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 having 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.

However, 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.
• And two or more of the following:
  • Kidney and liver failure or insufficiency, as indicated 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 show 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 102F.
• 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 (desquamation), 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 (2003). Toxic shock syndrome. In LK Pickering, ed., Red Book: 2003 Report of the Committee on Infectious Diseases, 26th ed., pp. 624–630. Elk Grove Village, IL: American Academy of Pediatrics.