toxic shock syndrome
ABBR: TSS
A life-threatening disorder caused by an exotoxin produced by certain strains of Staphylococcus aureus and group A streptococci. It was originally described in young women using vaginal tampons but has also been reported in users of contraceptive sponges and diaphragms, in burn patients, patients with cellulitis, and after surgical wound packing. The disease is fatal in roughly 5–50% of cases.
SEE: Staphylococcus.
Symptoms: The diagnosis is made when the following criteria are met: fever of 102°F (38.9°C) or greater; diffuse, macular (flat), erythematous rash (resembling a sunburn), followed in 1 or 2 weeks by peeling of the skin, particularly of the palms and soles; hypotension or orthostatic syncope; and involvement of three or more of the following organ systems: gastrointestinal (vomiting or diarrhea at the onset of illness), muscular (severe myalgia), mucous membrane (vaginal, oropharyngeal, or conjunctival) hyperemia, renal, hepatic, hematological (platelets less than 100,000/mm3), and central nervous system (disorientation or alteration in consciousness without focal neurological signs when fever and hypotension are absent). Results of blood, throat, and cerebrospinal fluid cultures are usually negative. The possibility of Rocky Mountain spotted fever, leptospirosis, or rubeola should be eliminated by blood tests.
Diagnosis: The diagnosis is based on observation of typical signs and symptoms. There is no definitive laboratory or radiologic diagnostic test result.
Prevention: Menstrual tampons should be removed and replaced frequently and ultra-absorbent tampons should be avoided. Wound packing should be removed as often as is feasible (typically daily).
Treatment: Penicillinase-resistant antibiotics such as nafcillin or oxacillin do not affect the initial syndrome but may prevent its recurrence. Patients who develop multiorgan system failure (such as kidney failure) may need supportive care that includes kidney dialysis, or ventilatory support for acute respiratory distress syndrome.
Patient Care: Supportive care (intravenous fluids, pressors, monitoring and treatment in an ICU) is provided to the patient until the crisis resolves. During the most critical stages of the illness, patients and families benefit from open and sympathetic communication by health care staff. Recovery from the illness may take weeks; patients should be prepared for a prolonged recovery. There are occasional relapses of TSS. Patients who develop TSS from using tampons should use menstrual pads rather than tampons after the illness. Evidence of relapse should be reported promptly to health care providers.