TOXIC SHOCK SYNDROME - PATHOPHYSIOLOGY TREATMENT AND PREVENTION

Toxic shock syndrome is a rare, potentially fatal complication of certain types of bacterial infections.

1. Sujithra.Y
Tutor cum Technologist
Microlabs-Diagnostic Center & Institute of
Research and Technology,
Sathuvacheri, Vellore.

2. Introduction
Toxicshocksyndromeisapotentiallyfatalillness
causedbyabacterialtoxin.Differentbacterialtoxin
maycauseatoxicshocksyndrome.
Thetoxinscanbereleasedbytwospecifictypesof
bacteria,groupAStreptococcus&Staphylococcus
aureus.
Itisamedicalemergencyrequiringapromptcare.
History
Theterm“toxinshocksyndrome”wasfirstusedin
1978byDenverpediatrician,JamesK.

3. Definition
Toxinshocksyndrome(TSS)isatoxin–mediated
acutelifethreatingillnessusuallyprecipitatedbythe
infectionwitheitherStaphylococcusaureusgroupA
StreptococcusalsocalledasStreptococcuspyrogens.
Althoughthisdiseasehasbeenfrequentlylinkedto
useoftamponsinmenstruatingwomen,itcanaffect
peopleofanygenderandtheage.
Abouthalfofthereportedcaseshavebeenlinkedto
useoftamponsinmenstruatingwomen,whilethe
remainingcasesareduetoothersituations.
TSScanoccurwithskininfections,burns,andafter
surgery.

4. Incidence
Mostcasesreportedinwesterncountriesstillinvolve
menstruatingwomenunderage30.TSSstilloccursinabout
17outofevery1,00,000menstruatinggirlsandwomen
eachyear;morethanhalfofthesecasesarerelatedto
tampons.Between5%and10%ofpatentswithTSSdie.
Inthedevelopingcountries,TSSoftenaffectsthechildren.
IncidenceofnonmenstruatingTSSnowexceedsmenstrual
TSSafterthehyperabsorbabletamponswereremovedfrom
themarket.
Itcanaffectchildren,postmenopausalwomenandmen.

5. Who Is affected ?
Use of tampons by menstruating women.
Less than half of the cases result from skin infections,
burns cuts and scrapes.
Involve children, men and the post menopausal
women.

6. pathophysiology
Colonization or infection with bacteria
Production of toxins
People who lack a protective antitoxin antibody
Toxins absorbed systemically
Production of cell mediating shock and tissue injury & systemic
manifestations of TSS.

8. Causes and Risks
Havingrecentlydeliveredababy.
Recentlyhadsurgery
Leavingadiaphragmorcervicalcapin
for36hoursorlonger.
Wearingthesametamponforlongerthan
8hours.
Alsobeenreportedinthosefollowing
nasalsurgeryoruseofnasalpackingfora
nosebleed.

9. Symptoms of TSS
Identify other serious symptoms
Watch for a flu-like symptoms
WatchforvisiblesignsofTSSlike
rashesonthehands,feet.
Fever
Confusion
Diarrhea
Dizziness or fainting
Headaches
Pelvic Pain
Sore throat

10. More Signs and Symptoms
Sunburn like rash anywhere on the body, but
usually on the soles of the hands and feet.
Vomiting
Photophobia-discomfort looking @ light.
Myalgia-aching muscles
Low blood pressure

11. Confirming and treating TSS
special precaution
should be taken.
Seek immediate medical
help if you suspect TSS
Prepare for substantial but
usually successful treatment
regimen
Limiting risks for TSS
Using tampons cautiouslyFollow the recommendations for
using certain types of female
contraceptives
Watch for other potential
causes of TSS that can
affect anyone.

12. Treatment
Placed in ICU department.
Start IV for antibiotics and to raise blood
pressure.
Provide oxygen if needed.
Look for any other possible source of infection.
People with suspected toxic shock syndrome
should be immediately taken to the hospital’s
emergency department.

13. diagnosis
History and Physical exam
Blood (cultures)
CBC (complete blood count)
Kidney Function tests
Liver Function tests
Spinal Tap
Throat cultures
Urinalysis
Vaginal
No specific test can
diagnose toxic shock
syndrome

14. Prevention
Alternate tampons with pads every other
day during the heaviest flow.
Avoid or minimize use of super absorbent
tampons.
Change tampons every 6-8 hrs.
Use pads while sleeping.
Wash hands regularly
Change dressings to wounds at least every
day
Keep area clean and dry
Practice aseptic technique

15. Medications
Nafacillin
Oxacillin
Penicillin
Clindamycin
Medications to raise blood pressure if low
Dopamine
Epinephrine.