Streptococcal toxic shock syndrome (STSS) STSS can happen following a streptococcus infection in the body, most often a skin infection or an infected wound. Within 48 hours of infection, blood pressure drops dangerously low, and the person may have fever, dizziness, confusion, difficulty breathing, and a weak and rapid pulse. The skin may be pale, cool, and moist, and there may be a rash that sometimes peels later on. The area around an infected wound can become swollen, red, and have areas of severely damaged or dying flesh. The liver and kidneys may begin to fail, and bleeding problems may develop.
Toxic shock syndrome from staphylococcus starts suddenly with vomiting, high fever (temperature at least 102° Fahrenheit [38.8° Celsius]), a rapid drop in blood pressure (with lightheadedness or fainting), watery diarrhea, headache, sore throat, and muscle aches. Within 24 hours, a sunburn-like rash appears. There also may be bloodshot eyes and an unusual redness under the eyelids or inside the mouth (and vagina in females). After that, broken blood vessels may appear on the skin. Other symptoms may include: confusion or other mental changes; decreased urination; fatigue and weakness; thirst; weak and rapid pulse; pale, cool, moist skin; and rapid breathing.
The bacteria that cause toxic shock syndrome can be carried on unwashed hands and prompt an infection anywhere on the body. So hand washing is extremely important. Girls can reduce their risk of TSS by either avoiding tampons or alternating them with sanitary napkins. Girls who use only tampons should choose ones with the lowest absorbency that will handle menstrual flow and change the tampons frequently. Between menstrual periods, store tampons away from heat and moisture (where bacteria can grow) — for example, in a bedroom rather than in a bathroom closet. Because staphylococcus bacteria are often carried on dirty hands, it's important for girls to to wash their hands thoroughly before and after inserting a tampon. If your daughter is just starting her menstrual period, she should know about taking these precautions. Any female who has recovered from TSS should check with her doctor before using tampons again. The best defense against STSS is to clean and bandage all skin wounds as quickly as possible. Call your doctor immediately whenever a wound becomes red, swollen, or tender, or if a fever begins. Although STSS almost never follows strep throat, check with your doctor whenever your child has a sore throat with fever, particularly if your child's condition is worsening despite medical treatment.
Doctors typically diagnose TSS and STSS by doing a physical exam and conducting blood tests that assess a child's liver and kidney function. In toxic shock syndrome, doctors may want to rule out conditions like measles or Rocky Mountain spotted fever, which can produce similar symptoms. A doctor may also take samples of fluid from an abscess, boil, or infected wound to look for a possible source of staphylococcus or streptococcus infection.
With proper treatment, patients usually recover in two to three weeks.The condition can, however, be fatal within hours.
The severity of this disease frequently warrants 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. The source of infection should be removed or drained if possible: abscesses and collections should be drained. Anyone wearing a tampon at the onset of symptoms should remove it immediately. Outcomes are poorer in patients who do not have the source of infection removed.
Antibiotic treatment should cover Staphylococcus aureus. This may include a combination of cephalosporins, penicillins or vancomycin. The addition of clindamycin or gentamicin reduces toxin production and mortality.