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Topic Overview

The two most common bacteria found in the diagnosis of toxic shock syndrome (TSS) are Streptococcus pyogenes (group A strep) or Staphylococcus aureus (staph). 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:

• 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).
• Pain at the site of infection, especially if the pain is greater than you would expect for the size of the wound.
• And two or more of the following:
  • Kidney and liver failure or insufficiency, as shown by blood and urine tests.
  • Blood-clotting problems, such as decreased platelet count or disseminated intravascular coagulation (DIC).
  • Acute respiratory distress syndrome.
  • Widespread red rash that may cause skin tissue to peel off.
  • Soft tissue death (necrosis), such as cellulitis, necrotizing fasciitis, or gangrene.

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 toxin that causes TSS.¹ For those who have not 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.

Symptoms of staph TSS include:

• Sudden 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. This is 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.
• Skin tissue shedding, especially from the palms of the hands and the soles of the feet, 7 to 14 days after a rash begins.