TOXIC SHOCK SYNDROME – Did you know anyone can get it?

Written by TSSIS May 2006

If you or a family member showed severe ‘flu’ like symptoms coupled with vomiting and diarrhoea would you be unduly worried? Probably not. However these symptoms can be early signs of toxic shock syndrome (TSS,) which is a very rare but serious illness for which urgent medical help should be sought.

Toxic shock syndrome is a form of blood poisoning which is caused by the common bacterium Staphylococcus aureus, which normally live harmlessly on the skin and in the nose, armpit, groin or vagina of one in every three people. In rare cases certain strains of these bacteria can produce the toxin TSST-1 which causes TSS.

TSS can occur in any member of the population, regardless of age or sex. It is usually seen as a consequence of localised infections following scalds, burns, wounds, surgery, piercings, chicken pox spots, childbirth etc. Menstrual TSS can occur during or following menstruation and has been linked to the use of tampons, although the actual reason for this association is not clear.

The condition will rapidly make a person become very unwell indeed where in addition to aches, pains, diarrhoea and vomiting, they may develop a high fever, low blood pressure, confusion and dizziness, and often sporadic patches of a sunburn like rash. With early diagnosis TSS can be easily treated, but unfortunately the initial symptoms are often mistaken for less serious conditions such as gastroenteritis. This may lead to a patient becoming critically ill before being correctly diagnosed and treated. Without medical help TSS rapidly becomes very serious and sadly a small number of people die each year from TSS. People who receive treatment in good time will usually make a full recovery.

Blood pressure measurement is one of the keys to the diagnosis of TSS as low blood pressure denotes shock, and this coupled with the other visible signs will give a clear indication that TSS may be present. Special equipment required to monitor children’s blood pressure is not always readily available. It is vital that anyone who suspects TSS in a child – or for that matter any individual - insists that this measurement is taken.

TSS is more likely to affect children and young people as they will have yet to develop the necessary levels of antibodies to protect them from the illness. Most women will have heard of menstrual TSS which has been linked to tampon use. However, very few people are aware that any member of the family can be affected by TSS. There are no official up to date figures available for cases in the UK, though it is commonly acknowledged that today there are fewer menstrual cases than a number of years back, while the incidence of TSS in children particularly following burns and scalds is more frequently seen.

Just this year Southampton NHS trust has been fined for failing to adequately supervise two junior doctors caring for a man who died of TSS following a routine knee operation. Newspaper reports stated that the two doctors failed to recognise TSS. A newspaper report from last year stated that a one year old baby died tragically in his father’s arms in an A&E department while waiting to be seen. Doctors did not recognise that the child who had received a minor scalding a few days before, was critically ill, and did not give him priority. While TSS is very rare, cases such as these where the diagnosis has been missed appear all too often in newspapers.

If you or anyone you know suspects TSS, it is important to get medical advice without delay, in order to rule out the possibility or to commence appropriate treatment. If a tampon is in use it should be removed immediately and the doctor should be told the patient was menstruating and using a tampon.

TSS Fact Box

Who can get it? Any member of the population can get TSS, although children and young people are more at risk.

What is it? A very rare but serious form of blood poisoning which needs urgent medical treatment. Sadly TSS can be fatal.

What causes TSS? TSS is caused by a common bacterium Staphylococcus aureus.

How does it happen? TSS can follow local infections caused by scalds, insect bites, chicken pox spots, piercings, surgery, childbirth etc. It can also occur during or following menstruation and has been linked to the use of tampons.

What are the symptoms? Some of the symptoms of TSS are like very severe ‘flu’ and include some or all of the following:

  • Sudden high fever
  • Vomiting
  • Diarrhoea
  • Dizziness
  • Fainting or feeling faint
  • Muscle aches
  • Patches of sunburn-like rash
  • Confusion

What should I do if I think I have TSS? Seek immediate medical help; if necessary go straight to your local casualty department. If you have been using a tampon remove it immediately and tell the attending doctor a tampon was being used.

Can it be treated? Yes, it is easiest to treat at an early stage, when the treatment is largely with antibiotics.

How can I help to minimise the risk? You cannot guard completely against TSS, however it is important take notice of wounds which become infected, and if you use tampons make sure you follow manufacturer’s guidelines.

How common is TSS? TSS is very rare indeed. Only a miniscule percentage of doctors will ever see a case in their entire career.