Toxic Shock Syndrome (TSS)
- Is a rare, potentially life threatening condition caused by a bacterial toxin secreted by Staphylococcus aureus in the blood stream.
- The cause is uncertain, but 70% of cases are associated with menstruation and tampon use.
- Research suggests that magnesium-absorbing fibers in tampons may lower magnesium levels in the body, thereby providing ideal conditions for toxic formations.
- It also occurred in non-menstruating people with conditions such as cellulitis, surgical wound infection, vaginal infections, and subcutaneous abscesses, and with the use of contraceptive sponges, diaphragms, and tubal ligation.
- Death may result from cardiovascular collapse and renal failure caused by shock.
- Sudden onset of high fever greater than 102°F (39°C).
- Vomiting and profuse, watery diarrhea.
- Rapid progression to hypotension and shock within 72 hours of onset.
- Mucous membrane hyperemia.
- Sometimes, sore throat, headache, and myalgia.
- Rash (similar to sunburn) that develops 1 to 2 weeks after onset of illness as followed by desquamation particularly of the palms and soles.
- Blood urine, throat, and vaginal or cervical cultures, and possibly cerebrospinal fluid culture, detect or rule out infectious organism.
- Additional tests may be required to rule out other febrile illnesses: Rocky Mountain spotted fever, Lyme disease, meningitis, Epstein-Barr, or Coxsackie viruses.
- Complete blood count, electrolytes, and renal function tests monitor condition.
- Fluid and electrolyte replacement to increase blood pressure and prevent renal failure.
- Supportive care to maintain cardio-respiratory functions.
- Vasopressors, such as dopamine, to treat shock.
- Antibiotics, such as penicillin-resistant penicillin, or cephalosporins to decrease the rate of relapse.
- Antipyretics to treat fever.
- Use of corticosteroids and immunoglobulins is controversial.
- Monitor core body temperature.
- Perform hemodynamic monitoring as indicated (ie, arterial line, central venous pressure, or pulmonary artery pressure).
- Maintain strict intake and output measurement.
- Insert indwelling catheter to monitor hourly urine output.
- Monitor respiratory status for pulmonary edema and respiratory distress syndrome caused by fluid overload from increased fluid replacement, diuretics may be necessary.
- Use cooling measures, such as sponge baths and hypothermia blanket, if indicated.
- Tell patient to expect desquamation of skin, as in peeling sunburn.
- Protect skin and avoid using harsh soaps and alcohol which cause drying.
- Tell patient to apply mild moisturizer and avoid direct sunlight until healed.
- Advise patient that reversible hair loss may occur 1 or 2 months after TSS.
- Tell patient to expect fatigue for several weeks to months after TSS.
- Tell patient to avoid using tampons to reduce risk of recurrence.
- Encourage follow-up visits for examination and cultures.
- Alternate use of pads with tampons; avoid super-absorbent tampons.
- Change pads or tampons frequently and do not wear one longer than 4 hours.
- Recognize and report symptoms of TSS.