Toxic shock syndrome TSS © 2025

Toxic shock syndrome TSS

Toxic shock syndrome (TSS) is a condition caused by bacterial toxins. Symptoms may include fever, rash, skin peeling, and low blood pressure. There may also be symptoms related to the specific underlying infection such as mastitis, osteomyelitis, necrotising fasciitis, or pneumonia. A few possible causes of toxic shock syndrome are: Cuts or open wounds on the skin, Surgical wounds, Viral infections (e.g. chickenpox), Contraceptive sponges, History of a recent birth, miscarriage, or abortion, Using super-absorbent tampons, Previously having TSS

Toxic shock syndrome

Toxic shock syndrome is a rare, life-threatening complication of certain types of bacterial infections. Often toxic shock syndrome results from toxins produced by Staphylococcus aureus (staph) bacteria, but the condition may also be caused by toxins produced by group A streptococcus (strep) bacteria. Toxic shock syndrome can affect anyone, including men, children and postmenopausal women. Risk factors for toxic shock syndrome include skin wounds, surgery, and the use of tampons and other devices, such as menstrual cups, contraceptive sponges or diaphragms.It is a cluster of symptoms that involves many systems of the body. Certain bacterial infections release toxins into the bloodstream, which then spreads the toxins to body organs. This can cause severe damage and illness. Toxic shock syndrome (TSS) is a rare but life-threatening condition caused by an infection. It can happen when using a tampon or menstrual cup, or from an infected wound. Symptoms develop quickly and you need urgent treatment.

The following bacteria commonly cause TSS:

TSS from Staphylococcus infections was identified in the late 1970s and early 1980s, when highly absorbent tampons were widely used by menstruating women. Due to changes in how tampons are made, the incidence of tampon-induced TSS has declined.

TSS from streptococcus infections is most commonly seen in children and the elderly. Other people at risk include those with diabetes, weak immune system, chronic lung disease, or heart disease.

Staphylococcus infections:

Staphylococcus aureus (or S. aureus) may normally exist on a person’s body and does not cause infection. Because it’s part of the body’s normal bacteria, most people develop antibodies to prevent infection. S. aureus can be spread by direct contact with infected persons. People who develop TSS usually have not developed antibodies against S. aureus. Therefore, it’s not usually considered a contagious infection. S. aureus infections may also develop from another infection, such as pneumonia, sinusitis, osteomyelitis (infection in the bone), or skin wounds, such as a burn or surgical site. If any of these areas are infected, the bacteria can penetrate into the bloodstream.

Streptococcus infections:

Streptococcus pyogenes (or S. pyogenes) TSS may occur as a secondary infection. Most commonly, this is seen in people who have recently had chickenpox, bacterial cellulitis (infection of the skin and underlying tissue), or who have weak immune systems.

Clostridium sordellii infections:

Clostridium sordellii (or C. sordellii) normally exists in the vagina and does not cause infection. The bacteria may enter the uterus during normal menstruation, childbirth, or gynecological procedures such as abortion. Intravenous drug use can also cause C. sordellii infections.

From using tampons or menstrual cups
From a contraceptive diaphragm or cap
After a vaginal birth or caesarean section
From a cut, wound, boil or burn that has become infected

Symptoms of TSS

Symptoms of TSS involve many systems and may look like other infections. While each person may experience symptoms differently.

The following are the most common symptoms of staphylococcal TSS include:

- Fever higher than 102°F (38.9°C)
- Chills
- Feeling unwell
- Headache
- Fatigue
- Rash that is red and flat and that covers most of the areas of the body
- Shedding of the skin in large sheets, especially over the palms and soles, seen one to two weeks after the onset of symptoms.
- Low blood pressure
- Vomiting
- Diarrhea
- Muscle pain
- Increased blood flow to the mouth, eyes, and vagina, making them appear red
- Decreased urine output and sediment in urine
- Decreased liver function
- Bruising due to low blood platelet count
- Disorientation and confusion

The following are the most common symptoms of streptococcal TSS:
- Dangerously low blood pressure
- Shock
- Decreased kidney function
- Bleeding problems
- Bruising due to low blood platelet count
- Rash that is red and flat and that covers most of the areas of the body
- Liver impairment
- Shedding of the skin in large sheets, especially over the palms and soles (this does not always occur)
- Difficulty breathing
The following are the most common symptoms of C. sordellii TSS:
- Nausea and/or vomiting
- Lethargy
- Flu-like symptoms
- Abdominal tenderness
- Generalized swelling from fluid buildup
- High white blood cell and red blood cell count
- No fever
- Low blood pressure
- Very fast heart rate