Angina

Tampon toxic shock syndrome: symptoms, treatment.

Syndrome toxic shock - an acute and severe multisystem disease characterized by sudden onset high fever, hypotension, vomiting, diarrhea, erythematous skin rashes that peel off during recovery, and damage to multiple organs.

Toxic shock syndrome is rare and is often a life-threatening illness that develops suddenly after infection and can immediately affect various systems organs, including lungs, kidneys and liver.

Because toxic shock syndrome progresses rapidly, immediate medical treatment is necessary.

What triggers / Causes of Toxic Shock Syndrome:

Toxic shock syndrome is rarely the result of bacterial infection Streptococcus pyogenes(group A streptococcus) or Staphylococcus aureus (staphylococcus). These bacteria produce toxins causing the syndrome toxic shock. These bacteria are common but usually do not cause problems. They can cause easily treatable throat or skin infections, such as a sore throat or impetigo. IN in rare cases toxins enter the bloodstream and cause severe immune reaction in people whose bodies do not fight these toxins. The body's response causes symptoms associated with toxic shock syndrome.

Often appears after childbirth, flu, chicken pox, surgery, small cuts to the skin, wounds or bruises that cause bruising, but do not violate the integrity of the skin.

Often appears after prolonged use of tampons (menstrual toxic shock syndrome) or after a surgical procedure such as nasal surgery using a dressing (nonmenstrual toxic shock syndrome).

Pathogenesis (what happens?) during Toxic Shock Syndrome:

The immune reaction leading to toxic shock syndrome is usually due to a lack of specific antibodies against streptococcal or staphylococcal toxins. Young people may not have such antibodies.

Outbreaks of toxic shock syndrome may appear in hospitals and medical institutions for chronically ill patients, where people live in close proximity to each other.

Symptoms of Toxic Shock Syndrome:

The rapid development of symptoms is one of the most important symptoms that may require immediate treatment for toxic shock syndrome.

Symptoms of toxic shock vary in severity depending on the type of streptococcal or staphylococcal bacteria.

Symptoms of toxic shock syndrome develop quickly and can cause death within 2 days.

The first signs of toxic shock syndrome usually include:
- Such severe symptoms flu-like muscle aches and pain, stomach cramps, headache or sore throat.
- Sudden rise in temperature above 38.9 C.
- Vomiting and diarrhea.
- Signs of shock including low blood pressure and rapid heartbeat, often with dizziness, loss of consciousness, nausea, vomiting, or dysphoria and confusion.
- Redness similar to sunburn. Redness may appear in several parts of the body or in specific areas, such as the armpits or groin.
- Severe pain at the site of infection (if there is a wound or damage to the skin).
- Redness of the nasal passages and mouth.

Other symptoms of toxic shock syndrome may include:
- Conjunctivitis (redness).
- Involvement of more than one organ system, usually the lungs or kidneys.
- Blood poisoning (sepsis), which affects the entire body.
- Death of skin tissue (necrosis), which appears at the beginning of the syndrome.
- Peeling of skin tissue that appears during recovery.

Streptococcal nonmenstrual toxic shock syndrome.
Symptoms usually develop:
- In women who have recently given birth, 2-3 days or several weeks after birth.
- In people with infected surgical wounds, 2 days - 1 week after surgery.
- In people with respiratory diseases 2-6 weeks after the onset of respiratory symptoms.

Staphylococcal menstrual toxic shock syndrome. Symptoms usually develop 3-5 days after the start of menstruation when a woman uses tampons.

Staphylococcal nonmenstrual toxic shock syndrome. Symptoms usually develop within 12 hours after surgery, in which surgical dressings are used, for example, after rhinoplasty.

Symptoms of toxic shock syndrome can suddenly affect several different organ systems, including the lungs, kidneys, and liver.

Redness similar to a sunburn may also appear early in the disease. Redness usually appears after 7-14 days on the palms of the hands and soles of the feet.

Toxic shock syndrome occurs less frequently in children compared to adults.

Dangerous complications of toxic shock syndrome include:
- Shock, abbreviation circulation of blood and oxygen in vital organs.
- Acute syndrome respiratory failure. Lung function decreases, it becomes difficult to breathe, and oxygen levels in the blood drop.
- Disseminated intravascular coagulation syndrome. This disease is caused by a blood clotting factor. Many blood clots can form throughout the body. This may cause excessive bleeding.
- Kidney failure, also called terminal stage renal failure. - Kidney failure occurs when kidney damage is so severe that it is impossible to prevent fatal outcome Treatment with dialysis or kidney transplant is necessary.

Talk to your doctor about possible complications if you have had multiple menstrual toxic shock syndromes.

Diagnosis of Toxic Shock Syndrome:

Because toxic shock syndrome progresses rapidly, it is usually diagnosed and treated based on symptoms and signs of infection without waiting for laboratory test results. Additional Analysis blood and tissue tests can help determine the type of bacteria causing the infection.

Typically, by the time a person with toxic shock syndrome sees a doctor, the disease progresses rapidly and the person feels very unwell. Shock usually needs to be treated before any test results are available.

If medical worker If you suspect you have toxic shock syndrome, you will undergo several types of tests, including:
- Full clinical analysis blood- counting red and white blood cells, platelets and other basic indicators of your blood.
- Cultures of blood and other fluids and tissues body for signs of streptococcal or staphylococcal bacteria. For menstrual toxic shock syndrome, a sample of vaginal fluid is tested. For nonmenstrual toxic shock syndrome, a swab or tissue sample is taken from a suspected lesion or other injured area of the body. Blood culture usually does not detect staphylococcal toxic shock syndrome when it is present, but streptococcus may be detected in a blood sample or cerebrospinal fluid or by tissue biopsy. Cultures from the throat, vagina, or saliva may also reveal bacteria.
- Fluorography to look for signs of lung damage (respiratory distress syndrome).
- Tests to detect other infections which can cause symptoms similar to those of toxic shock syndrome, such as blood poisoning (sepsis), a tick-borne bacterial infection (American tick-borne rickettsiosis), a bacterial infection caused by contact with the urine of an infected animal (leptospirosis), or typhoid fever.

Sometimes other tests are needed, depending on how the disease has progressed and what problems it has caused.

Treatment of Toxic Shock Syndrome:

Emergency treatment often requires intravenous plasma volume restoration and intensive care in the hospital, especially when the body is in shock. Further treatment includes antibiotics to kill bacteria, removal of any source of infection, and treatment of any complications. Unless there are other complications, most people recover within 2 weeks when treated with antibiotics.

If you think you have toxic shock syndrome, call your doctor right away. If you have symptoms of shock such as severe weakness, dizziness or loss of consciousness, call an ambulance immediately. Because toxic shock syndrome can cause life-threatening complications, you may need to be treated in a hospital where your condition can be closely monitored.

By the time a person with toxic shock syndrome sees a doctor, emergency treatment is usually required. Because toxic shock syndrome can progress very quickly and be life-threatening, treatment is almost always done in a hospital where the patient is closely monitored. Treatment for shock or organ failure is usually necessary before the results of any tests are known. Admission to intensive care is usually necessary when a patient shows signs of shock or trouble breathing (respiratory failure).

Treatment for streptococcal or staphylococcal toxic shock syndrome includes:
- Removing the source of infection. If a woman uses tampons, a diaphragm or a contraceptive sponge, they should be removed immediately. Infected wounds usually cleared of bacteria. Your doctor may give you an injection to numb the area so that you can use a scalpel or scissors to remove dead or severely infected tissue. It's called surgical treatment wounds. Once the source of infection is removed, the patient's condition often improves quickly.
- Treatment of complications of the disease, including low blood pressure, shock and organ failure. The specifics of treatment depend on what problem arose. The administration of large amounts of intravenous fluid is usually used to replace fluid losses due to vomiting, diarrhea and fever in order to avoid complications of the form. low blood pressure and shock.
- Antibiotics to kill bacteria that produce toxins that cause toxic shock syndrome. Clindamycin stops the production of toxins and immediately treats symptoms. Other medications such as cloxacillin or cefazolin may be added when laboratory tests specific streptococcal or staphylococcal bacteria were detected. Staphylococcus aureus strains may be resistant to drugs such as cloxacillin and cefazolin, which are widely used around the world. These staphylococcal strains are called methicillin-resistant Staphylococcus aureus (MRSA). Other antibiotics may be needed to kill these bacteria. These antibiotics include vancomycin, daptomycin, linezolid, or tigecycline.

With timely treatment and absence serious complications most patients recover within 1-2 weeks.

Streptococcal toxic shock syndrome has a mortality rate of about 50%. This may be because streptococcal toxic shock syndrome can be difficult to identify until serious complications such as blood poisoning (sepsis) or a rare bacterial infection that destroys the skin (necrotizing fasciitis) occur.

Staphylococcal toxic shock syndrome is serious, but leads to death in only 5% of people who are not diagnosed and treated correctly.

Toxic shock syndrome is a rapidly progressive, life-threatening illness that cannot be treated at home. If you think you may have toxic shock syndrome, seek medical help immediately.

Antibiotics are used to treat toxic shock syndrome. The sooner therapy begins, the less possible complications may arise. Antibiotics are used for as long as needed, depending on the streptococcal or staph bacteria and the severity of the symptoms.

Antibiotics may also help prevent recurrent episodes of toxic shock syndrome.

Intravenous immunoglobulin administration may be used when toxic shock syndrome is severe or the patient's condition does not improve after taking antibiotics. IV immune globulin works differently than antibiotics. It contains antibodies that can help the body remove specific toxins that cause toxic shock syndrome. But experts have not determined whether intravenous administration immunoglobulin is effective in the treatment of toxic shock syndrome.

Your doctor can give you blood pressure medications to help your organs function better.

For toxic shock syndrome caused by staphylococcal bacteria, surgery is extremely rare but is part of the necessary treatment. In some cases surgical removal infected tissue leads to a significant improvement in the patient's condition. For example, surgery may be necessary when:
- Toxic shock syndrome developed after surgery and surgical suture must be drained and cleaned to remove the source of infection.
- Streprococcal bacteria cause necrotizing fasciitis – bacterial infection, which destroys the skin, and dead tissue and toxins produced by bacteria must be removed.

Streptococcal toxic shock syndrome with necrotizing fasciitis progresses rapidly and is life-threatening, so it is necessary to emergency surgery to remove the source of infection.

In the hospital, you may need intravenous fluids and simple protein to replace what your body has lost.

Prevention of Toxic Shock Syndrome:

You can take the following steps to prevent toxic shock syndrome:
- Do not use tampons or barrier contraceptives during the first 12 weeks after birth, when the risk of developing toxic shock syndrome is high.
- Follow the instructions on the package when inserting tampons, diaphragms or contraceptive sponges. Change your tampons at least every 8 hours, or only use tampons a few hours a day. Do not leave the diaphragm or contraceptive sponge in for more than 12-18 hours.
- Keep all skin wounds clean to prevent infection and promote healing. This includes cuts, punctures, scrapes, burns, insect or animal bites, and surgical stitches.
- Do not allow children to scratch chickenpox sores.
- If you have already had menstrual toxic shock syndrome, do not use tampons, barrier contraceptives such as a diaphragm, cervical cap, sponge, or intrauterine device(Navy).

Careful use of tampons, diaphragm and contraceptive sponge
- Follow package directions when inserting tampons, diaphragms, and contraceptive sponges.
- Wash your hands with soap and water before inserting or removing tampons, diaphragms, or contraceptive sponges.
- Change tampons at least every 8 hours or use tampons only a few hours a day. Do not leave the diaphragm and contraceptive sponge inside for more than 12-18 hours.
- As an alternative to tampons, use pads. For example, use pads at night and tampons during the day.
- Use tampons with a lower absorbency rate than you need. The risk of toxic shock syndrome is highest when using superabsorbent tampons.

Caring for skin wounds to prevent skin infections
- Keep all skin wounds clean to prevent infection and promote healing. Skin damage, including cuts, burns, bruises, insect and animal bites, chickenpox sores, and surgical stitches.
- Make sure children do not scratch chickenpox sores.

Preventing streptococcal infections during pregnancy or after childbirth

Women who are pregnant or have recently given birth have increased risk developing streptococcal toxic shock syndrome, especially if one of her children has a sore throat. Any pregnant or postpartum woman with a baby who is showing signs of a sore throat should talk to her gynecologist or obstetrician.

Which doctors should you contact if you have Toxic Shock Syndrome:

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ITS or infectious toxic shock is a sharp decrease blood pressure, due to human damage by infectious bacteria. Their toxic effects expose the body to state of shock. The syndrome is caused by the action of endo- and exotoxins or viruses and disrupts the functioning of vital systems, primarily the cardiovascular, nervous and respiratory systems. With this exacerbation, immediate medical intervention, without which the risk of death increases.

Reasons

Infectious-toxic shock is caused by a number of bacteria, such as streptococci, Staphylococcus aureus and salmonella, therefore there is a high risk of developing ITS during various infectious diseases, including influenza with strain A. It is worth noting that there are also risk factors for ITS:

open wounds (burns);
positive HIV status;
development of infection on postoperative sutures(or introduced during the operation);
sepsis (postpartum);
typhoid fever and others;
drug use (intravenous);
use of tampons.

The greatest likelihood of developing infectious-toxic shock in cases typhoid fever and immunodeficiency (about 70% of cases), while with salmonellosis it is only 6%, and when using vaginal tampons, the syndrome is rarely observed (only 4 women out of 100,000).

Today there is an opinion that non-steroidal anti-inflammatory drugs can cause infectious-toxic shock. But there is no 100% confirmed data.

Stages of infectious-toxic shock

After toxins enter the blood, infectious-toxic shock develops in three stages:

The early stage is compensated shock.
The patient is clearly conscious, but there is anxiety. The mucous membranes and tongue turn red (in some cases, the feet and palms), swelling of the face occurs, breathing is erratic, the pulse ranges from 110 to 120 beats/min, but may at times return to normal. Blood pressure rises, and difficulties arise with urination (urine output decreases). Diarrhea and painful sensations in the upper abdomen, most often found in children.
The most pronounced stage is subcompensated shock.
The patient is overcome by apathy, his actions and thought process difficult. The skin becomes cold, damp and pale. Nails and limbs turn blue, the temperature drops critically, shortness of breath appears, and heart rate, which can reach up to 160 beats/min. Blood pressure also drops to critical levels, urine output is difficult (most often absent in the second stage). Markings similar to bruises or a rash that resembles sunburn appear on the skin. The possibility of gastric bleeding cannot be ruled out.
The last stage is decompensated shock.
The patient's consciousness is confused, there is no reaction to the world around us, constant fainting cannot be ruled out. Limbs turn blue, body temperature drops below normal indicators,BP is not monitored at times. Urination is completely absent, shortness of breath increases. In some cases, the patient may fall into a coma.

Symptoms

The disease can progress rapidly without surgical intervention, death may occur as early as the second day. It is very important to recognize the first symptoms of infectious-toxic shock:

the occurrence of flu-like symptoms (sore throat, aches, discomfort in the stomach);
a sharp rise in temperature to 39 degrees;
consciousness becomes confused, vomiting, fainting, and causeless anxiety begin;
A rash appears in the groin and armpits. Redness of the mucous membrane;
pain in the area of the infected wound.

The manifestation of any of these symptoms requires urgent hospitalization in intensive care unit. 6-12 hours after infection, other complications may appear:

peeling of the skin on the extremities;
blood poisoning;
: blepharitis, etc.;
skin neurosis.

Development of infectious-toxic shock. The process of the influence of toxins on the human body. How intoxication can lead to ITS and what actions should be taken at the first signs of the disease.

Diagnosis

Due to the fact that infectious-toxic shock rapidly progresses, it is diagnosed only by the symptoms that appear. Treatment is prescribed until response laboratory research, since tests only establish the type of infectious agent. To do this, the following series of analyzes is required:

chest x-ray;
blood test;
urine test (if the patient is in the first stage of ITS);
smears of mucous membranes.

Based on laboratory studies, it is determined clinical picture diseases. Toxic shock syndrome is accompanied by metabolic acidosis(acidification and lowering the pH in the blood to 7.5). The level of lactic acid in the blood increases, and sodium and albumin decrease. Disseminated intravascular coagulation or DIC is one of the complications of shock that is diagnosed in the laboratory.

Treatment

Treatment of infectious-toxic shock is carried out in a hospital (at late stages in intensive care). Elimination of the disease involves the following actions:

intravenous administration of drugs such as Dopamine and Dexamethasone;
the use of antibiotics and antibacterial drugs (cephalosporins) is necessary;
elimination of allergic reactions;
elimination oxygen starvation(if the condition worsens, connect to an artificial respiration apparatus);
to eliminate intoxication, use the drug Enterosgel or its analogue, but at the same time protect the body from dehydration;
blood purification with saline solution, administration of albumin or aminophylline to eliminate hemorheological disorders;
therapy is prescribed aimed at restoring the immune system;
in the first days, the patient is fed through a catheter to relieve the stomach and give it time to recover;
if necessary surgical method remove the source of infection.

If the patient does not experience complications, then his condition can stabilize within 10-14 days. During this time, the patient is under constant observation, with registration of all changes occurring in the body.

Emergency care for infectious-toxic shock

A person’s anxiety, along with a rise in temperature, pale skin and motor agitation, requires an immediate call to a doctor, due to all the symptoms of ITS. At this stage, it is worth giving the patient warm water. It is well absorbed in the stomach, supplying the body with the necessary moisture.

If the first symptoms go unnoticed, skin became pale and cold, the skin on the extremities peels off, and the nails become blue tint and when you press them, the white marks last for more than three seconds - this indicates a worsening of the situation and the onset of the second stage. Before the ambulance arrives, the patient must be given independent first aid medical care:

free from tight clothing;
lay on your back with your head slightly raised;
warm your feet;
give the patient constant access to fresh air.

This is all that can be done to help a person without a qualified medical education. The actions of doctors should be as follows:

increased oxygen flow (oxygen mask);
installation of an intravenous catheter;
administration of glucocorticoid (dexamethasone and prednisolone);
urgent hospitalization of the patient in a hospital (in the last stages in intensive care).

Special cases

Infectious-toxic shock can also occur in in some cases- V childhood, obstetrics and pneumonia. Moreover, symptoms, treatment and first aid methods may vary. In order to correctly determine ITS in particular cases, it is necessary to familiarize yourself with them in more detail.

In children

As in adult patients, infectious-toxic shock in children occurs as a result of infectious diseases. The most common cases of ITS occur with influenza, diphtheria, dysentery and scarlet fever. The syndrome develops rapidly and can reach its maximum spread in just two days.

The first symptom is high temperature, sometimes reaching critical limits of 41 degrees. The child's consciousness is confused, there is motor agitation, vomiting, and headache. Convulsions may occur. The mucous membranes and skin turn pale, severe chills occur, the pulse is weakly palpable, and the heart rate increases. Blood pressure drops, which can lead to acute renal failure.

In addition to diseases, infectious-toxic shock can be caused by scratching scratches, burns or abrasions. It is worth paying attention to all, even minor, injuries of the child, treating them in a timely manner and changing bandages. Infectious-toxic shock requires immediate hospitalization to the intensive care unit, as any delay could be fatal.

In obstetrics

Infectious-toxic shock in obstetrics is most often referred to as septic shock. Among obstetric infections and complications causing this state, the following factors can be mentioned:

abortions during which an infection was introduced into the body;
C-section;
Chorioamnionitis.

The main focus is most often located in the uterus. The severity of the condition is determined by the rapid proliferation of infection in the uterus, occupying a large wound surface. The time frame for the development of ITS can be different, from several hours (lightning fast) to 7-8 days.

Symptoms begin to appear within a few hours in the form of an increase in temperature to 39-40 degrees, rapid heartbeat and wheezing in the lungs. Progressing pulmonary failure, turning into pulmonary edema, the feeling of anxiety can change dramatically apathetic state, the skin takes on a purple tint, and the lips and fingertips turn blue. After 12 hours, a hemorrhagic rash appears, and blood pressure decreases. As shock increases, partial or complete failure some internal organs, acute renal failure develops.

Treatment should be prescribed without delay, because in such cases the probability of death reaches 60-70%. Antibacterial therapy is prescribed with removal of the purulent focus or drainage of the uterus.

For pneumonia

Since this is bacterial disease lungs, affecting the alveoli, one of its most serious exacerbations is infectious-toxic shock. At the slightest suspicion of ITS, the patient is transferred to the intensive care unit for constant monitoring for the work of all internal organs. The probability of death is quite high and amounts to 40-50% of cases.

Among initial symptoms may be observed respiratory alkalosis, cerebral disorders, expressed through apathy or anxiety, hyperventilation. Often, these symptoms may not attract attention, which does not allow the disease to be detected in time, thereby worsening the prognosis for recovery. With the progression of toxic shock, shortness of breath increases, tachycardia and a tendency to hypertension appear. The skin becomes warm and dry.

Treatment is carried out antibacterial therapy under constant supervision and recording of all clinical data.

Consequences and prognosis

The consequences of infectious-toxic shock can be very serious if treatment is not started on time.

Possible complications:

rhabdomyolysis;
renal and liver failure;
DIC syndrome;
cerebral edema;
encephalopathy.

At quick response With proper diagnosis and treatment, the prognosis is quite favorable. The body is fully restored within two to three weeks, the ability to work returns, and the patient can be prepared for discharge from the hospital. High percentage mortality in the second and third stages of the disease, due to failure or malfunction internal organs. Also, the development of disseminated intravascular coagulation syndrome during infectious-toxic shock often leads to death.

Prevention

Preventing the disease is not so difficult. It is enough to follow a few simple rules that will help you avoid not only infectious-toxic shock, but also a host of other infectious diseases.

quit bad habits, destroying the immune system;
All possible diseases treat as soon as possible and completely;
take vitamins and minerals that strengthen the immune system;
treat all skin lesions with an antiseptic, change bandages in a timely manner;
do not allow children to scratch chickenpox wounds;
do not self-medicate infectious diseases;

As a preventative measure, it is better for women after childbirth to refrain from using tampons.

By following simple tips, you protect yourself from all unpleasant infectious diseases. But it is worth remembering that if the first symptoms of infectious-toxic shock are discovered, it is necessary to urgently hospitalize the person, where he will be provided with professional assistance. After all, a minute's delay can cost your life or many months rehabilitation.

Next article.

What is Toxic Shock Syndrome?

Toxic shock syndrome is an acute and severe multisystem disease characterized by the sudden onset of high fever, hypotension, vomiting, diarrhea, erythematous skin rashes that desquamate upon recovery, and multiorgan involvement.

Toxic shock syndrome is rare and often a life-threatening illness that develops suddenly after infection and can immediately affect multiple organ systems, including the lungs, kidneys, and liver.

Because toxic shock syndrome progresses rapidly, immediate medical treatment is necessary.

What Causes Toxic Shock Syndrome?

Toxic shock syndrome is rarely the result of bacterial infection Streptococcus pyogenes(group A streptococcus) or Staphylococcus aureus(staphylococcus). These bacteria produce toxins that cause toxic shock syndrome. These bacteria are common but usually do not cause problems. They can cause easily treatable throat or skin infections, such as a sore throat or impetigo. In rare cases, toxins enter the bloodstream and cause a strong immune response in people whose bodies do not fight the toxins. The body's response causes symptoms associated with toxic shock syndrome.

Often appears after childbirth, flu, chicken pox, surgery, small cuts to the skin, wounds or bruises that cause bruising, but do not violate the integrity of the skin.

Often appears after prolonged use of tampons (menstrual toxic shock syndrome) or after a surgical procedure such as nasal surgery using a dressing (nonmenstrual toxic shock syndrome).

Pathogenesis (what happens?) during Toxic Shock Syndrome

The immune reaction leading to toxic shock syndrome is usually due to a lack of specific antibodies against streptococcal or staphylococcal toxins. Young people may not have such antibodies.

Outbreaks of toxic shock syndrome disease can occur in hospitals and long-term care facilities where people live in close proximity to each other.

Symptoms of Toxic Shock Syndrome

Rapid development of symptoms is one of the most important symptoms that may require immediate treatment for toxic shock syndrome.

Symptoms of toxic shock vary in severity depending on the type of streptococcal or staphylococcal bacteria.

Symptoms of toxic shock syndrome develop quickly and can cause death within 2 days.

The first signs of toxic shock syndrome usually include:
- Severe flu-like symptoms such as muscle aches and pain, stomach cramps, headache or sore throat.
- Sudden rise in temperature above 38.9 C.
- Vomiting and diarrhea.
- Signs of shock, including low blood pressure and rapid heart rate, often with dizziness, loss of consciousness, nausea, vomiting, or dysphoria and confusion.
- Redness similar to sunburn. Redness may appear in several parts of the body or in specific areas, such as the armpits or groin.
- Severe pain at the site of infection (if there is a wound or damage to the skin).
- Redness of the nasal passages and mouth.

Streptococcal nonmenstrual toxic shock syndrome.
Symptoms usually develop:
- In women who have recently given birth, 2-3 days or several weeks after birth.
- In people with infected surgical wounds, 2 days to 1 week after surgery.
- In people with respiratory diseases, 2-6 weeks after the onset of respiratory symptoms.

Staphylococcal menstrual toxic shock syndrome. Symptoms usually develop 3-5 days after the start of menstruation when a woman uses tampons.

Staphylococcal nonmenstrual toxic shock syndrome. Symptoms usually develop within 12 hours of surgery that uses surgical dressings, such as rhinoplasty.

Symptoms of toxic shock syndrome can suddenly affect several different organ systems, including the lungs, kidneys, and liver.

Redness similar to a sunburn may also appear early in the disease. Redness usually appears after 7-14 days on the palms of the hands and soles of the feet.

Toxic shock syndrome occurs less frequently in children compared to adults.

Dangerous complications of toxic shock syndrome include:
- Shock, causing a reduction in blood circulation and oxygen in vital organs.
- Acute respiratory failure syndrome. Lung function decreases, it becomes difficult to breathe, and oxygen levels in the blood drop.
- Disseminated intravascular coagulation syndrome. This disease is caused by a blood clotting factor. Many blood clots can form throughout the body. This may cause excessive bleeding.
- Kidney failure, also called end-stage renal disease. - Kidney failure occurs when kidney damage is so severe that treatment with dialysis or a kidney transplant is necessary to prevent death.

Talk to your doctor about possible complications if you have had multiple menstrual toxic shock syndromes.

Diagnosis of Toxic Shock Syndrome

Because toxic shock syndrome progresses rapidly, it is usually diagnosed and treated based on symptoms and signs of infection without waiting for laboratory test results. Additional blood and tissue testing can help determine the type of bacteria causing the infection.

If your healthcare provider suspects you have toxic shock syndrome, you will undergo several types of tests, including:
- Complete clinical blood test- counting red and white blood cells, platelets and other basic indicators of your blood.
- Cultures of blood and other fluids and tissues body for signs of streptococcal or staphylococcal bacteria. For menstrual toxic shock syndrome, a sample of vaginal fluid is tested. For nonmenstrual toxic shock syndrome, a swab or tissue sample is taken from a suspected lesion or other injured area of the body. Blood culture usually does not detect staphylococcal toxic shock syndrome when it is present, but streptococcus can be detected in a blood or cerebrospinal fluid sample or by tissue biopsy. Cultures from the throat, vagina, or saliva may also reveal bacteria.
- Fluorography to look for signs of lung damage (respiratory distress syndrome).
- Tests to detect other infections which can cause symptoms similar to those of toxic shock syndrome, such as blood poisoning (sepsis), a tick-borne bacterial infection (American tick-borne rickettsiosis), a bacterial infection caused by contact with the urine of an infected animal (leptospirosis), or typhoid fever.

Sometimes other tests are needed, depending on how the disease has progressed and what problems it has caused.

Treatment of Toxic Shock Syndrome

Emergency treatment often requires intravenous plasma volume resuscitation and intensive care in the hospital, especially when the body is in shock. Further treatment includes antibiotics to kill the bacteria, removal of any source of infection, and treatment of any complications. Unless there are other complications, most people recover within 2 weeks when treated with antibiotics.

Treatment for streptococcal or staphylococcal toxic shock syndrome includes:
- Removing the source of infection. If a woman uses tampons, a diaphragm or a contraceptive sponge, they should be removed immediately. Infected wounds are usually cleared of bacteria. Your doctor may give you an injection to numb the area so that you can use a scalpel or scissors to remove dead or severely infected tissue. This is called debridement. Once the source of infection is removed, the patient's condition often improves quickly.
- Treatment of complications of the disease, including low blood pressure, shock and organ failure. The specifics of treatment depend on what problem arose. The administration of large amounts of intravenous fluid is usually used to replace fluid losses from vomiting, diarrhea and fever in order to avoid complications such as low blood pressure and shock.
- Antibiotics to kill bacteria that produce toxins that cause toxic shock syndrome. Clindamycin stops the production of toxins and immediately treats symptoms. Other medications, such as cloxacillin or cefazolin, may be added when laboratory tests have detected specific streptococcal or staphylococcal bacteria. Staphylococcus aureus strains may be resistant to drugs such as cloxacillin and cefazolin, which are widely used around the world. These staphylococcal strains are called methicillin-resistant Staphylococcus aureus (MRSA). Other antibiotics may be needed to kill these bacteria. These antibiotics include vancomycin, daptomycin, linezolid, or tigecycline.

With timely treatment and the absence of serious complications, most patients recover within 1-2 weeks.

Staphylococcal toxic shock syndrome is serious, but leads to death in only 5% of people who are not diagnosed and treated correctly.

Toxic shock syndrome is a rapidly progressive, life-threatening illness that cannot be treated at home. If you think you may have toxic shock syndrome, seek medical help immediately.

Antibiotics are used to treat toxic shock syndrome. The sooner therapy begins, the fewer possible complications may occur. Antibiotics are used for as long as needed, depending on the streptococcal or staph bacteria and the severity of the symptoms.

Antibiotics may also help prevent recurrent episodes of toxic shock syndrome.

Intravenous immunoglobulin administration may be used when toxic shock syndrome is severe or the patient's condition does not improve after taking antibiotics. IV immune globulin works differently than antibiotics. It contains antibodies that can help the body remove specific toxins that cause toxic shock syndrome. But experts have not determined whether intravenous immunoglobulin is effective in treating toxic shock syndrome.

Your doctor can give you blood pressure medications to help your organs function better.

For toxic shock syndrome caused by staph bacteria, surgery is rarely required but is part of the necessary treatment. In some cases, surgical removal of infected tissue leads to significant improvement in the patient's condition. For example, surgery may be necessary when:
- Toxic shock syndrome has developed after surgery and the surgical suture must be drained and cleaned to remove the source of infection.
- Streprococcal bacteria cause necrotizing fasciitis, a bacterial infection that destroys the skin, and the dead tissue and toxins produced by the bacteria must be removed.

Streptococcal toxic shock syndrome with necrotizing fasciitis progresses rapidly and is life-threatening, requiring emergency surgery to remove the source of infection.

In the hospital, you may need intravenous fluids and simple protein to replace what your body has lost.

Prevention of Toxic Shock Syndrome

Preventing streptococcal infections during pregnancy or after childbirth

Women who are pregnant or have recently given birth have an increased risk of developing streptococcal toxic shock syndrome, especially if one of her children has strep throat. Any pregnant or postpartum woman with a baby who is showing signs of a sore throat should talk to her gynecologist or obstetrician.

Which doctors should you contact if you have Toxic Shock Syndrome?

Infectious disease specialist
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Hygienic tampons save many girls during their periods, allowing them to wear any clothes or dance without feeling discomfort. But many gynecologists are against regularly wearing these hygiene products, as they are associated with various disorders, for example, inflammation of the vagina, dysbiosis, thrush and others. Toxic shock syndrome from tampons is one of the most unpleasant consequences, so every girl should know why it occurs and how to avoid it.

TSS (toxic shock syndrome) – acute pathological condition, which suddenly arises due to severe intoxication of the body. It develops quickly, within a few hours the symptoms become critical and complications in the functioning of the kidneys and liver may appear.

The occurrence of TSS is associated with a developing infection, and pathogenic organisms can be bacteria: streptococci, staphylococci, as well as some protozoa, for example, malarial plasmodium. Toxic shock syndrome develops due to the release of large amounts of toxic waste from microorganisms into the human bloodstream. Toxin molecules enter the tissues of the kidneys, liver and brain, and then an acute condition begins.

TSS has clear symptoms that require a person to be taken to hospital immediately:

severe chills;
a sharp increase in temperature to 39-40 degrees;
nausea or vomiting;
problems with stool (diarrhea, diarrhea);
decreased blood pressure due to dehydration;
muscle aches and cramps;
swollen tongue;
rash, redness of the palms and soles;
impaired concentration and coordination;
foggy thoughts, loss of consciousness;
blood from the nose;
change in skin color and white of the eyes due to liver intoxication.

In the first hours the patient with similar symptoms it is necessary to provide medical assistance because activated carbon or other sorbents will not cope with so many toxins.

On days 4-14, the victim experiences sensory disturbances in the fingers and transient paralysis. vocal cords, and in severe cases, kidney damage is acute tubular necrosis and renal failure.

TSS when using tampons

Toxic shock often develops when wearing tampons, which are designed to maintain vaginal hygiene and protect it. This happens because staphylococci or streptococci begin to develop on the surface of these hygiene products moistened with blood. How do they get there? Lives on every person's skin huge amount bacteria, and some of them may be pathogens dangerous diseases, for example, Staphylococcus aureus. But they become pathogenic only when they multiply uncontrolled or after getting into wounds.

Toxic shock syndrome in a girl when wearing tampons can occur due to the following reasons:

untimely shift hygiene product;
choosing a tampon that is too large, which, when swollen with blood, causes inflammation of the vaginal mucosa;
if the girl already has problems with the vaginal microflora, and the body cannot protect itself from pathogenic microorganisms.

TSS may not occur immediately; often before this pathological condition, for several days or months, the woman’s microflora composition is disrupted, the vaginal mucosa becomes inflamed, and discomfort appears when inserting a tampon.

When toxic waste from multiplied pathogenic bacteria begins to enter a woman's bloodstream, she develops symptoms of TSS. They are especially pronounced in the first days of menstruation, since during this period the body is weakened.

Diagnosis of TSS

Diagnosis in the case of developed toxic shock syndrome consists of a urine and blood test for the presence of bacteria themselves and their metabolic products; it is also necessary to take a smear from the vagina for bacterial culture, and to collect tissue from the cervix.

These diagnostic measures will help determine the type of pathogenic bacteria, and without this information it is impossible to carry out treatment properly. A urine and blood test will help determine not only the amount of toxins that have entered the body, but will also show the condition of the liver and kidneys. If the first organ is damaged, there will be more bilirubin in the blood, and if the function of the second organ is impaired, the glucose content in the urine will increase and the amount of salts will decrease.

Treatment of TSS

Treatment of toxic shock syndrome is complex and painful, because it is accompanied by unpleasant intravenous injections antibiotics, constant drips to cleanse body fluids and other procedures. Therapy can only be carried out in a hospital setting under the constant supervision of a doctor.

To neutralize toxic shock and prevent its reoccurrence, it is necessary to cope with the cause of the pathological condition - bacteria. Superficial antibiotics should not be introduced into the vagina, as they will not only disrupt the composition of the microflora, but can also leave burns.

Oral antibacterial drugs are also ineffective in the case of TSS, since they will take a long time to “get” to their destination.

In case of toxic shock syndrome after using tampons, a woman is prescribed a course of intravenous injections of an antibiotic selected based on test results. In addition to such medicines, a course of gamma globulin injections is often prescribed to maintain protective system body. This drug will control the functioning of white blood cells and stimulate them to destroy bacteria.

When using antibiotics, we must not forget about prebiotics, without which, after treatment, the composition of a woman’s intestinal and vaginal microflora will significantly deteriorate. Start a course of drugs with beneficial bacteria necessary 3-4 days after starting antibiotics, so as not to burden the liver.

Complementary therapy

In case of TSS, it is necessary to cleanse the blood of toxic substances. For this, active sorbents are used, and the girl is also given IVs with saline several times a day. We must also not forget that toxic shock syndrome often leads to sharp decline blood pressure, this is especially dangerous for the blood vessels of the brain, so it is necessary to take drugs that eliminate hypotension.

One of the main factors effective treatment TSS – bed rest and constant calm, since intense exercise, stress and lack of sleep will only increase intoxication of the body and also lead to complications.

Complications of TSS

In the body, the main blood-filtering “stations” are the kidneys and liver, so they become the main victims of toxic shock syndrome. They keep inside large number toxic substances, their cells begin to die. Without timely treatment and with heavy loads on the body, a person develops kidney or liver failure, which is manifested by disruption of the functioning of these organs. In this case, the girl experiences yellowing of the skin and white of the eye, a decrease in the amount of urine and a more intense color, pain in the lumbar region and right hypochondrium.

Toxins are dangerous not only for the kidneys and liver, they settle in large quantities in the heart muscle, which passes through all the body’s blood in less than a minute, and in the brain tissues, which are abundantly supplied with blood. In this case, heart failure occurs - sharp pains in the chest on the left, pressure decreases, mental activity is disrupted.

How to Reduce Your Risk of TSS

To reduce the risk of toxic shock syndrome when using tampons, you should: simple rules wearing these hygiene products:

tampons need to be changed every 4 hours so that a large number of pathogenic bacteria do not develop on them;
the maximum time to wear a tampon is 8 hours, but after that you need to wash yourself thoroughly using intimate hygiene gel;
You should use tampons only when necessary (when going to the pool, playing intense sports: athletics, dancing, etc.);
It is important to choose the right tampon size and degree of absorbency.

By observing these preventive measures, a girl can significantly reduce her risk of TSS. But many gynecologists recommend abandoning tampons altogether in favor of regular sanitary pads, and there are several reasons for this.

Firstly, when inserting even a freshly unpacked hygiene product, a girl can introduce bacteria into the vagina from the skin, from the air, or from the surface of the tampon itself, which is not sterilized. Secondly, a tampon soaked in blood begins to rub the vaginal mucosa, causing inflammation and microtraumas, which can easily become infected.

Who is at risk

The following categories of users are at risk of developing TSS while using tampons:

girls with inflammatory processes in the reproductive system;
girls with disturbances in the composition of the vaginal microflora, as well as those suffering from thrush or STDs;
owners of weak immunity;
those who use tampons for longer than the permitted time or do not observe hygiene rules after using them.

Toxic shock syndrome when using tampons occurs due to the proliferation of pathogenic bacteria in the vagina, which release toxic waste into the body. This pathological condition is dangerous for the health of many organs and even for human life, so it is necessary to follow the rules of wearing tampons or completely abandon them.

Description:

Toxic shock is rare and often a life-threatening condition that develops suddenly after infection and can immediately affect multiple organ systems, including the lungs, kidneys, and liver.

Symptoms:

Symptoms develop quickly and can cause death within 2 days. The first signs usually include:

      *Severe symptoms similar to, such as muscle pain and pain, stomach cramps, or.
      *Sudden increase in temperature above 38.9 C.
      *Vomiting and .
      *Signs of shock include low blood pressure and rapid heartbeat, often with dizziness, loss of consciousness, nausea, vomiting, or dysphoria and confusion.
      *Redness similar to sunburn. Redness may appear in several parts of the body or in specific areas, such as the armpits or groin.
      *Severe pain at the site of infection (if there is a wound or damage to the skin).
      *Redness of the nasal passages and mouth.

Other symptoms of toxic shock may include:

      *Conjunctivitis (redness).
      *Involvement of more than one organ system, usually the lungs or kidneys.
      *Blood poisoning (sepsis), which affects the entire body.
      *Death of skin tissue (necrosis), which appears at the beginning of the syndrome.
      *Peeling of skin tissue that appears during recovery.

Symptoms of toxic shock vary in severity depending on the action of streptococcal or staphylococcal bacteria.

Causes:

Toxic shock is rarely the result of infection with the bacteria Streptococcus pyogenes (group A streptococcus) or Staphylococcus aureus (staph). These bacteria produce toxins that cause toxic shock. These bacteria are common but usually do not cause problems. They can cause easily treated throat or skin infections, such as a sore throat or. In rare cases, toxins enter the bloodstream and cause a strong immune response in people whose bodies do not fight the toxins. The body's response causes symptoms associated with toxic shock.

*Streptococcal toxic shock often appears after childbirth, flu, chickenpox, surgery, small skin wounds or wounds that cause but do not violate the integrity of the skin.
*Staphylococcal toxic shock often occurs after prolonged use of tampons (menstrual toxic shock) or after a surgical procedure such as nasal surgery using a dressing (nonmenstrual toxic shock).

Treatment:

For treatment the following is prescribed: