It is SO important to know that Toxic Shock Syndrome (TSS), while most known for its association with tampons and menstruating women, can happen to ANYONE. In fact, TSS occurs equally between men and women!
Toxic Shock Syndrome is a rare but life-threatening condition where the body starts to shut down after an infection with the bacteria Staph or Strep.
It starts out as a seemingly small infection like a cold, skin abrasion, recent surgery, or with internal packing such as tampons or nasal packing. The difference is that it quickly progresses to bigger and more worrisome symptoms like high fevers, low blood pressure, abdominal pain, high heart rate and delirium.
Why Does This Happen?
In TSS the bacteria, Staph or Strep, produce something called a Super Antigen (exotoxin) that causes havoc on the immune system. Usually the immune system is activated by a lock and key type of method where the antigen (part of the bacteria) fits into the T-cell (policemen of immune system). This causes the T-cells to activate a release of a little bit chemicals (cytokines) to combat this bacteria. This reaction is supposed to only activate 0.01-0.1% of the T-cells.
In TSS, the Super Antigen bypasses this lock and key method of activation and acts like a masterkey and activates 2500X the normal response (25% of T-cells). This causes a MASSIVE release of cytokines which makes the response destructive to the body.
That would be the equivalent of calling in the national guard, all police forces, the Air Force, Army and Navy because someone stole a pack a gum, rather than just a policeman or 2.
What Are The Symptoms?
- High Fever
- Sunburn Rash INVOLVING Palms of hands and Soles of Feet
- Cramping, Vomiting, Diarrhea
- Low Blood Pressure (blue fingers or toes)
- High Heart Rate
- Often No Purulence
- Confusion, Delirium, Seizures
- Organ Failure
With this giant release of cytokines, the body starts to become very inflamed. A very high fever ensues to try to kill the bacteria. A rash that stings like a sunburn also develops. Whats notable is that this rash can also be on the palms of the hands and soles of the feet. The blood vessels become dilated and leaky causing the blood pressure to drop. The heart rate becomes very fast for both those reasons. The intestines start to cramp from the reaction causing cramping, vomiting and diarrhea. Lastly, the organs begin to shut down as a way to try to preserve other parts of the body. The person may also start to become delirious, confused, have seizures or even become unconscious.
What Is The Treatment?
It is very important that those with this type of symptom go the ER right away as time is of the essence. Many times upon arrival to the ER, it will not be know exactly what is causing the person to present with these symptoms of shock or sepsis (shock/sepsis = body shutting down).
Because these symptoms are very worrisome, the person will be assessed on how to stabilize the situation so that it does not progress. This may involve intubation, sedation, medications to help increase the blood pressure and battle the fever. At the same time the ER and ICU team will investigate what is going on with several blood tests, cultures, and a good physical exam and history from the family.
Broad spectrum antibiotics are also started. This means that antibiotics are chosen to cover a variety of classes of bacteria.
(🤓 Nerd Note: Once TSS is confirmed, an antibiotic called clindamycin is added to the mix (but does not replace the others) because they are known to stop the replication of the bacteria (bacteriostatic) but not kill it. Linezolid is another great option for this.)
Who Does This Happen To?
Fortunately this is rare as most adults develop immunity to the Stap and Strep super antigen. Young children and the immunocompromised are the most at risk.
What Can Be Done To Prevent This?
- Hand washing, although often over looked in importance, is very important to help stop the spread of diseases.
- If using tampons, it is preferred to have less absorbent tampons and more frequent changes. Super absorbency tampons are associated with a higher risk of TSS.
- Nasal packing done for either nose bleeds or septo-rhinoplasty requires antibiotics that cover Staph/Strep.
- Prompt visit to your doctor if not feeling well
- ER visit asap if any of the above mentioned symptoms arise
