Signs and symptoms of toxic shock syndrome

What happens to the body?

Once the toxins released by bacteria begin circulating in the bloodstream, T cells of the immune system are activated. These cells then produce cytokines, chemicals which cause the system to ‘go into shock’, resulting in tissue damage. The TSST-1 toxin is the one seen most often with toxic shock syndrome infections (80%), but others such as those produced by enterococci A, C, D, E and H or GAS bacteria result in the remainder of infection cases.

GAS or group A streptococcus bacteria which contains a filamentous protein, known as M protein makes a bacterial strain more potent, which results in an infection (causing cell damage and inflammation). A strain that lacks this protein is usually less severe (lethal).

The bacteria essentially need an environment conducive to bacterial growth (i.e. where growth happens quickly) and where toxins can be easily released into the bloodstream. This is why menstruating women, in particular, are vulnerable when using tampons. If a tampon which is inserted makes microscopic tears (via fibres which can scratch) in the wall lining of the vagina (especially if used with a light menstrual flow which can cause dryness), tiny blood vessels can be ruptured, allowing bacteria into the bloodstream. Menstrual sponges, cervical caps, diaphragms and tampons should not be left in a woman’s vagina for long periods of time as a result.

Alternate means for infection include bacteria entering the body through a wound (opening in the skin) or a burn either through injury, childbirth or surgery.

Signs and symptoms of TSS

It’s important to spot the signs of TSS quickly as prompt medical treatment will be required. As a condition, it is classified as rare, but any recognisable signs can quickly lead to a life-threatening condition. Once toxins are released into the bloodstream, an infection can affect multiple areas of the body all at once. An infection typically shows signs within 2 days.

The most common signs and symptoms to look out for include:

• A sudden high fever (38.9 degrees Celsius or 102 degrees Fahrenheit)
• Vomiting and nausea
• Diarrhoea
• Fatigue
• Headache
• Muscle aches
• Confusion
• General malaise
• Acute respiratory distress (or failure)
• Low blood pressure (hypotension) and feeling faint
• A red rash (resembling sunburn) that is flat (not raised) and turns white when pressed lightly
• Redness or swelling around the eyes, mouth and / or throat
• Shedding of the skin, particularly the palms of the hands or soles of the feet
• Seizures

Other signs may be noted in the following:

• A decrease in kidney function (or failure)
• Blood clotting problems (platelets)
• Abnormal liver enzyme measurements
• Necrotising fasciitis, gangrene or myositis (damaged or dead soft tissues)

Some common sign groupings may be recognisable according to the type of bacteria causing an infection. These can include:

• Symptoms caused by the staph bacteria: A sudden high fever, headache, fatigue, vomiting, diarrhoea, red rash (flat), redness around the eyes, mouth, throat or vagina, low urine output, skin shedding (usually within 1 to 2 weeks of an infection entering the bloodstream) and bruising.
• Symptoms caused by streptococcus pyogenes: Considerably low blood pressure, a state of shock (lack of blood flow in the body), pain that is sudden and severe, bruising, bleeding, red rash, shedding skin or difficulties with breathing. This can occur as a complication following a bout of chickenpox (varicella) or a skin infection.
• Symptoms caused by Clostridium sordellii (C. sordellii): Symptoms occur as a result of an infection in the uterus and include nausea and vomiting, abdominal pain, swelling, lack of energy and body weakness, a rapid heart rate, a high red and white blood cell count and general flu-like symptoms. A high fever is not a common symptom with this TSS causing bacterial infection.

When to call the doctor

Any and all signs of toxic shock syndrome must be attended to by a medical professional as soon as possible. If any symptoms are noted shortly after an injury, skin infection, surgery, or use of tampons, diaphragms and sponges, immediate medical assistance is necessary.