Bacteria that cause toxic shock syndrome (TSS)

The two most common bacteria found in the diagnosis of toxic shock syndrome (TSS) are Streptococcus pyogenes (group A strep) or Staphylococcus aureus (staph).1 In some cases of TSS, the strep or staph bacteria may cause a serious infection in the body, such as pneumonia, osteomyelitis, or endocarditis.

Strep TSS is not as likely as staph TSS to come back. A person with staph TSS has an increased chance for getting it again.

Streptococcus pyogenes (group A strep)

Strep TSS may be related to:

  • Chickenpox (varicella). Children with chickenpox have a higher chance of getting TSS.
  • Advanced age. Older adults have a higher chance of getting TSS.
  • Diabetes , heart or lung disease, HIV, alcohol use, or intravenous (IV) drug use. People with these conditions have a higher chance of getting TSS.

But strep TSS can develop in people who have no risk factors.

Symptoms of strep TSS include:

Group A strep bacteria can be identified by cultures from a sample of blood or cerebrospinal fluid (CSF) or by a tissue biopsy. Cultures from the throat, the vagina, or a sputum sample may also contain the bacteria.

Staphylococcal aureus (staph)

In adults, staph may be part of the normal body bacteria on the skin and in the nose and vagina; more than 90% of adults have developed antibodies to the staph bacteria that causes TSS.1 For those who haven't developed an immunity and contract a staph infection, toxic shock syndrome may be related to:

  • Prolonged use of a tampon, typically a superabsorbent type.
  • The presence of a foreign body at the site of infection.
  • Infection after surgery, generally from a person's own staph bacteria.1

Symptoms of staph TSS include:

  • Fever over 102°F (38.89°C).
  • Red rash that is widespread over the body.
  • Dangerously low blood pressure (hypotension). The first sign of this life-threatening condition can be dizziness when rising from a sitting or lying position (orthostatic hypotension).
  • Involvement of more than one organ system, indicated by the presence of three or more of the following symptoms:
    • Vomiting or diarrhea
    • Severe muscle ache or pain
    • Confusion or decreased level of consciousness
    • Extremely red mucous membranes in the mouth, nose, throat, eye, or vagina
    • Elevated kidney and liver blood test results
    • Decreased platelet count
  • Skin tissue shedding, especially from the palms of the hands and the soles of the feet, 7 to 14 days after rash begins.

Citations

  1. American Academy of Pediatrics (2006). Toxic shock syndrome. In LK Pickering et al., eds., Red Book: 2006 Report of the Committee on Infectious Diseases, 27th ed., pp. 660–665. Elk Grove Village, IL: American Academy of Pediatrics.

Last Updated: March 3, 2008

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