Toxic shock syndrome (TSS) is also known as tampon disease. It is a dangerous infection that causes massive symptoms and can lead to organ failure and death. Fortunately, this disease is no longer common in Germany.
What is toxic shock syndrome?
Toxic shock syndrome is caused by the metabolic products of dangerous strains of bacteria, Streptococcus and Staphylococcus aureus, which find their way into the human body in most cases through the prolonged wearing of a tampon, but also through festering wounds, insect bites or the like. The infection leads to a series of highly unpleasant symptoms. High fever between 38.9 and 40 degrees occurs, often accompanied by severe muscle pain, low blood pressure (often associated with fainting or weakness), palpitations, hematomas, irritation of mucous membranes (redness), and disorientation or confusion. In the gastrointestinal tract, the infection often manifests as nausea and/or vomiting, liver and kidney dysfunction is present, and there is extensive skin rash (the skin typically peels on the palms of the hands and soles of the feet). If the infection is caused by streptococcus, respiratory problems, necrosis, and bleeding disorders are sometimes also present.
Causes
In roughly fifty percent of cases, the trigger is actually a (highly absorbent) tampon that has remained in the vagina too long, providing an optimal breeding ground for the pathogens. However, purulent wounds, wearing a diaphragm for contraception, and burn and surgical wounds can also be entry points for the pathogens Staphylococcus aureus and Streptococcus. The metabolic processes of these two types of bacteria, which target humans, produce toxins that cause the disease (hence “toxic,” which means poisonous in German). Streptococcal infection is slightly more dangerous, but it is also less common than toxic shock syndrome caused by Staphylococcus aureus.
Symptoms, complaints, and signs
Toxic shock syndrome is characterized by a sudden onset of severe illness. Without treatment, the condition can quickly lead to death. It is notable that this syndrome occurs mainly in young and previously healthy individuals whose immune systems are intact. However, since this is the first time that affected individuals come into contact with the bacterial toxin at the onset of the disease, the body’s violent reactions can be explained. Toxic shock syndrome is characterized by severe general symptoms, skin symptoms and, in women, often gynecological symptoms. General symptoms include chills, fever, nausea, vomiting, diarrhea, dizziness, muscle pain, and even circulatory collapse. Blood pressure is very low and body temperature usually exceeds 38.9 degrees Celsius. Skin symptoms typically include extensive skin rashes and, after about one to two weeks, skin peeling on the soles of the feet and palms of the hands. Since the infections are very often triggered by tampons in the genital area, there is often inflammation of the mucous membranes in the vagina and purulent vaginal discharge. In addition to the gastrointestinal tract, skin and vaginal mucosa, the liver, kidneys, blood or even the central nervous system can also be damaged. Therefore, the development of liver or kidney failure is also possible in the course of the disease. Furthermore, states of confusion may occur. In particularly severe cases, life-threatening shock symptoms develop with cold sweat, cyanosis, greatly increased respiratory rate due to the lack of oxygen, an insatiable feeling of thirst, and acute kidney failure.
Diagnosis and course
Many of the symptoms are similar to other infections and may initially lead medical professionals down the wrong path. If sufferers are experiencing the symptoms described above and are aware that they have been wearing a tampon for an extended period of time or have allowed the bacteria a similar entry point, they should report this to the doctor immediately. The symptoms themselves are severe and similar to those of blood poisoning. Clinical evidence of toxic shock syndrome is provided by a blood smear in which antibodies to the bacterial toxin TSST-1 can be detected during illness.If toxic shock syndrome is detected and treated in time, there is a very good chance of complete recovery. However, if left untreated, it can also lead to organ failure or even death.
When should you see a doctor?
The affected person is dependent on medical treatment and examination for this disease, as only this can lead to a cure. If the disease is treated late or not at all, serious complications and, in most cases, death of the affected person due to organ failure will occur. Therefore, a doctor must be contacted at the first symptoms and signs of this disease. The doctor should be consulted if the affected person suffers from sudden nausea or vomiting. There is also fever and, in most cases, very severe pain in the muscles. Most sufferers also experience dizziness and quite often loss of consciousness. Confusion or a blue coloration of the skin and lips can also indicate this syndrome and should be examined by a physician. If these symptoms occur, an emergency physician should be called directly or a hospital should be visited. Further treatment is then usually carried out as an inpatient. The further course depends very much on the exact symptoms and on the cause of the syndrome.
Treatment and therapy
Rapid treatment of toxic shock syndrome is urgently recommended, because those affected are extremely unwell with the symptoms. If not treated promptly, (multiple) organ failure and even death may result. Affected individuals must be hospitalized immediately and given a relevant antibiotic intravenously to fight the infection and kill the bacteria. Supportive measures are often taken to stabilize the patient as best as possible. These include providing sufficient fluids (also intravenously) to keep body functions constant and counteract shock. In some cases, oxygen is also given or, if the kidneys are damaged, dialysis is performed.
Prevention
In Europe, after the disease wave of the 1970s, the production and storage of tampons improved significantly from a hygienic point of view, and tampons were (for the most part) made less absorbent, necessitating more frequent changes, which in turn reduced the risk for toxic shock syndrome. Tampons sold in Germany must provide information about toxic shock syndrome on the packaging or in the package insert. The best prevention is indeed to change tampons frequently (always with thoroughly washed fingers, of course!) and to use pads instead sometimes, for example at night. Contraceptive diaphragms should not remain in the vagina longer than necessary. The fact that good education about toxic shock syndrome is already paying off can also be seen in the very moderate annual infection rate – compared to the U.S. – which is about 1 per 200,000 people.
Follow-up
Toxic shock syndrome is a rare condition that requires consistent follow-up care. Contacts are the gynecologist or specialists in affected parts of the body, such as the nephrologist or internist for kidney problems or the dermatologist with regard to frequent skin involvement. The psychologist can provide follow-up support to help those affected cope well psychologically with the often severe clinical picture after therapy. The change to a monthly hygiene other than tampons is very important in the context of aftercare, since tampons are a frequent trigger of TSS, which is often also referred to as tampon disease in the vernacular. In addition to pads, menstrual cups, which are also used by sustainably oriented consumers to avoid mountains of waste around menstruation, also come into question. Often, Toxic Shock Syndrome is a burden on the whole organism. Therefore, the body should be spared and at the same time strengthened in the aftercare. Sufficient sleep and a healthy diet are important factors in this context. In addition, sufficient drinking helps to flush toxins out of the body and stabilize the circulation in the long term. Exercise serves to regenerate the body, but should be done with particular care at first. Walks are often sufficient. The areas of skin that may be affected should initially be consistently protected from UV light, even during aftercare.
You can do it yourself
Toxic shock syndrome is a serious condition that requires medical treatment. Depending on the course, various self-help measures can be taken. Affected individuals must take it easy and follow an appropriate diet. During the first days and weeks after hospitalization, a sparing diet is recommended. If fever has occurred in the course of toxic shock syndrome, the body temperature must be checked regularly. In case of doubt, the attending physician must be contacted. This is particularly recommended in the case of recurrent symptoms that do not subside despite rest and bed rest. If treated early without serious complications, bed rest is sufficient to overcome toxic shock syndrome. If serious complications occur, such as organ failure or high fever, a long recovery period is required following treatment to allow the body to regenerate sufficiently. After or during recovery, the causes of toxic shock syndrome must be identified and eliminated. Physical hygiene must be improved to prevent the recurrence of the disease. Women must take into account the instructions regarding the use of tampons. In general, risk factors should be minimized.
