Download Staphylococcus aureus: Toxic Shock Syndrome

Staphylococcus aureus: Toxic Shock Syndrome
By Dipti Prasad
Toxic Shock Syndrome (TSS) is a bacterial infection most commonly caused by the
toxins released by Staphylococcus aureus1. S. aureus is a normal bacteria present on human
bodies and can be found mainly in moist areas, especially the nose and vagina4. Research
shows that the syndrome can also be caused by another group of bacteria called
Streptococcus pyogenes, however this is more rare2. TSS is a sudden and dangerous disease
if left untreated. The syndrome has long been associated with women and their use of
tampons, especially if they are left in for too long1. Hyper-absorbant tampons and douching
can result in TSS because their prolonged use can enhance the growth of S. aureus and
cause the bacteria to release exotoxins into the bloodstream5. However, the syndrome can
also affect men, women, and children1. S. aureus produces “superantigenic exotoxins,
including TSS toxin-1, which activates a vast number of T-cells...”3 Cytokines that are
produced by the T-cell and activated by the TSS toxin-1 cause the symptoms of TSS3.
The symptoms of TSS include1:
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High fever
Hypotension (low blood pressure)
Vomiting and/or diarrhea
A rash (looks like a sunburn), especially on palms and soles
Confusion
Muscle aches
Eyes, mouth, and throat are red
Seizures
Headaches
TSS cannot be transmitted from an infected person to an uninfected person.
However, the bacteria S. aureus can be transmitted between persons. It is the toxins that S.
aureus releases that cause symptoms of TSS and not the actual bacteria4. S. aureus is a gram
positive bacteria normally seen as clusters; they live on the skin and mucosal sites6. They
are non-motile and do not form spores; they are also a facultative anaerobe. S. aureus
ferments mannitol and produces lactic acid6.
There is no specific test that can diagnose TSS, however a doctor can do a physical
and pelvic exam. In addition, a blood and urine test might be done, and in some cases a
biopsy7. The doctor will check the “blood count, electolytes, and liver kidney functions”8. If
the patient has an elevated white blood cell count or abnormal kidney and liver functions,
this could indicate TSS8. A chest exam may be done to check for fluid in the lungs8.
Basically, since there is no specific test for TSS, doctors often run tests to rule out other
disease possibilities8.
TSS was first discovered to affect children in 1978, however it was not recognized
as a serious disease until after the epidemic in 19818. It was found that women using super
absorbency tampons were having symptoms of TSS8. TSS was the cause of death of several
young women in the early 1980s who were using a super absorbent brand name tampon,
which was taken off the market after the deaths5.
S. aureus has many virulence factors. The capsule and Fibronectin-binding proteins
are the cell surface factors; however, the exoproteins, such as cytolysins and superantigens
help in the progression of the infection by damaging the tissues to the mucous membranes
and skin9. S. aureus disrupts host cell through secretions such as “superantigens, poreforming toxins, exoenzymes, and miscellaneous proteins”9. According to the textbook of
bacteriology, S. aureus also have invasins that help spread the toxin to other areas of the
body; “biochemical properties” that allow the bacteria to resist phagocytosis; and resistance
to “antimicrobial agents” 9.
If diagnosed with TSS, the patient must immediately seek medical attention5. The
goal of the treatment is to prevent organ failure and stop the poison from spreading to other
areas of the body. If the symptoms are caused due to tampon use, the vaginal cavity will be
flushed out with saline. In most cases, IV fluids will be given to the patient because they
have lost so much fluid. The patient may also need a ventilator to help with breathing. If
kidneys have been affected, then the patient might need dialysis to help the toxins exit the
blood. Finally, medications for blood pressure or fever may be given7.
Best way to avoid TSS is prevention. Do not use superabsorbent tampons, as they
can be left in the vaginal cavity for too long and also can cause microscopic rips in the
cavity when pulled out. Another important way to prevent TSS is to wear sanitary napkins
instead of tampons at night. Using the least absorbent tampon for the menstrual flow is
important so the tampon can be changed more regularly; do not leave tampons in for more
than 8 hours. And lastly, remove any cervical caps, menstrual sponge, or diaphragm when it
is not being used. None of these contraceptives should be left in for longer than 24 hours5.
TSS was recognized as a serious disease in 1980 after the epidemic between 19791980. After the epidemic, number of cases decreased from 6 to 12 per 100,000 to 1 per
100,000 women between the ages of 15 and 44 in 1986 10. No known outbreaks have been
recorded in Texas.
ANON. Mayo Clinic. “Diseases and Conditions Toxic Shock Syndrome.” 7 May 2011. 4
May 2014. http://www.mayoclinic.org/diseases-conditions/toxic-shocksyndrome/basics/symptoms/con-20021326
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2
Smit, M. A, Nyquist, A., Todd, J.K. “Infectious shock and toxic shock syndrome
diagnoses in hospitals, Colorado, USA”. November 2013. 7 May 2014.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3837668/
3
Matsuda, Y. et al. “Early and definitive diagnosis of toxic shock syndrome by detection of
marked expansion of t-cell-receptor vβ2-positive t cells.” 3 March 2003. 4 May 2014.
http://wwwnc.cdc.gov/eid/article/9/3/02-0360_article.htm
Virginia Department of Health. “(Staphylococcal) Toxic Shock Syndrome” 28 September
2011. 4 May 2014. http://www.vdh.state.va.us/epidemiology/factsheets/Staphylococcal.htm
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5
Todd, N. “Understanding toxic shock syndrome: the basics.” 17 March 2014. 4 May 2014.
http://www.webmd.com/women/understanding-toxic-shock-syndrome-basics
6
Toddar, K. “ Staphylococcus aureus and staphylococcal disease.” 2008. 4 May 2014.
http://textbookofbacteriology.net/staph.html
7
Wood, D. “Toxic shock syndrome.” August 2013. 4 May 2014.
http://medicine.med.nyu.edu/conditions-we-treat/conditions/toxic-shocksyndrome#prevention
8
Bushra, J. M. “Toxic Shock Syndrome.” 26 Oct 2005. 4 May 2014.
http://www.emedicinehealth.com/toxic_shock_syndrome/page5_em.htm
9
Lin, Y. & Peterson, M. “New insights into the prevention of staphylococcal infections and
toxic shock syndrome.” Expert Rev Clin Pharmacol. 2010, 3(6): 753-767. 4 May 2014.
http://www.medscape.com/viewarticle/733074_3
10
Hajjeh, R. et al. “Toxic Shock Syndrome in the United States: Surveillance Update 19791996.” Emerging Infectious Diseases. 5(6):807-810. November-December 1999. 6 May
2014. http://wwwnc.cdc.gov/eid/article/5/6/pdfs/99-0611.pdf