Toxic shock syndrome

Classification according to ICD-10
A48.3	Toxic Shock Syndrome
ICD-10 online (WHO version 2019)

The toxic shock syndrome ( TSS , colloquially sometimes referred to as "tampon disease") is a serious circulatory and organ failure, which occurs very rarely with about one case per 200,000 population per year, caused by bacterial toxins . Mostly they come from the bacterium Staphylococcus aureus , more rarely from streptococci ( streptococci-induced toxic shock syndrome ).

Symptoms

The toxins produced by Staphylococcus aureus lead to the main symptoms of fever , drop in blood pressure and a rash . Further consequences are muscle pain, nausea and diarrhea , kidney and liver damage, clouding of consciousness and multi-organ failure .

The Centers for Disease Control of the United States (CDC) have proposed the following criteria for the definition of toxic shock syndrome:

Body temperature ≥ 38.9 ° C, low blood pressure (accompanied by fainting or dizziness ), widespread rash, peeling skin (especially on the palms of the hands and soles of the feet , 1–2 weeks after the onset of the disease)

Damage to at least three of the following organ systems: gastrointestinal tract ( vomiting or diarrhea ), muscles (severe muscle pain ), liver (decreased liver function), kidneys (decreased urination or increase in creatinine levels ), blood (hematomas), central nervous system (disorientation or Confusion), mucous membranes (reddening of the eyes as well as of the oral and vaginal mucosa)

In principle, any purulent wound can be the gateway for the TSS pathogen. However, it is believed that some of the TSS cases come from infected tampons . This assumption led to numerous lawsuits in the United States, including that of attorney Tom Riley v Procter & Gamble , described in his book The Price of a Life .

Streptococcal-induced TSS

The streptococcal-induced Toxic Shock Syndrome (STSS) is the most threatening form of a so-called invasive streptococcal infection, i.e., a infection , wherein the streptococci invade the body. It is mainly caused by type A streptococci , but also type C or type G streptococci.

Certain exotoxins (so-called superantigens ), which are produced by human-pathogenic strains of Staphylococcus aureus and Streptococcus pyogenes , have been identified as the cause of the disease . Due to improved production conditions in tampon manufacture, the number of tampon-induced TSS has decreased significantly. Other relevant sources of infection in women can be diaphragms and vaginal sponges . A wound infection can also trigger a TSS.

The CDC suggested the following criteria for defining streptococcal-induced toxic shock syndrome:

Detection of type A streptococci, hypotension (low blood pressure), and at least two of the following symptoms:
Damage to the kidneys (decreased urine excretion), coagulopathy (bleeding disorders), liver dysfunction, skin rash (which can spread, especially 1–2 weeks after the onset of the disease), breathing difficulties, tissue necrosis ( myositis , necrotizing fasciitis , gangrene )

Other test procedures include blood cultures and blood tests, as well as urine tests .

risk groups

TSS or STSS is observed in both female and male patients of all ages. As a rule, the disease is based on a local or systemic infection. It is noteworthy that TSS or STSS usually occurs predominantly in previously healthy people between the ages of 20 and 50, although otherwise infants, toddlers, seniors or immunocompromised people are more susceptible to staphylococcal and streptococcal infections.

Tampons should be changed often, and clean hands should be ensured when inserting the tampon. If a diaphragm is used for contraception , it should not be worn longer than absolutely necessary.

therapy

The disease can be treated well with antibiotics (preferably second generation cephalosporins or amoxicillin ). The treatment of the STSS essentially corresponds to that of the TSS. The treatment is always carried out as an inpatient. The pathogen is fought by administering antibiotics intravenously . The following measures can further support this treatment:

intravenous hydration to reduce the risk of shock and organ damage
Stabilization of blood pressure
Dialysis in patients with kidney failure
Administration of blood products
Surgical interventions to clean the source of infection
Breathing support through the administration of oxygen , sometimes also through artificial respiration

Web links

Information on Strep -Induced Toxic Shock Syndrome from the Centers for Disease Control on cdc.gov

Individual evidence

↑ C. Lang u. a .: Special features of intensive care medicine in the case of toxic shock syndrome ('toxic-shock-syndrome', TSS). Review publication and case report on a TSST-1-associated toxic shock syndrome with ARDS and multiple organ failure after staphylogenic panaritium . In: Der Anaesthesist 52, 2003, No. 9, pp. 805-813 ( doi: 10.1007 / s00101-003-0552-5 ).
↑ Kehm v. Procter & Gamble Mfg. Co., 724 F.2d 613.
↑ Tom Riley: The Price of a Life . Adler & Adler, 1986. ISBN 0-917561-06-6 .

[1] C. Lang u. a .: Special features of intensive care medicine in the case of toxic shock syndrome ('toxic-shock-syndrome', TSS). Review publication and case report on a TSST-1-associated toxic shock syndrome with ARDS and multiple organ failure after staphylogenic panaritium . In: Der Anaesthesist 52, 2003, No. 9, pp. 805-813 ( doi: 10.1007 / s00101-003-0552-5 ).

[2] Kehm v. Procter & Gamble Mfg. Co., 724 F.2d 613.

[3] Tom Riley: The Price of a Life . Adler & Adler, 1986. ISBN 0-917561-06-6 .