Toxic shock syndrome is caused by a toxin produced by some types of staphylococcus bacteria. A similar problem, called toxic shock-like syndrome (TSLS), can be caused by a toxin from streptococcal bacteria. Very few staph or strep infections cause toxic shock syndrome.
The earliest cases of toxic shock syndrome involved women who used tampons during their menstrual periods. However, today less than one half of cases are linked to tampon use. Toxic shock syndrome can also occur with skin infections, burns, and after surgery. The condition can also affect children, postmenopausal women, and men.
Risk factors include:
Recent childbirth
Infection with Staphylococcus aureus (S aureus), commonly called a staph infection
Foreign bodies or packings (such as those used to stop nosebleeds) inside the body
Recent surgery
Tampon use (with higher risk if you leave one in for a long time)
Widespread red rash that looks like a sunburn -- skin peeling occurs 1 or 2 weeks after the rash, particularly on the palms of the hand or bottom of the feet
Exams and Tests
No single test can diagnose toxic shock syndrome.
The health care provider will look for the following factors:
Fever
Low blood pressure
Rash that peels after 1 to 2 weeks
Problems with the function of at least 3 organs
In some cases, blood cultures may be positive for growth of S aureus or Streptococcus pyogenes.
Treatment
Treatment includes:
Removal of materials, such as tampons, vaginal sponges, or nasal packing
Drainage of infection sites (such as a surgical wound)
The goal of treatment is to maintain important body functions. This may include:
Antibiotics for any infection (may be given through an IV)
Dialysis (if severe kidney problems are present)
Fluids through a vein (IV)
Medicines to control blood pressure
Intravenous gamma globulin in severe cases
Staying in the hospital intensive care unit (ICU) for monitoring
Outlook (Prognosis)
Toxic shock syndrome may be deadly in up to 50% of cases. The condition may return in those who survive.
Possible Complications
Complications may include:
Organ damage including kidney, heart, and liver failure
Shock
Death
When to Contact a Medical Professional
Toxic shock syndrome is a medical emergency. Seek medical help right away if you develop a rash, fever, and feel ill, particularly during menstruation and tampon use or if you have had recent surgery.
Prevention
You can lower your risk for menstrual toxic shock syndrome by:
Avoiding highly absorbent tampons
Changing tampons frequently (at least every 8 hours)
Only using tampons once in awhile during menstruation
Kroshinsky D. Macular, papular, purpuric, vesiculobullous, and pustular diseases. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 406.
Que Y-A, Moreillon P. Staphylococcus aureus (including staphylococcal toxic shock syndrome). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 194.
Rapose A. Toxic shock syndrome. In: Kellerman RD, Rakel DP, Heidelbaugh JJ, Lee EM, eds. Conn's Current Therapy 2024. Philadelphia, PA: Elsevier 2024:718-719.
Review Date:
5/23/2024
Reviewed By:
Jatin M. Vyas, MD, PhD, Roy and Diana Vagelos Professor in Medicine, Columbia University Vagelos College of Physicians and Surgeons, Division of Infectious Diseases, Department of Medicine, New York, NY. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
