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Toxic Shock Syndrome

Topic Overview

What is toxic shock syndrome?

Toxic shock syndrome (TSS) is a rare illness that happens suddenly after an infection. It quickly can harm several different organs, including the lungs, the kidneys, and the liver, and it can be deadly. Since toxic shock syndrome gets worse quickly, it requires medical treatment right away.

What causes toxic shock syndrome?

An infection caused by strep or staph bacteria can lead to toxic shock syndrome. These bacteria are common and usually don't cause problems. But in rare cases, the toxins enter the bloodstream and cause a severe immune reaction. This reaction causes the symptoms of TSS.

  • Toxic shock syndrome caused by strep most often occurs after childbirth, the flu (influenza), chickenpox, surgery, minor skin cuts or wounds, or injuries that cause bruising but may not break the skin.
  • Toxic shock syndrome caused by staph most often occurs after a tampon is kept in too long (menstrual TSS) or after surgery (nonmenstrual TSS).

If you have had TSS, you are more likely to get it again.1, 2

What are the symptoms?

Toxic shock symptoms get worse quickly and can be deadly within 2 days. Symptoms include:

  • Sudden fever over 102°F (39°C).
  • Signs of shock, including low blood pressure and rapid heartbeat; nausea; vomiting; or fainting or feeling lightheaded, restless, or confused.
  • A rash that looks like a sunburn. The rash can be on several areas of your body or just in certain places, such as the armpits or the groin.
  • Severe pain in an infected wound or injury.

Other TSS symptoms may include:

  • Severe flu-like symptoms, such as muscle aches and pains, stomach cramps, a headache, or a sore throat.
  • Redness inside the nose and mouth.
  • Pinkeye (conjunctivitis).
  • Scaling, peeling skin, especially on the palms of the hands and soles of the feet.

Having sudden, severe symptoms is one of the most important clues that you may have toxic shock syndrome. If you think you have TSS, get medical care right away.

How is toxic shock syndrome diagnosed?

Doctors usually diagnose toxic shock syndrome based on your symptoms. Tests can help show whether staph or strep bacteria are causing the infection. Tests you may need include:

How is it treated?

Treatment for toxic shock syndrome almost always takes place in a hospital. Treatment includes:

  • Removing the source of the infection or cleaning the wound.
  • Treating complications, such as shock or liver, kidney, and lung failure.
  • Using antibiotics and other medicines to fight the infection.

Sometimes surgery is needed if TSS developed after surgery or if the infection is destroying the skin and soft tissue (necrotizing fasciitis).

After having TSS, you may get better in 1 to 2 weeks. But it will take longer if you had major complications.

How can you prevent toxic shock syndrome?

You can take steps to prevent TSS:

  • Keep all skin wounds clean to help prevent infection. This includes cuts, punctures, scrapes, burns, sores from shingles, insect or animal bites, and surgical wounds.
  • Help keep children from scratching chickenpox sores by managing itching.
  • Avoid using tampons and barrier contraceptives (such as diaphragms, cervical caps, or sponges) during the first 12 weeks after childbirth.
  • Follow the directions on package inserts for tampons, diaphragms, and contraceptive sponges. Change your tampon at least every 8 hours, or use tampons for only part of the day. Don't leave in your diaphragm or contraceptive sponge for more than 12 to 18 hours.
  • If you have had menstrual TSS, do not use tampons, barrier contraceptives, or an intrauterine device (IUD).

Other Places To Get Help

Organization

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References

Citations

  1. Que Y-A, Moreillon P (2010). Staphylococcus aureus (including staphylococcal toxic shock). In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed., vol. 2, pp. 2543–2578. Philadelphia: Churchill Livingstone Elsevier.
  2. Ainbinder SW, et al. (2007). Toxic shock syndrome section of Sexually transmitted diseases and pelvic infections. In AH DeCherney et al., eds., Current Diagnosis and Treatment Obstetrics and Gynecology, 10th ed., pp. 689–691. New York: McGraw-Hill.

Other Works Consulted

  • American Public Health Association (2008). Toxic shock syndrome. In DL Heymann, ed., Control of Communicable Diseases Manual, 19th ed., pp. 576–577. Washington, DC: American Public Health Association.
  • Centers for Disease Control and Prevention (2008). Group A Streptococcal (GAS) Disease. Available online: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/groupastreptococcal_g.htm.
  • Larioza J, Brown RB (2011). Toxic shock syndrome. In ET Bope et al., eds., Conn’s Current Therapy 2011, pp. 88–90. Philadelphia: Saunders.
  • Low DE (2012). Nonpneumococcal streptococcal infections, rheumatic fever. In L Goldman, A Shafer, eds., Goldman's Cecil Medicine, 24th ed., pp. 1823–1829. Philadelphia: Saunders.
  • Stevens DL, et al. (2006). Successful treatment of staphylococcal toxic shock syndrome with linezolid: A case report and in vitro evaluation of the production of toxic shock syndrome toxin type 1 in the presence of antibiotics. Clinical Infectious Diseases, 42: 729–731.

Credits

By Healthwise Staff
E. Gregory Thompson, MD - Internal Medicine
Dennis L. Stevens, MD, PhD - Internal Medicine, Infectious Disease
Last Revised February 23, 2012

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