Toxic shock syndrome

 

toxic shock syndrome

 

In this article, we will talk about one of the critical and dangerous clinical conditions called "toxic shock syndrome" which is a set of signs and symptoms that suddenly occur following a special kind of bacterial infection. Those bacteria that produce and release toxins (produced by a microorganism and released into our body) are responsible for causing this problem. For example, Staphylococcus aureus toxin (Staph. A) and the toxin of some streptococci can cause toxic shock syndrome. The toxin released by these bacteria causes the human immune system to have a series of reactions that can be fatal if left untreated. In other words, the patient will die due to the intensity of his/her own immune system's reactions. In the following you will read more on the following topics:

 

which bacteria can cause toxic shock syndrome?

What are the symptoms of septic shock syndrome?

Who is at risk for toxic shock?

Diagnosis of Toxic Shock Syndrome

Prevalence of Toxic Shock Syndrome

Will toxic shock syndrome return?

Main treatments for toxic shock syndrome

Are there any ways to prevent Toxic Shock Syndrome?

 

 

Which bacteria can cause toxic shock syndrome?

  • Staphylococcus aureus ( Commonly called Staph.A among physicians)

Staphylococcus aureus may be present naturally in the body especially on skin without causing infection. Most people make antibodies against this bacterium that normally prevents inflammation and infection from this bacteria. This is why it doesn't cause infections in healthy person. People with toxic shock syndrome usually do not make and do not have antibodies against Staphylococcus aureus and this is why they get infected. Staphylococcus aureus infections can also occur in organs beside the blood but the infectious toxin can still be released into the bloodstream. 

  • Bacteria that cause pneumonia 

  • Staphylococcus sinusitis 

  • Bacteria that cause osteomyelitis

  • Bacteria that cause skin infections following surgery

  • Bacteria that cause skin infections following burns

  • Streptococcus pyogenes

  • Strep pyogenes infections

it often occur as a secondary infection following another infection. For example,

  • someone who have recently had chickenpox
  • someone who had bacterial cellulitis (infection of skin and structures beneath it like muscles and fatty tissues called cellulitis)

Strep pyogenes infections can also occur in people with weakened immune systems.

  •  Clostridium sordellii infections:

This bacterium is naturally present in the vagina without being infectious. However, this bacterium can enter the urethra during normal childbirth, menstruation and surgeries such as abortion.Patients receiving intravenous drugs are also more likely to spread this bacteria in their bloodstream.

 

What are the symptoms of septic shock syndrome?

The following symptoms are more common in toxic shock with Staphylococcus aureus:

Fever

  • People with "toxic shock syndrome" have high fevers.
  • The fever is above 102 degrees Fahrenheit (above 38/9 degrees Celsius)

Trembling

  • High fever is usually accompanied by trembling.

Headache

Feeling sick and tired

Myalgia

  • In the first few days, patients experience a series of flu-like symptoms.

Skin rashes

  • The rash related to TSS (Toxic Shock Syndrom) is smooth and flat and covers most of the surface of the patient's skin.

Vascular problems

  • Patients develop vasodilation and hypotension.

Diarrhea or vomiting

Redness of the mucosa

  • Blood flow to the mucous membranes of the mouth, eyes, and vagina increases.

Liver dysfunction

Kidney dysfunction

Decreased urinary concentration

Decreased urine volume (urinary output)

Extensive bleeding

Peeling skin

  • Usually one to two weeks after the onset of the disease, large pieces of skin are peeled spontaneously, especially from the skin of palms and soles of the feet.

Consciousness disorders

 

The following symptoms are more common in toxic shock caused by strep pyogenes:

  • Dangerous blood pressure drop
  • Diffuse bleeding
  • Disseminated coagulation disorders
  • Kidney dysfunction
  • Red and flat rashes all over the skin
  • Difficulty in breathing
  • Peeling skin

 

Common symptoms of toxic shock caused by Clostridium sordellii:

  • Symptoms similar to the flu
  • Diarrhea and vomiting
  • Very rapid heart rate
  • Lower blood pressure
  • Total edema
  • having fever is rare
  • Stomachache

Changes in the number of blood cells seen in all types of TSS:

  • Increase in the number of White Blood Cells (WBCs)
  • Increase in the number of Red Blood Cells (RBCs)

 

Who is at risk for toxic shock?

  • Women who use vaginal tampons during menstruation (especially high-absorption vaginal tampons)
  • People who use of vaginal diaphragms (contraceptives)
  • Women using any type of tampon
  • People who have skin infections (cellulite, wounds, etc.)
  • Patients with surgical wounds
  • Women who have recently had a normal delivery
  • Women who have recently had an abortion

 

Diagnosis of toxic shock syndrome

In the medical center, the following tests are taken by the medical team to diagnose the toxic shock syndrome:

Blood tests:

  • Blood cell count test
  • Coagulation tests
  • Measurement of blood electrolytes (lab tests to measure substances like Na or K)
  • Blood culture (a test that determines the type of bacteria in the blood)

Urine tests:

  • urine culture
  • Urine analysis

Lumbar puncture:

  • Occasionally, cerebrospinal fluid (CSF) extraction will be necessary for culture and analysis.

Use of sponges, cervical caps, and diaphragms in women:

In general, anything left in the vagina for more than thirty hours, even the remaining of pieces of sponge, etc., are factors that may lead in toxic shock syndrome.

As mentioned above, Staphylococcus aureus is a bacterium that lives naturally and normally in the vagina and will not cause infection and TSS by itself. To cause toxic shock syndrome, the following must happen:

  • Production of bacterial toxin (Staph bacterium toxin) in large quantities and
  • Entrance of this toxin into the bloodstream

In fact, when the toxin enters the bloodstream and spreads throughout the body, this is when it will start disrupting the normal functioning of the body's immune systems.

 

Prevalence of toxic shock syndrome?

One-third of cases of toxic shock syndrome are in women under the age of nineteen.

 

Will we get toxic syndrome again?

It is interesting to know that about thirty percent of women, who have been diagnosed with this syndrome, will experience toxic shock syndrome again during their lifetime. Therefore, if you are one of those people who have been diagnosed with TSS once, you better to be careful. Be aware of your clinical symptoms and in case of observing alarming symptoms, go to an equipped medical center ASAP.

Differential Diagnosis:

One of the most important diagnoses that must be rejected in patients suspected of toxic shock syndrome is Rocky Mountain Spotted Fever (RMSF). The cause of this disease is rickettsia, which is transmitted to the body by ticks, begins with fever and headache, and can be fatal if left untreated.

 

What affects the toxic shock syndrome treatment?

The following factors determine the type of treatments that will be adopted to each patient in medical centers:

  • Patient age
  • Patient general health
  • Patient underlying diseases
  • How long it has been since the onset of the disease
  • Previous history of TSS

If you are one of the women who uses tampons, cervical-vaginal diaphragmatic caps or sponges during menstruation and suffer from fever and severe vomiting, you should go to a medical center.

 

What are the main treatments for toxic shock syndrome?

Treatment measures:

  • First, a safe vascular pathway is implanted for the patient.
  • Intravascular volume compensation is necessary to treat shock phase and prevent any possible damage to the organs of the body due to hypotension.
  • Medications may be used to raise blood pressure.
  • Injection of blood products if needed.
  • Start dialysis in case of kidney failure.
  • Start non-invasive oxygenation and, if necessary, intubation (tube placement for better breathing).
  • Removing the source of infection by surgery or cleaning the infected wound.

Attention:

Toxic shock syndrome can lead to death if left untreated. Amputation or amputation of the fingers can be the result of late treatment. Toxic shock syndrome develops very rapidly, meaning there is a short time between a typical infectious disease and a life-threatening crisis, so act immediately if you experience any of the above symptoms.

 

Are there any ways to prevent TSS?

If you have a surgical wound or skin infection, make sure it is treated completely and correctly. As mentioned, 30% of women who develop TSS after using a cap and diaphragm, tampon or vaginal sponge, experience a recurrence of this syndrome. So it is recommended that if there is fever, vomiting and fatigue during menstruation, be sure to go to an equipped medical center. Today, caps, sponges, and diaphragms are made smaller in size, so using them inside the vagina is less risky.

The final word

Remember that the early symptoms of this deadly syndrome are similar to other infections, so having the knowledge and understanding of TSS is essential to prevent this life-threatening disease.

 

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