What is Toxic Shock Syndrome?
Toxic shock syndrome is an acute and severe polysystemic disease, which is characterized by a sudden onset of high fever, hypotension, vomiting, diarrhea, erythematous rash on the skin, peeling during recovery, and damage to many organs.
Toxic shock syndrome is rare and often life-threatening, it develops suddenly after infection and can instantly affect various organ systems, including the lungs, kidneys and liver.
Since toxic shock syndrome progresses rapidly, immediate medical treatment is necessary.
Causes of Toxic Shock Syndrome
Toxic shock syndrome is rarely the result of infection by bacteria of Streptococcus pyogenes (Streptococcus Group A) or Staphylococcus aureus (Staphylococcus). These bacteria produce toxins that cause toxic shock syndrome. These bacteria are common, but usually do not cause problems. They can cause throat or skin infections that are easily treated, such as sore throat or impetigo. In rare cases, toxins enter the bloodstream and cause a strong immune response in people whose body does not fight these toxins. The body’s reaction causes symptoms associated with toxic shock syndrome.
Streptococcal toxic shock syndrome often occurs after childbirth, flu, chickenpox, surgery, minor skin cuts, wounds or bruises that cause bruising, but do not violate the integrity of the skin.
Staphylococcal toxic shock syndrome often occurs after long-term use of tampons (menstrual toxic shock syndrome) or after a surgical procedure, such as a nose operation with a dressing (non-menstrual toxic shock syndrome).
Pathogenesis during Toxic Shock Syndrome
The immune reaction leading to toxic shock syndrome is usually associated with a lack of specific antibodies against streptococcal or staphylococcal toxins. Young people may not have such antibodies.
Outbreaks of toxic shock syndrome can appear in hospitals and medical institutions for chronic patients, where people live in close proximity to each other.
Symptoms of Toxic Shock Syndrome
The rapid development of symptoms is one of the most important symptoms that may require immediate treatment of toxic shock syndrome.
Symptoms of toxic shock vary in severity, depending on the type of streptococcal or staphylococcal bacteria.
Symptoms of toxic shock syndrome develop quickly and can lead to death within 2 days.
The first signs of toxic shock syndrome usually include:
- Severe flu-like symptoms like muscle soreness and pain, stomach cramps, headache or sore throat.
- Sudden temperature increase above 38.9 C.
- Vomiting and diarrhea.
- Symptoms of shock, including low blood pressure and rapid heartbeat, often with dizziness, loss of consciousness, nausea, vomiting or dysphoria and confusion.
- Redness, like a sunburn. Redness may appear in several parts of the body or in certain places, such as the armpits or the groin.
- Severe pain at the site of infection (if there is a wound or damage to the skin).
- Redness of the nasal passages and mouth.
Other symptoms of toxic shock syndrome may include:
- Conjunctivitis (redness).
- Involvement of more than one organ system, usually lung or kidney.
- Blood infection (sepsis), which affects the entire body.
- The death of skin tissue (necrosis), appearing at the beginning of the syndrome.
- Peeling of skin tissue that appears during recovery.
Streptococcal nonmenstrual syndrome of toxic shock. Symptoms usually develop:
- In women who have recently given birth, 2-3 days or a few weeks after giving birth.
- In people with infected surgical wounds, 2 days later – 1 week after surgery.
- In people with respiratory problems 2-6 weeks after the onset of respiratory symptoms.
Staphylococcal menstrual toxic shock syndrome. Symptoms usually develop 3-5 days after the onset of menstruation when a woman uses tampons.
Staphylococcal nonmenstrual syndrome of toxic shock. Symptoms usually develop within 12 hours after surgery, in which surgical dressings are used, for example, after rhinoplasty.
Symptoms of toxic shock syndrome can suddenly affect several different organ systems, including the lungs, kidneys and liver.
Redness similar to sunburn may also appear at the onset of the disease. Redness usually appears after 7-14 days on the palms of the hands and the soles of the feet.
Toxic shock syndrome occurs less frequently in children than in adults.
The dangerous complications of toxic shock syndrome include:
- Shock, causing a reduction in the circulation of blood and oxygen in vital organs.
- Syndrome of acute respiratory failure. Lung function decreases, it becomes difficult to breathe, the level of oxygen in the blood falls.
- Syndrome of disseminated intravascular coagulation. This disease causes a coagulation factor. Multiple blood clots can form throughout the body. This can cause heavy bleeding
- Kidney failure, also called end-stage renal disease. – Kidney failure occurs when kidney damage is so severe that treatment with dialysis or a kidney transplant is necessary to prevent death.
Talk with your doctor about possible complications if you have had several menstrual toxic shock syndromes.
Diagnosis of Toxic Shock Syndrome
As toxic shock syndrome progresses rapidly, it is usually diagnosed and treated based on the symptoms and signs of infection without waiting for the results of laboratory tests. An additional blood and tissue test can help identify the type of bacteria that caused the infection.
Usually, while a person with toxic shock syndrome turns to a doctor, the disease progresses rapidly and the person feels very bad. Treatment of shock is usually necessary to carry out to obtain the results of any tests.
If a medical professional suspects you have toxic shock syndrome, you will receive several types of tests, including:
- Complete blood count – counting red and white blood cells, platelets and other key indicators of your blood.
- Sowing blood and other body fluids and tissues for signs of streptococcal or staphylococcal bacteria. In menstrual toxic shock syndrome, a sample of vaginal fluid is tested. In non-menstrual toxic shock syndrome, a smear or tissue sample is taken from a suspicious focus of damage or another damaged area of the body. Hemoculture does not usually detect toxic staphylococcal syndrome when it is present, but streptococcus can be determined in a sample of blood or cerebrospinal fluid, or by using a tissue biopsy. Crops from the throat, vagina, or saliva can also be detected by bacteria.
- Fluorography for examination of signs of lung damage (respiratory failure syndrome).
- Analyzes to determine other infections that can cause symptoms similar to toxic shock syndrome symptoms such as blood infection (sepsis), tick-borne bacterial infection (American tick-borne rickettsiosis), bacterial infection caused by contact with the urine of an infected animal (leptospirosis) or typhoid fever.
Sometimes other tests are required, depending on how the disease developed and what problems it caused.
Treatment of Toxic Shock Syndrome
Emergency treatment often requires intravenous plasma volume recovery and intensive care in a hospital, especially when the body is in a state of shock. Further treatment includes antibiotics, killing bacteria, removal of any source of infection, and treatment of any complications. If there are no other complications, most people recover within 2 weeks of antibiotic treatment.
If you think you have toxic shock syndrome, call your doctor immediately. If you have symptoms of shock, such as severe weakness, dizziness, or loss of consciousness, immediately call an ambulance team. Since toxic shock syndrome can cause life-threatening complications, you may need treatment in a hospital where they can constantly monitor your condition.
By the time a person with toxic shock syndrome meets with a doctor, emergency treatment is usually required. Since toxic shock syndrome can progress very quickly and is life threatening, treatment is almost always carried out in a hospital where the patient’s condition is constantly monitored. Treatment of shock or organ failure is usually necessary before the results of any tests are known. Hospitalization for resuscitation is usually necessary when the patient shows signs of shock or breathing problems (respiratory failure).
Treatment for streptococcal or staphylococcal toxic shock syndrome includes:
- Removal of the source of infection. If a woman uses tampons, diaphragm, or contraceptive sponge, they should be removed immediately. Infected wounds are usually cleared of bacteria. Your doctor may give you an injection to numb the area in order to use a scalpel or scissors to remove dead or heavily infected tissue. This is called wound debridement. Once the source of the infection is removed, the patient’s condition often improves rapidly.
- Treatment of complications of the disease, including low blood pressure, shock and organ failure. The specific treatment depends on the problem that occurred. Intravenous administration of large amounts of fluid is usually used to compensate for fluid losses during vomiting, diarrhea and fever in order to avoid complications in the form of reduced pressure and shock.
- Antibiotics for the destruction of bacteria that produce toxins that cause toxic shock syndrome. Clindamycin stops the production of toxins and immediately starts treating the symptoms. Other drugs, such as cloxacillin or cefazolin, can be added when specific streptococcal or staphylococcal bacteria have been detected by laboratory tests. Strains of Staphylococcus aureus can be resistant to drugs such as cloxacillin and cefazolin, which are widely used in the world. These staphylococcal strains are called methicillin resistant Staphylococcus aureus (MRSA). Other antibiotics may be needed to destroy these bacteria. These antibiotics include vancomycin, daptomycin, linezolid, or tigecycline.
With timely treatment and the absence of serious complications, most patients recover within 1-2 weeks.
Toxic shock streptococcal syndrome has a mortality rate of about 50%. This may be due to the fact that streptococcal toxic shock syndrome can be difficult to identify before serious complications such as blood poisoning (sepsis) or rare bacterial infections that destroy the skin (necrotizing fasciitis) appear.
The staphylococcal syndrome of toxic shock is serious, but only 5% of people who did not have time to diagnose and properly treat it lead to death.
Toxic shock syndrome is a rapidly progressing, life-threatening disease that cannot be treated at home. If you think you may have toxic shock syndrome, seek medical attention immediately.
Antibiotics are used to treat toxic shock syndrome. The sooner the therapy begins, the less possible complications may occur. Antibiotics are used for as long as necessary, and this depends on the streptococcal or staphylococcal bacteria and the severity of the symptoms.
Antibiotics can also help prevent repeated episodes of toxic shock syndrome.
Intravenous immunoglobulin can be used when toxic shock syndrome is severe or the patient’s condition does not improve after taking antibiotics. Immunoglobulin intravenously does not work like antibiotics. It contains antibodies that can help the body remove specific toxins that cause toxic shock syndrome. But experts did not determine whether intravenous immunoglobulin is effective in treating toxic shock syndrome.
Your doctor can give you blood pressure medications to help your organs function better.
In toxic shock syndrome caused by staphylococcal bacteria, surgery is rarely required, but is part of the necessary treatment. In some cases, surgical removal of infected tissue leads to a significant improvement in the patient’s condition. For example, surgery may be necessary when:
- Toxic shock syndrome developed after surgery and surgical suture must be drained and cleaned to remove the source of infection.
- Strepococcal bacteria cause necrotizing fasciitis – a bacterial infection that destroys the skin, and dead tissue and toxins produced by bacteria must be removed.
Streptococcal toxic shock syndrome with necrotizing fasciitis progresses rapidly and poses a threat to life, so an emergency operation is needed to remove the source of infection.
At the hospital, you may need to inject intravenous fluids and simple protein in order to compensate for your loss.
Prevention of Toxic Shock Syndrome
You can take the following steps to prevent toxic shock syndrome:
- Do not use tampons and barrier contraceptives during the first 12 weeks after delivery, when the risk of developing toxic shock syndrome is high.
- Follow the instructions on the package when inserting tampons, diaphragms or contraceptive sponge. Change tampons at least every 8 hours or use tampons only a few hours a day. Do not leave the diaphragm or contraceptive sponge in for longer than 12-18 hours.
- Keep all wounds on the skin clean to prevent infection and speed healing. These include cuts, pricks, scratches, burns, insect or animal bites, and surgical sutures.
- Do not allow children to scratch chickenpox sores.
- If you already had menstrual toxic shock syndrome, do not use tampons, barrier contraceptives such as diaphragm, cervical cap, sponge or intrauterine device (IUD).
Careful use of tampons, diaphragm and contraceptive sponge:
- Follow the instructions on the package when inserting tampons, diaphragms and contraceptive sponge.
- Wash your hands with soap and water before inserting or removing tampons, diaphragms or contraceptive sponge.
- Change tampons at least every 8 hours or use tampons only a few hours a day. Do not leave the diaphragm and contraceptive sponge in for longer than 12-18 hours.
- As an alternative to tampons, use gaskets. For example, use gaskets at night and tampons during the day.
- Use tampons with a low degree of absorption than you need. The risk of toxic shock syndrome is highest when using superabsorbent tampons.
Skin wound care to prevent skin infections
- Keep all wounds on the skin clean to prevent infection and speed healing. Skin damage, including incisions, burns, bruises, insect and animal bites, chickenpox sores and surgical sutures.
- Make sure that children do not comb the ulcers from chickenpox.
Prevent streptococcal infection during pregnancy or after childbirth
Pregnant women or those who have recently given birth have an increased risk of developing toxic shock syndrome, especially if one of her children has a sore throat. Any pregnant or newly born woman with a child who has signs of tonsillitis should talk to her gynecologist or obstetrician.