Toxic Shock Syndrome: Symptoms & Causes

I’m sure most women have heard of toxic shock syndrome. But do you know what actually causes it? In this lesson we will explore the bacterial cause and common symptoms of this potentially serious illness.

Tampon Trouble

Today, we’re going to talk about toxic shock syndrome. To all the ladies in the audience: I’m sure you’re familiar with this illness, so you might be able to skip this introduction and get right to the meat of the lesson. To all the guys, sit tight and I’ll give you a brief history lesson before we get started.

In the mid-1970s, a new manufacturing company dove into the tampon production market. This company claimed that they had solutions for all the common complaints of tampon users. They produced a tampon with a new, more comfortable shape, made from superabsorbent, synthetic and natural materials and claimed that it would not leak even after an entire day of heavy menstrual bleeding.

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In the late ’70s, the company started a massive advertising campaign, mailing out over 16 million samples to households across the country. The new tampon was a smashing success. It delivered exactly what the company had promised, plus one little thing that no one could have foreseen – toxic shock syndrome, or TSS.

Women were being hospitalized at an alarming rate, all exhibiting the same symptoms and all recently using the newly-designed tampon. By 1980, news reports were full of stories detailing the horrors of TSS and warning women everywhere to use tampons carefully and sparingly, if at all. In reality, tampon use itself was not the problem.

The outbreak was a result of several compounding factors specific to the new tampon on the market, but we’ll get to those in a little bit. Today, TSS is relatively rare, impacting less than 0.003% of menstruating women. So, let’s dig a little deeper, discover the specifics of TSS, and learn why it’s not just women who can come down with this potentially deadly illness.

Toxic Shock Syndrome

Toxic shock syndrome is an acute, systemic shock resulting from the host immune response to an exotoxin produced by the bacteria Staphylococcus aureus. Staph aureus is a species of cocci-shaped bacteria normally found on the skin, in the nasal passages and in the vagina of healthy humans. Normally, Staph aureus populations are kept to a low level by your immune system and through competition with your other normal microbial species.

If conditions change, Staphylococcus can overgrow, leading to a potentially deadly staph infection. Changing conditions can include a reduction in your immune function, a change in the normal microbial populations as a result of antibiotic use or changes in the physical conditions of the body, like an abrasion, a pH change or the introduction of a new food source.

As Staph aureus grows, it releases a very potent exotoxin. An exotoxin is a toxic compound produced by bacteria and released into the environment. Toxic shock syndrome toxin (TSST) is an exotoxin produced by Staphylococcus aureus that causes a massive immune response in a host.

Any compound that causes an immune response is called an antigen. The immune response to TSST is so great, it is classified as a superantigen! When TSST gets absorbed and enters the bloodstream of a host, it spreads throughout the body, causing an abnormally large activation of immune cells. The immune cells, in turn, cause body-wide inflammation. This inflammation leads to the symptoms of TSS.

If you decided to listen through the introduction, you might be wondering why those new tampons caused so much trouble. It turns out the new tampons were changing several normal vaginal conditions from unfavorable for Staphylococcus aureus growth to perfect. First, the larger tampons were causing abrasions to the vaginal wall, opening pathways for the exotoxin to enter the bloodstream more rapidly. Second, the longer use led to large pools of blood, and blood-soaked tampons, which raised the vaginal pH from a normal acidic 4 to a more neutral 7.4. Staph aureus can only begin producing toxic shock syndrome toxin when the pH reaches 7.

Thirdly, the new, natural absorbent materials provided a great food source for the bacteria, increasing its growth rate. This perfect storm led to the widespread outbreak, but it also dramatically increased awareness and led to newer tampon safety guidelines, likely sparing many women from developing toxic shock syndrome.

Symptoms

Initially, victims of toxic shock syndrome will very suddenly develop a high fever, up to 105 degrees Fahrenheit, accompanied by diarrhea, vomiting, and low blood pressure. Within the next few hours to days, the patient develops a full-body rash, resembling a sunburn, a sore throat, and muscle pain. Three to fourteen days later, the patient’s skin begins peeling off, starting with the palms and bottoms of the feet. Without treatment, the inflammatory response continues, blood pressure falls even further and organs begin to fail. Eventually, the patient will suffer seizures before dying from the illness.

Diagnosis and Treatment

Fortunately, treatment is usually effective at eliminating the infection. The combination of the high fever, low blood pressure, and rash are all the evidence a doctor needs to start treatment. The first line of defense is to start a course of any one of the more common antibiotics, like penicillin. Next, patients usually require intravenous fluids to raise blood pressure. Finally, the source of the bacteria needs to be removed. In the case of the menstruating women, this means avoiding tampon usage until the infection is eliminated.

Toxic shock syndrome doesn’t only affect women, though. Education and improved tampon technology has reduced the number of cases linked to tampon usage. Today, just as many cases are a result of Staphylococcus-contaminated surgical sites, tattoos and skin abscesses as tampons. These sources impact men and women of any age equally.

Lesson Summary

Toxic shock syndrome is an acute, systemic shock resulting from the host immune response to an exotoxin produced by the bacteria Staphylococcus aureus. Staph aureus is a common inhabitant of the human body, but can overgrow and cause disease if normal body conditions are disrupted. Actively growing Staph aureus releases an exotoxin. An exotoxin is a toxic compound produced by bacteria and released into the environment.

Toxic shock syndrome toxin (TSST) is the exotoxin produced by Staphylococcus aureus that causes a massive immune response in a host. Once absorbed into the bloodstream, TSST causes the body’s immune system to spring into action, resulting in body-wide inflammation. Symptoms of this inflammation include high fever, vomiting, diarrhea, full-body rash, muscle aches, peeling skin, sore throat and low blood pressure. Low blood pressure will eventually lead to organ failure, seizures and death. Based on this combination of symptoms, doctors will prescribe antibiotics to eliminate the infection. Intravenous fluids are often required to raise blood pressure.

Initially, it was predominantly menstruating women who used tampons that developed toxic shock syndrome. Today, thanks to better education and tampon technology, only about half of TSS cases are linked to tampon usage. Today, just as many cases are a result of Staphylococcus-contaminated surgeries, tattoos and skin abscesses. These causes can impact men and women alike.

Learning Outcomes

After watching this lesson, you should be able to:

  • Define toxic shock syndrome (TSS)
  • Identify the causes and symptoms of TSS
  • Report on treatment methods, and recognize the reason that women are not the only ones at rick of getting it
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