Toxic Shock Syndrome


by Lacey Shaver



Etiologic Agent:


The main causative agent of Toxic Shock Syndrome is Staphylococcus aureus.1 Another bacterium that can cause this disease is Streptococcus pyogenes but it is more uncommon.2




Toxic Shock Syndrome can not be transmitted from an infected person to an uninfected person. However, Staphylococcus aureus (the microbe that causes TSS) lives on the skin and in mucosal sites on the human body and can be transmitted by direct contact between people.2




Humans are the largest natural reservoir for Staphylococcus aureus but some animals, like cows, can also be reservoirs.2


General Characteristics of MO:


Staphylococcus aureus is a bacterium that makes up a large part of the normal human flora, this microbe is found on the skin and in mucosal sites. When Staphylococcus aureus is grown on agar this microbe is very distinct because it forms golden colonies and when viewed under a microscope (after using a Gram Stain) the microbe is Gram positive, staining a dark purple color, and is arranged in grape-like clusters.  Staphylococcus aureus is also non-motile and is a facultative anaerobe allowing this microbe to survive in almost any environment.3


Key tests for identification:


The key tests for identifying Staphylococcus aureus are the Coagulase Test and Catalase Test; in each the bacterium is positive. There are no specific tests for Toxic Shock Syndrome; however, the patient may give blood or urine samples to test for the bacterium Staphylococcus or Streptococcus to see if that is the cause of the infection.3


Signs and symptoms of Toxic Shock Syndrome:

 The signs and symptoms of TSS are:

û       High fever (greater than 102° F)

û        Quick drop in blood pressure

û       Widespread rash that looks like a sun burn

û       Vomiting and diarrhea

û       Muscle aches and  weakness

û       Bright red coloring of the eyes, throat, and vagina

û       Headache, confusion, disorientation

û        Seizures

û       Kidney and other organ failure can occur

These signs and symptoms develop quickly and are very severe because Staphylococcus aureus is a Gram positive microorganism that produces exotoxins, as the bacteria grows the toxins produced are released  into the blood causing toxemia and disrupting the homeostatic balance of the body.4

Historical information:


Initially, Toxic Shock Syndrome was first seen in children when this disease was discovered in 1978 but researchers began to see that this disease was more prominent in women that used super absorbent tampons than in children.  As researchers began to learn more about this disease they discovered that super absorbent tampons trapped bacteria in the vagina, this allowed the bacteria to grow and produce their toxins in a warm and moist environment. Toxins produced by the bacteria, Staphylococcus aureus, are released into the blood stream and enter through small cuts that tampons make in the vagina.  Over half of the Toxic Shock Syndrome cases were caused by these super absorbent tampons that are no longer manufactured.5


Virulence factors:


These are the virulence factors of Staphylococcus aureus:


1)      Surface proteins that encourage colonization of the host’s tissues.


2)      Invasins help the bacteria spread in the host’s tissues (leukocidins and kinases).


3)      Capsules and Protein A allow the microorganism to resist phagocytosis.


4)      Catalase and carotenoids enhances Staphylococcus aureus’ survival in phagocytes.


5)      Coagulase helps disguise the microbe from the host’s immune system.


6)      Staphylococcus aureus damages and even lyses eukaryote cell membranes with toxins such as hemolysins, leukotoxins, and leukocidins.


7)      The release of exotoxins damage host tissues and “provoke” symptoms of disease.


8)      Resistance to antibiotics.6  





Several procedures are done to control and treat patients with Toxic Shock Syndrome. These are the following steps followed:


1)      The source of infection is removed immediately from the body this includes tampons and diaphragms and any other types of contraceptives that are inserted vaginally.


2)       After the sources of infection are removed, the wounds are cleaned to make sure that all bacteria have been removed. As soon as the source of infection is removed the patient’s condition begins to improve rapidly because the toxins are eliminated from the body.


3)      Next, illnesses produced by Staphylococcus aureus, like low blood pressure and shock are treated. Fluids that were lost from vomiting, fever, and diarrhea are replenished by intravenous (IV) fluids; this helps avoid complications of shock and low blood pressure.


4)      Finally, antibiotics are given to the patient to kill the Staphylococcus and the toxins that it is producing. Clindamycin is an antibiotic that is given right away and it stops production of toxins and treats the symptoms of the patient immediately.  There are other medications given but it depends on the strain of Staphylococcus aureus that is found in the patient. Also, some strains of Staphylococcus aureus are resistant to antibiotics and these strains are called methicillin-resistant Staphylococcus aureus or MRSA.7  



Prevention/ Vaccines


Although there are not any vaccines at this time there are several ways to prevent this deadly disease. 


û       Re-infection of Toxic Shock Syndrome is very common so menstruating women should avoid tampons if they have already had Toxic Shock Syndrome before.


û        Women that use foreign body items such as tampons and diaphragms should use them minimally because it helps reduce the risk of Toxic Shock Syndrome by not giving bacteria the opportunity to grow.


û       Women should change their tampons every 4-8 hours.


û       Women can decrease bacterial growth by picking the right size of tampon according to their menstrual flow.8


Local cases/Outbreaks


In the United States, the last surveillance of Toxic Shock Syndrome was in 1987. During that period of time the annual incidence of this disease was 1-2/100,000 women ages 15 to 44 years old. These results were produced from four different states that studied a population of 12 million people all together.1


Global cases/Outbreaks


Information regarding global outbreaks of Toxic Shock Syndrome caused by Staphylococcus aureus is very limited. Before antibiotics were introduced there was a 90% rate of mortality in people that had an infection caused by Staphylococcus aureus. Today, there are strands of Staphylococcus aureus (MRSA) that are resistant to antibiotics this has initiated a response to create a vaccine for this microbe.9


Works Cited:


  1.    National Center for Immunization and Respiratory Diseases: Division of Bacterial Diseases. “Toxic Shock Syndrome.” 24 Oct 2005. 4 May 2010.   


2.    Massachusetts Department of Public Health, Bureau of Communicable Disease Control. “Toxic Shock Syndrome.” June 2006. 4 May 2010.


3.    Todar, Kenneth. “Staphylococcus aureus and Staphylococcal Disease.” 2008. 4 May 2010.


4.    The Nemours Foundation. “Toxic Shock Syndrome.”1995-2010. 5 May 2010.


5.    Martin, Eva. “Toxic Shock Syndrome.” 19 Jan 2007. 5 May 2010.


6.    Todar, Kenneth. “Staphylococcus aureus and Staphylococcal Disease.” 2008. 4 May 2010.


7.    Healthwise Incorporated. “Toxic Shock Syndrome – Treatment Overview.” 3 March 2008. 5 May 2010.


8.    The University of Virginia Health System. “Infectious Diseases: Toxic Shock Syndrome.” 12 Feb 2004. 4 May 2010.


9.    World Health Organization. “Bacterial Infections: Staphylococcal Infection.” 2010. 5 May 2010.