Toxic Shock Syndrome
Toxic shock syndrome (TSS) is an uncommon but sometimes life-threatening form of bacterial poisoning usually associated with Staphylococcus or Streptococcus bacteria.
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What Is Going On?
Between October 1979 and May 1980, doctors all over the United States began reporting a new illness to the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. Fifty-five women between the ages of 13 and 52 had shown up with symptoms of serious infections. The cooperation of doctors, health officials, epidemiologists, and laboratory scientists in the months that followed revealed a surprising coincidence—all the women were menstruating and used tampons * . This discovery led to recommendations that reduced the risk for the illness.
What Is Toxic Shock?
Bacteria are microscopic one-celled organisms found all over the earth. Many bacteria play a beneficial role in producing antibiotics and nutrients such as vitamins for use by humans, plants, and animals. Bacteria are also essential ingredients in foods such as yogurt and sauerkraut. But bacteria can also cause disease. Staphylococcus aureus (staf-i-lo-KOK-us AW-ree-us) is a bacterium that normally lives harmlessly on the skin and in the nose, armpit, groin, or vagina * , but which can cause disease under certain circumstances.
For reasons that no one understands, certain forms of bacteria sometimes produce, or secrete, poisonous substances called toxins. People whose bodies are not equipped to fight these toxins may develop a severe reaction to them called toxic shock syndrome. In human beings, the toxin does not poison the cells directly. Instead, it stimulates the immune cells—the body's defenders against disease—to secrete huge amounts of cytokines (SI-to-kines), which are proteins that act on other cells. The action of these cytokines produces the symptoms of TSS.
A second kind of TSS, caused by Streptococcus (strepto-KOK-us) bacteria and called STSS, was officially recognized in 1987. This illness behaves similarly to TSS and is treated in the same way, but it is much rarer and is related to injured skin and wounds, not to tampon use.
* tampon is a plug of cofton or other material placed in the vagina during menstruation to absorb menstrual blood and other fluids.
* vagina In girls and women, the vagina is the canal that leads from the uterus—the womb (the organ where a baby develops)—to the outside of the body.
* menstruation (men-stroo-AY-shun) refers to the monthly flow, or discharge, of the blood-enriched lining of the uterus that occurs in women who are old enough to bear children. Most girls have their first period between the age of 9 and 16. Menstruation ceases during pregnancy and after menopause.
How Does a Person Get Toxic Shock?
Anyone—men, women, and children—can get TSS. TSS is not contagious like the cold or flu, but a person who has the bacteria on his or her hands can infect areas of broken skin or wounds anywhere on the body. Half of TSS cases involve women who use tampons during menstruation * or who have had injuries to the vagina from other causes, and half are related to infections arising from burns, insect bites, chickenpox blisters, or wounds resulting from surgery.
Signs and Symptoms
TSS begins with vomiting, a high fever, diarrhea, and muscle aches. A sunburn-like rash develops over the body during the first two days of illness. Curiously, the place on the body where the bacteria are multiplying and producing toxin may appear perfectly normal. The early signs and symptoms of TSS go away within a few days. As the rash heals, the skin on the torso, face, hands, and feet begins to peel. Later symptoms may include low blood pressure and heart and kidney failure. Most people with TSS recover in 7 to 10 days, but 3 percent of people who get TSS die from it. People are more likely to die from TSS that is unrelated to menstruation.
The early symptoms of TSS may resemble those of severe allergic drug reactions or other illnesses. Lacking any other explanation, a doctor will suspect TSS in certain patients, such as women who use vaginal methods of birth control (for example, a diaphragm) or anyone who has recently had an operation. A blood test can confirm the diagnosis.
How Is TSS Treated?
Hospitalization is usually recommended for TSS. Doctors treat TSS with antibiotics and anti-inflammatory drugs. The place on the body where the toxin is being produced is disinfected. During the worst part of the illness, a person is given fluids to maintain normal blood pressure, a breathing machine (ventilator) may be required, and if the kidneys fail, waste products may have to be removed from the blood in a procedure called dialysis (di-AL-a-sis).
Can TSS Be Prevented?
There is no sure way to prevent TSS, but women can take precautions against it. Menstruating women should avoid using superabsorbant tampons, change tampons frequently, and never leave a tampon inserted overnight. They also should wash their hands before and after inserting tampons. Girls and women who have had TSS should check with their doctor before using tampons again.
The staphylococci were among the first human disease-causing organisms to be discovered. They grow in various shapes, including irregular bulky clusters from which they get their name (the Greek word staphulé means "grapelike"). Staphylococci are the most common causes of infections that people get in hospitals. In fact, they are at the root of about 2 million hospital infections each year. There are various kinds of staphylococci. Some are particularly dangerous to people whose systems are already weak from other diseases. Staphylococcus aureus, the bacterium that causes TSS, is a major public health worry because it is very destructive and the infections it causes can be hard to treat.
Dusenberry, David B. Life at Small Scale: The Behavior of Microbes. New York: W H. Freeman, 1996.
Snedden, Robert, and Steve Parker. Yuck! A Big Book of Little Horrors. New York: Simon and Schuster, 1996.
Centers for Disease Control and Prevention (CDC), 1600 Clifton Road,
N.E., Atlanta GA 30333. The United States government authority for
information about infectious and other diseases.
Bacteria, like all other organisms, are named by a pair of Latin words that identify them in the same way that a person's name identifies him or her. For organisms, the family name is called the genus, and the first name, or given name, is called the species. So, for example, some members of the genus Staphylococcus are named Staphylococcus aureus, Staphylococcus epidermidis, and Staphylococcus saprophyticusto distinguish them from one another. Like members of a family, they are all related, but each acts in a different way.
"Introduction to the Bacteria." An engaging, easy-to-read
primer on bacteria, with very good links.
"Toxic Shock Syndrome." A guide to toxic shock syndrome
for parents and children from the experts at the Nemours Foundation,