Recurring Toxic Shock Syndrome

• Cause and Risks

  Infection by Staphylococcus aureus causes toxic shock syndrome. The bacterium appears to enter people's bodies primarily through small and large scrapes and cuts caused by super-absorbent tampons, insertable contraceptive devices, surgery and injuries. Ninety-five percent of cases of toxic shock syndrome occur in menstruating women, according to data compiled by the U.S. Centers for Disease Control and Prevention. Women who have recently given birth, people with an existing staph infection and people who have had their nasal passages stuffed with gauze to stop a nosebleed also run a risk for developing toxic shock syndrome.

• Symptoms

  Initial and subsequent cases of toxic shock syndrome produce the same symptoms. Symptoms physicians use to diagnose toxic shock syndrome include a persistent fever of 102.2 degrees Fahrenheit (38.9 degrees Celsius) or higher, chills, low blood pressure, red and widespread flat rash that resembles a sunburn, vomiting, diarrhea, severe muscle pain, liver dysfunction, kidney dysfunction, easy bruising, decreased platelet count, mental confusion and redness around the mouth, vagina or eyes. These symptoms occur suddenly and worsen rapidly. Within a week of developing toxic shock syndrome, people can begin losing skin from the palms of their hands and the soles of their feet.

• Complications

  Data compiled by the CDC during the 1980s show that 5 percent of cases of toxic shock syndrome prove fatal. People who develop toxic shock syndrome can also experience seizures due to the high fever the syndrome produces, and dropping blood pressure can lead to dizziness and fainting. Patients may go into shock from their fever, low blood pressure or a combination of the two.

• How Recurrent?

  The CDC estimated in 1987 that toxic shock syndrome struck 1 or 2 of every 100,000 U.S. women between the ages of 15 years and 44 years. Other sources, such as the New Zealand Dermatological Web site DermaNet NZ, cite the recurrence rate of toxic shock syndrome among all women as being between 30 percent and 30 percent. Such an estimate of recurrence gains some credence from research published in the Dec. 18, 1980 New England Journal of Medicine. In that journal, researchers led by J.P. Davis identified 35 cases of toxic shock syndrome in menstruating women living in Wisconsin between September 1975 and June 1980. Of those 35 women, 10 (28.57 percent) had more than one episode of toxic shock syndrome.

• Treatments

  People suffering from toxic shock syndrome usually require hospitalization so they can receive intravenous antibiotics, I.V. fluids and, sometimes, dialysis. Doctors rely on clindamycin (e.g., Cleocin Phosphate from Pfizer) to treat serious S. aureus infections. I.V. fluids help patients maintain a healthy blood pressure and prevent dehydration from the diarrhea and the high fever associated with toxic shock syndrome. If a patient's kidneys fail because of toxic shock syndrome, the person will require dialysis.

• Prevention of Recurrence

  Women who have had one case of toxic shock syndrome should avoid using tampons. All people who had toxic shock syndrome need to protect themselves against subsequent staph infections by washing their hands frequently, not sharing personal are items such as razors and toothbrushes, wiping down surfaces and items frequently touched by many people with a bleach solution and keeping wounds and cuts covered with clean, dry bandages. People at risk for recurring toxic shock syndrome should also contact their primary health care provider whenever they begin experiencing symptoms of a bacterial infection.

References & Resources

• Toxic shock syndrome information from Mayoclinic.com
• Toxic shock syndrome information from DermaNet NZ
• Toxic shock syndrome data from the CDC
• Staph infections fact sheet from MayoClinic.com
• Tampon safety from California State University--Northridge
• Staph infection prevention guidelines from the Texas Department of State Health Services