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The Toxic Shock Syndrome (TSS) has been described in 1978 as a disease that affects multiple systems of the body in children, and the Staphylococcus aureus bacteria has been identified as the main culprit. In 1980, TSS begins to occur as an epidemic in young white females, during the menstrual cycle. In the vagina of the patients, Staphylococcus aureus is discovered once again. TSS has been connected to the introduction of certain types of the highly absorbent (super absorbent) tampons. The public education and the pulling of the super absorbent tampons from the American stores have resulted in a significant decrease in the numbers of the reported cases of TSS.
Cause
Staphylococcus aureus (Golden Staphylococcus) is a gram-positive round bacterium. After the cell division, they remain mutually connected, hence the name of the genus (Greek Stapilo = raceme and coccus = grain); they are facultative anaerobes. Staphylococcus aureus’s natural environment is the human body surface, as well as the body surface of many other mammals and birds. Besides on the skin, it can be found in the mucosae, as a transient flora. It is present in the dust and on the generally used objects, and can also be found in milk and some other types of food, to which they are usually transferred from human hands. Staphylococcus aureus excretes an abundance of enzymes and poisons, the so-called exotoxins, which participate in the occurrence of the infections. The exotoxin called TSS1 (per the English name ‘toxic shock syndrome toxin’), causes the toxic shock syndrome. The toxic shock syndrome can appear during any infection caused by the Golden Staphylococcus, which excretes this enzyme.
The appearance of the disease
Staphylococcus aureus is present in the vagina of 20-50% of women. If the release of its exotoxin in the bloodstream occurs, a toxic shock can happen. The development of the toxic shock syndrome can occur during the menstruation and with the use of tampons, especially if the tampons are not being changed for longer periods of time, which causes the blood to linger in the vagina longer and Staphylococci to develop in greater numbers, as well as their toxins.
During menstruation, a toxic shock syndrome also occurs as skin infection complication, the wound infection after natural birth and Cesarean section, tissue infection, pneumonia after influenza, and, rarely, after the primary staphylococcus bacteremia (the presence of bacteria in the blood). The menstrual and non-menstrual TSS have the same symptoms.
Diagnosis
Diagnosis is determined based on the conversation with the patient, examination, and taking samples for macro-biological diagnosis. The diagnosis is usually simple due to the existence of typical symptoms and characteristic circumstances in which these symptoms occur – the beginning of menstruation or during the Staphylococcus infection.
Treatment
The treatment is directed towards eliminating the shock, insufficient kidney and lung functioning, and disseminated intravascular coagulation. Antibiotics are given intravenously. High dosages of antibiotics are needed – penicillin, klindamicin, gentamicin. If the infection has occurred outside of the hospital, it is assumed that staphylococcus that is sensitive to penicillin is the main cause – so penicillin is introduced into the treatment and it is not necessary to eliminate the type and examine its sensitivity. However, if it’s an in-hospital infection, a sample for macro-biological diagnosis must be taken, and the isolated type is tested for the sensitivity to antibiotics, which are determined according to the test results.
If the local layers of pus are present as a result of a Staphylococcus infection, a surgical procedure is needed. It is necessary to stop using tampons, which will prevent the reoccurrence of the illness.
Prevention
The Toxic Shock Syndrome can be prevented with timely treatment of Staphylococcus infections, taking proper care of the post-surgical wounds, and frequent tampon change. A quick identification of TSS and the emergency treatment measures in order to prevent death or the eventual consequences of the illness are also considered as preventive actions.