What do you need to know about Toxic Shock Syndrome?

What do you need to know about Toxic Shock Syndrome?

Toxic shock syndrome is a rare multisystem disease with many widespread symptoms. It is caused by a toxin that is produced and secreted by the bacterium Staphylococcus Aureus. Often staphylococcus aureus is blamed for toxic shock syndrome but it also can happen due to group A streptococcus (strep) bacteria. These bacteria are commonly found in some areas on our bodies such as nose, armpit, skin, groin, or vagina of every one in three people and they usually don’t cause any problems, but they make toxins that in rare cases can enter in our blood stream which leads to Toxic shock syndrome. The underlying mechanisms involves the production of super antigens during invasive streptococcus infection or a localized staphylococcus infection. In both TSS and TSLS, disease progression stems from a super antigen Toxin 1 from staphylococcus aureus or TSST-1 secreted as single polypeptide chain. The gene encoding toxic shock syndrome toxin is carried by a mobile genetic element of S. aureus and the SAPi family of pathogenicity islands. The toxin causes the non-specific binding of MHC II, on professional antigen presenting cell, with T-cell receptors, on T cells. In typical T-cell recognition, an antigen is taken up by an antigen-presenting cell, processed, expressed on the cell surface in complex with class II major histocompatibility complex in a groove formed by the alpha and beta chains of class II MHC, and recognized by an antigen-specific T-cell receptor. This results in polyclonal T-cell activation. Super antigens do not require processing by antigen-presenting cells but instead interact directly with invariant region of the class II MHC molecule. In patients with TSS, up to 20% of the body’s T-cells can be activated at one time. This polyclonal T-cell population causes a cytokine strom, followed by multisystem disease. Most cases of toxic shock syndrome occur in menstruating females in association with the use of tampons. It has been associated with the superabsorbent tampons. Toxic shock syndrome can effect anyone child, male and female possible cause can include, high fever, accompanied by low blood pressure. Malaise and confusion, which can rapidly progress to stupor, coma, and multiple organ failure. The severity if the disease often needs hospitalization. Admission to the intensive care unit is often necessary for supportive care (for aggressive fluid management, ventilation, renal replacement therapy and inotropic support), particularly in the case of multiple organ failure.Treatment includes removal or draining of the source of infection often tampon and draining of abscesses. Outcomes are poorer in patients who do not have the source of infection removed. 

Antibiotic treatment should cover both S pyogenes and S aureus. This may include a combination of cephalosporin’s, penicillin’s or vancomycin. The addition of clindamycin or gentamycin reduces oxin production and mortality. 

A significant number of cases of TSS involve tampon use and especially super absorbent tampons. Soft tissues injuries that can also lead to TSS include the complications of childbirth, an injury or burn, a localized infection, such as a boil, or the use of a contraceptive sponge. Tampon use is implicated in 55 percent of cases, but another 15 percent are linked to childbirth and infected wounds. From December 2015 to March 2016, five cases of menstrual-related TSS were reported in Michigan State. Four of the women were using super absorbency tampons. The bacteria that cause TSS are not uncommon. Between 20 percent and 30 percent of all humans carry S. aureus on their skin and nose usually without complications. Most people have antibodies to protect them. It may be that some people do not develop the necessary antibodies. One possibilities are that super absorbent tampons, the ones that stay inside the body for the longest time become breeding grounds for bacteria. Another is that tampon fibers scratch the vagina, making it possible for bacteria to get through and into the bloodstream. Either the action or the composition of the tampons combined with preexisting staphylococcal bacteria in the vagina, probably triggering the disease. 

Preventing toxic shock syndrome

The following things can reduce your risk to toxic shock syndrome 

Treat wounds and burns quickly and get medical advice if your notice signs of an infection, such as swelling, redness and increasing pain

Always use a tampon with the lowest absorbency suitable for your period

Alternate between tampons and a sanitary towel or panty liner during your period 

Wash your hand before and after inserting tampon 

Change tampons regularly- as often as directed on the pack (usually at least every 4 to 8 hours) 

Never have more than one tampon in your vagina at a time 

When using a tampon at night, insert a fresh tampon before going to bed and remove it when you wake up.

Remove a tampon at the end of your period 

When using female barrier contraception, follow the manufacturers instruction about how long you can leave it in 

It’s a good idea to avoid using tampons or female barrier contraception of you has TSS before.

Precaution is always better than a cure.