Alternative names
Toxic shock syndrome; Staphylococcal toxic shock syndrome

Toxic shock syndrome is a severe disease caused by a toxin made by Staphylococcus aureus, characterized by shock and multiple organ dysfunction.

Causes, incidence, and risk factors

Toxic shock syndrome (TSS) is caused by a toxin produced by certain types of staphylococcus bacteria. Although the earliest described cases involved mostly menstruating women using highly absorbent tampons, only 55% of current cases are associated with menstruation. The illness can also occur in children, postmenopausal women, and men.

Risk factors include recent menstruation, recent use of barrier contraceptives such as diaphragms and vaginal sponges, vaginal tampon use (especially prolonged), recent childbirth, recent surgery, and current S. aureus infection.


  • High fever, sometimes accompanied by chills  
  • Profound malaise  
  • nausea, vomiting, and/or Diarrhea  
  • Diffuse red rash resembling a sunburn  
  • Rash followed in 1 or 2 weeks by peeling of the skin, particularly the skin of the palms or soles  
  • Redness of eyes, mouth, throat  
  • Confusion, seizures, headaches  
  • Myalgias (muscle aches)  
  • Hypotension (low blood pressure)  
  • Organ failure (usually kidneys and liver)

Signs and tests

The diagnosis of toxic shock syndrome is based on several criteria: fever, low blood pressure (hypotension), rash that peels after 1-2 weeks, and at least 3 organs with signs of dysfunction. In some cases, blood cultures may be positive for growth of S. aureus.


Treatment involves examination for and removal of foreign material (such as tampons, vaginal sponges, or nasal packing) and drainage of any identified site of infection (such as surgical wounds).

Supportive measures are essential and may include intravenous fluids, Blood pressure support, and dialysis (if severe kidney dysfunction is present). Antibiotic therapy is also used and in some cases, intravenous immunoglobulin may be required.

Expectations (prognosis)
Toxic shock syndrome may be fatal in up to 50% of cases. Among survivors it may recur.


  • Severe organ dysfunction:       o Kidney failure       o heart failure       o liver failure  
  • Profound shock

Calling your health care provider
TSS is a medical emergency. You must seek immediate attention if you develop fever or rash, particularly during menstruation and tampon use, or if you have had recent surgery.

Menstrual TSS can be prevented by avoiding the use of highly absorbent tampons. Risk can also be reduced by using less absorbent tampons, and by using tampons only intermittently during menstruation.

Johns Hopkins patient information

Last revised: December 6, 2012
by Simon D. Mitin, M.D.

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