Toxic Shock Syndrome

Toxic shock syndrome (TSS) is a serious but uncommon bacterial infection. TSS was originally linked to the use of tampons, but it is now also known to be associated with the contraceptive sponge and diaphragm birth control methods. In rare cases, TSS has resulted from wounds or surgery incisions where bacteria have been able to enter the body and cause the infection.

The symptoms of TSS include sudden high fever, a faint feeling, watery diarrhea, headache, and muscle aches. If your child has these symptoms, it's important to call your child's doctor right away.

There are steps you can take to prevent TSS. Hand washing can play an important role in guarding against TSS. And if your daughter is just starting her menstrual period, she should understand what precautions she can take to prevent this infection.

What Is Toxic Shock Syndrome?

There are actually two different types of this condition. Toxic shock syndrome, which is caused by Staphylococcus aureus bacteria, has been associated with the use of tampons. (TSS was initially linked to a particular type of tampons, which has since been taken off the market.) Although the exact connection is still not clear, researchers suspect that certain types of high-absorbency tampons provided a moist, warm home where the bacteria could thrive.

Although TSS usually occurs in menstruating women, it can affect anyone who has any type of staph infection, including pneumonia, abscess, skin or wound infection, a blood infection called septicemia, or a bone infection called osteomyelitis.

A related infection, streptococcal toxic shock syndrome, or STSS, is caused by streptococcus bacteria. Most often STSS appears after streptococcus bacteria have invaded areas of injured skin, such as cuts and scrapes, surgical wounds, and even chickenpox blisters. It almost never follows a simple streptococcus throat infection (Rocky Mountain spotted fever, which can produce similar symptoms. A doctor may also take samples of fluid from an abscess, boil, or infected wound to look for a possible source of staphylococcus or streptococcus infection.

Doctors typically treat TSS with antibiotics. If there is a pocket of infection, like an abscess, a doctor also may need to drain the infected area. A child who has TSS is monitored for signs of shock until the condition has stabilized and seems to be improving. Steroids are also sometimes used to treat severe cases of TSS.

As with TSS, doctors typically treat STSS with antibiotics and give intravenous fluids and medications to maintain normal blood pressure. Surgery is sometimes necessary to remove areas of dead skin and muscle around an infected wound.

When to Call Your Child's Doctor

Call your child's doctor immediately if your child has any of the following signs and symptoms:

• Signs of shock: Go to the emergency department immediately or call an ambulance if your child has cold hands and feet; a pulse that is fast and weak; confusion or other mental changes; pale, moist skin; shortness of breath; abnormally fast breathing; or a strong feeling of anxiety or fear.
• Signs of TSS: Look for fever; rash (especially a rash that looks like sunburn); nausea and vomiting; watery diarrhea; confusion or other mental changes; and decreased urination. If your daughter uses tampons, ask her to tell you immediately if she notices any unusual vaginal discharge, especially if it smells strange or bad. Most of the time that will be due to other causes, but no matter the cause, it still rates evaluation.
• Signs of STSS: Look for the symptoms of shock listed above, plus a fever; blotchy rash; and an area of infected skin that is red, swollen, and painful.

Once you realize that something is wrong, it's important to get medical attention right away. The sooner your child gets treatment, the quicker the recovery will be.

Reviewed by: Joel Klein, MD