Toxic Shock Syndrome Health Article

Definition

Toxic shock syndrome (TSS) is an uncommon but potentially serious illness that occurs when poisonous substances (toxins) produced by certain bacteria enter the bloodstream. The toxins cause a type of blood poisoning caused by staphylococcal, or less commonly streptococcal, infections in the lungs, throat, skin or bone, or from injuries. Women using super-absorbent tampons during menstruation were found to be most likely to get toxic shock syndrome.

Description

TSS first came to the attention of the public in the 1970s. Shortly after the introduction of a super-absorbent tampon, young women across the United States experienced an epidemic of serious but unexplained symptoms. Thousands went to emergency rooms with high fever, vomiting, peeling skin, low blood pressure, diarrhea, and a rash resembling sunburn. The only thing they had in common was that they all were menstruating at the time they felt sick, and all were using tampons—especially super-absorbent products.

At its height, the epidemic affected 15,000 people in the United States each year between 1980 and 1984; 15% of the women died. Since the offending products were taken off the market, the numbers of TSS cases have declined sharply. As of 1998, only about 5,000 cases are diagnosed annually in the United States, 5% of which are fatal. The decline is most likely due to the tampon manufacturers' discontinuing the use of some synthetic materials, and the removal from the market of the brand of tampon associated with most cases of TSS. As of the early 2000s, most of these products are made with rayon and cotton.

In spite of TSS's association with menstruating women, the disease can affect anyone of either sex or any age or race. The infection may occur in children, men, and non-menstruating women who are weakened from surgery, injury, or disease, and who cannot fight off a staphylococcal infection. New mothers are also at higher risk for TSS, particularly if they had a caesarean section or if they are breastfeeding their infants.

Most cases reported in Western countries still involve menstruating women under age 30. TSS still occurs in about 17 out of every 100,000 menstruating girls and women each year; more than half of these cases are related to tampons. Between 5% and 10% of patients with TSS die.

In the developing countries, however, toxic shock syndrome often affects children. A recent report of staphylococcal TSS from Saudi Arabia concerned a four-month-old infant. Burns appear to increase the risk of TSS in children in all countries.

Streptococcal toxic shock syndrome (STSS)

A new type of toxic shock syndrome is caused by a different bacterium, called Group A streptococcus. This form of TSS is called streptococcal toxic shock syndrome, or STSS. Officially recognized in 1987, STSS is related to the strain of streptococcus called the flesh-eating bacterium. STSS affects only one or two out of every 100,000 Americans. It almost never follows a simple strep throat infection.

In Europe and the United Kingdom, however, the incidence of streptococcal toxic shock syndrome has continued to rise through the 1990s. In one district in the United Kingdom, the annual rate rose from 1.1 cases per million population in 1990 to 9.5 cases per million by 1999. The fatality rate is 64%, even in healthy young adults.

Transmission

STSS is caused by a strain of Streptococcus pyogenes found in the nose, mouth, and occasionally the vagina. The bacteria produce a characteristic toxin. In large enough quantities, the toxin can enter the bloodstream, causing a potentially fatal infection.

While experts know the name of the bacterium, more than 10 years after the 1980s epidemic scientists still do not fully understand the link between TSS and tampons. Most medical researchers today suspect that the absorbent tampons introduce oxygen into the vagina, which is normally an oxygen-free area of the body. Oxygen triggers bacterial growth, and the more absorbent the tampon, the more bacteria it can harbor. Some experts believe that the reason TSS is linked to tampons in particular is that bacteria can contaminate and multiply in a tampon. If left in place for a long time—as a woman could do with a super absorbent product—the bacteria have a better chance of multiplying and producing a large amount of toxin. It is also possible that the tampons or the chemicals they contain may irritate the vaginal lining, enabling the toxin to enter the bloodstream.

These type of bacteria are normally present either on hands or in the vagina, and it takes an amount of bacteria only the size of a grain of sand to start an infection. Of the 15% of women who carry Staphylococcus aureus, only about 5% have the strain that produces the TSS toxin.