progressing faster and more severely than those caused by a less serious condition.
  • Fever over 38.8° C suddenly occurred.
  • Vomiting and diarrhea.
  • Sunburn-like disorder.
  • Shock signs, including low blood pressure and rapid ventricular pressure, fainting sensation, syncope, nausea, vomiting or agitation and confusion.
  • Conjunctivitis.
  • Pain around the infection`s area (if a skin lesion is involved).
  • More than 1 organ involved, usually the lungs and kidneys.
  • Disseminated blood infection throughout the body (sepsis).
  • Epidermal necrosis (skin tissue death), which occurs early in the evolution of the syndrome.
  • Peeling (exfoliating skin tissues), which occurs during the healing period.

Symptoms of Non-Menstrual Streptococcal TSS

The signs are developing rapidly:

  • In women who gave birth recently, from 2 – 3 days to a few weeks from childbirth.
  • In patients with infected surgical wounds, from 2 days to a week after surgical treatment.
  • In patients with respiratory infections, in 2 to 6 weeks after the onset of respiratory symptoms.

Symptoms of Staphylococcal Menstrual TSS

The symptoms occur after 3 – 5 days from the onset of the menstrual cycle, if the woman uses internal tampons. – Check this out!

Symptoms of Staphylococcal Non-Menstrual TSS

The signs occur in up to 12 hours after surgery.

Pathophysiogenetic Mechanism

TSS can quickly affect various organs, including the lungs, kidneys and liver. A sunburn-like eruption that might occur early is commonly followed 7 – 14 days later by tegumentary desquamation, especially in the palms and feet. Children are less likely to have severe complications of TSS than adults. – Click here!

The life-threatening complications of the conditions include:

  • Shock – Which causes low blood circulation and oxygen to the vital organs.
  • Acute respiratory distress syndrome (ARDS) – Decreases the pulmonary functions, the breathing becomes difficult and lowers blood oxygen concentration. – More info!
  • Disseminated intravascular coagulation (CID) – decreases blood clotting capacity, and major organs, like brain, heart, liver or spleen, are affected, as well as the blood vessels throughout the boy.
  • Kidney failure.

Episodes of recurrent menstrual TSS may cause progressive complications, like memory loss, rash, blue fingers or increased allergies. – Find out more!

Risk Factors

Some people are normally more susceptible to TSS, even in the absence of risk factors. These people have a deficiency of antibodies directed against the toxins of streptococci and staphylococci. Patients with immune system disorders, like diabetes, cancer or autoimmune diseases, are at greater risk for developing TSS because they don`t have a specific systemic immune response directed against toxins.

Read for more Thrombophilia During Pregnancy: Symptoms, Diagnosis & Treatment!

Risk Factors for Menstrual TSS

The long-term use of a tampon, especially one with a high absorption power, increases the risk of menstrual TSS. Patients with an episode of TSS have a high risk of recurrence.

Risk Factors for Non-Menstrual Streptococcal TSS

In children, varicella (chickenpox) is the most important risk factor for a streptococcal infection which can lead to TSS. Varicella vesicle damage through grating can lead to a group A streptococcal skin infection, increasing the risk for this syndrome to occur in children.

In adults, the risk factors are:

  • Recent childbirth.
  • Recent surgical abortion.
  • Skin lesions, like cuts, burns, bruises, insect and animal bites, ulcers determined by herpes zoster or chickenpox, mastitis (breast swelling), piercing and tattoos.
  • Flu.
  • Muscle infections, like myositis, or joint infections, like bursitis.
  • Recent respiratory infections, like sinusitis, sore throat (pharyngitis), laryngitis, tonsillitis or pneumonia.

Risk Factors for Non-Menstrual Staphylococcal TSS

The risk for non-menstrual staphylococcal toxic shock syndrome is increased by:

  • The use of contraceptive sponges, diaphragms or intrauterine devices.
  • Vaginal irritation and inflammation (vaginitis).
  • Skin lesions, including surgical wounds, especially nose surgery, when packing bandages are used.
  • Abscesses.
  • Recent respiratory infections, like sinusitis, sore throat, laryngitis, tonsillitis or pneumonia.
  • Historical staphylococcal menstrual shock syndrome.

The Risk of Recurrence

After an episode of menstrual TSS, about 30% of patients will still have at least 1 more episode. After such an episode, the risk of recurrence is most likely higher for the first 3 menstrual cycles, especially if the initial infection hasn`t been eradicated with the appropriate antibiotic treatment. The eradication of this infection is particularly important, research showing that around 65% of patients don`t develop antibodies after menstrual TSS. Without antibodies, there is a vulnerability to bacterial toxins that cause TSS.

Patients with a history of TSS associated with the use of internal tampons might reduce the risk of recurrence avoiding the use of buffers as well as diaphragms, contraceptive sponges and intrauterine devices. Patients with a history of non-muscular TSS have an increased risk of recurrence, although this is rare.

Specialized Consultation

Patients with TSS require immediate medical treatment and probably hospitalization. The specialist will be consulted immediately if sudden fever appears, or any sunburn-like eruptions or shock signs, especially if:

  • Are used pads, diaphragms or contraceptive sponges.
  • There`s a recent childbirth.
  • There are recent nose surgeries when are used wrapping bandages.
  • There`s an increasing pain in the surgical wound or at the level of a skin lesion.
  • There`s a recent history of respiratory infections.
  • There are recent skin lesions with signs of infection.
  • There`s a history of TSS.

Watchful Waiting

Patients with TSS require immediate medical treatment and probably hospitalization. It isn`t appropriate to wait and see the symptoms without medical treatment.

Patients with symptoms of TSS won`t administer non-injected medicines, like non-steroidal anti-inflammatory drugs, to relieve pain or fever. These drugs improve the symptoms, but delay the medical evaluation.

Specialists Recommend Doctors

Until a patient with TSS receives professional advice, the disease progresses rapidly and the patient is in critical condition. Specialists who can diagnose and treat TSS are:

  • Emergency medicine specialists.
  • Medical family.
  • Gynecologists.
  • Infectious disease doctors.
  • Pediatricians.
  • Medical mediators.


Until a patient experiencing this syndrome receives professional advice, the disease progresses fast and the patient is in critical condition. The treatment for TSS will be necessary before the results of the investigations made are available.

The tests can be carried out in case of suspicion of TSS are:

  • Complete count of red blood cells, white blood cells, thrombocytes (platelets) and other blood indices. – Read here!
  • Hemocultures and cultures of other fluids and tissues for staphylococci and streptococci in non-menstrual TSS, testing of samples from a suspected lesion, wound or any affected area; in hemoculture, staphylococci isn`t detected when it`s present, but streptococcus can be identified in a cerebrospinal fluid sample or tissue biopsy. Cultures from pharyngeal tissue samples, vagina or sputum cultures can also indicate bacteria.
  • Chest radiography for signs of lung damage.
  • Investigations to eliminate other infections that might cause symptoms similar to those of TSS, like blood infection (sepsis), a tick-borne infection, a bacterial infection caused by contact with urine of infected animals or typhoid fever.

Sometimes other investigations are necessary, depending on how the disease develops and its complications. – Read this!


When a patient that is experiencing TSS receives specialist advice, it`s required immediate medical treatment. Due to the fact that TSS can progress very fast and develop serious complications, the treatment is always done in the hospital where the patient can be carefully monitored. The treatment of the shock or organic insufficiencies will be necessary, usually, before the results of the investigations are made available. The transfer to intensive care is necessary when the patient has signs of shock or breathing difficulties (respiratory failure).

The treatment for staphylococcal or streptococcal TSS includes:

  • Removing the infection outbreak: if the patient uses an internal tampons, a diaphragm or a contraceptive sponge, they`ll be removed immediately; the infected wounds will be cleaned to disinfect the bacterial area; once the source of the infection is eliminated, the patient`s general condition improves rapidly.
  • Treatment the complications, including low blood pressure, shock and organic insufficiencies: the specific treatment depends on the type of problem that has occurred; large amounts of intravenous fluids are administered to replace the fluids lost through vomiting, diarrhea and fever, and to avoid the complications of hypotension and shock.
  • Antibiotics directed against the bacteria that cause TSS: clindamycin stops the production of toxins and is administered immediately to relieve the symptoms; Other drugs, like cloxacilin or cefazolin, might be added when staphylococci or streptococci are identified by lab tests. – Check for more!

When major complications don`t occur, most patients will be fully resuscitated within 1 – 2 weeks with antibiotic treatment. When identified and treated appropriately, staphylococcal TSS is severe, but rarely fatal (3% – 6%).

Read more on Hyperemesis Gravidarum: Causes, Symptoms, Diagnosis & Treatment!

Streptococcal TSS has a fatality rate of 30% – 60%. This rate might be due to the fact that streptococcal TSS can be difficult to diagnose before serious complications occur, like blood infections or the development of a rare bacterium that can destroy the skin.


The risk of developing TSS might be reduced by taking into account some simple precautions:

  • Avoiding internal tampons and barrier contraceptive methods (diaphragm or sponges) used during the first 12 weeks after childbirth, when the risk for developing TSS is increased.
  • Women with a history of TSS won`t use internal tampons, barrier contraceptives or intrauterine devices.
  • Careful use of internal tampons, diaphragm and contraceptive sponges.
  • Following the guidelines in the package related to the use of internal tampons, diaphragm and sponges.
  • Washing your hands with soap before inserting or removing a tampon, diaphragm or contraceptive sponge.
  • The tampon will be changed to no more than 8 hours or the tampon will be used only in one part of the day; the diaphragm or contraceptive sponges won`t be used for more than 12 to 18 hours.
  • Tampons should be alternated with absorbents; for instance, tampons should be used during the day and absorbents at night.
  • It`s required the use of tampons with the lowest absorption power; the risk for TSS is higher in tampons with high absorption power.
  • Skin wounds will be kept clean to prevent infection and promote healing; these include cuts, punches, scratches, burns, herpes zoster vesicles, insect or animal bites, and surgical wounds.
  • Avoiding varicella lesions in children.

If there are any signs of infection, the patient will consult a doctor immediately. These signs may include:

  • Intense pain, swelling, redness and heat around the affected area.
  • Red stripes extended from the affected area.
  • Drainage of pus from the affected area.
  • Inflamed lymph nodes in the neck, the ex or the inguinal region.
  • Fever of 37.8° C, without a known cause.
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