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admin | Prevent Bv | 05.07.2014
Toxic shock syndrome is rare but life threatening, caused by bacterial toxins from staphylococcus aureus.
Toxic Shock Syndrome is due the bacterial infection via the skin, vagina or pharynx into the bloodstream. While it is not uncommon for Staph bacteria to colonize the skin, a cut, surgery or wound in some individuals may lead to the bacteria entering the blood without immunity to fight it. Diagnosis is made based on physical examination, blood or urine test or swaps from the cervix, vagina and throat. If the internal organs are affected, it can lead to liver, kidney, heart failure, seizure and shock.
Certain precautions for menstruating female who uses tampon are to change the tampon every 4 to 8 hours and to use a low-absorbency tampon.
Acute rheumatic fever (ARF) is caused by a reaction to a bacterial infection with particular strains of group A streptococcus.
Symptoms of ARF generally develop several weeks after an episode of streptococcal pharyngitis (however many patients do not recall having a sore throat).
Carditis (inflammation of the heart) – This involves the heart valves, heart muscle, and membrane surrounding the heart.
Sydenham chorea – This is a disorder of the nervous system characterised by personality changes, muscle weakness, and involuntary movements.
Subcutaneous nodules (small lumps under the skin) – These are now uncommon, occurring in less than 2% of patients with ARF. The diagnosis of ARF is challenging, as there are no clinical features or diagnostic tests available to confirm or rule out this condition. Culture of throat swabs and rapid antigen tests for group A streptococcus are less accurate. Following a diagnosis of rheumatic fever, it is standard practice to treat the group A streptococcal infection that led to the disease with oral penicillin (although this practice has not been proven to alter long-term outcomes). Following the initial attack, patients are treated with continuous penicillin to prevent further streptococcal colonisation or infection and additional damage to the heart.
Patients with rheumatic heart disease may occasionally require heart surgery to repair or replace damaged heart valves. ARF can be prevented with timely treatment of group A streptococcal pharyngitis, particularly in people aged 5-15 years.
About 15–40 per cent of healthy humans are carriers of S aureus, that is, they have the bacteria on their skin without any active infection or disease (colonisation).
Despite being harmless in most individuals, S aureus is capable of causing various infections of the skin and other organs. Most staph infections occur in normal individuals, but underlying illness and certain skin diseases increase the risk of infection.
Staphylococcal aureus bacteria are classified as Gram-positive cocci based on their appearance under a microscope.
They are only able to invade via broken skin or mucous membranes, hence intact skin is an excellent human defence. Release toxins (intoxication) – these do not require the presence of live bacteria to have an effect. Staphylococcal scalded skin syndrome (SSSS), which usually affects children less than five years old or rarely, adults with kidney failure. In staphylococcal intoxications there may be no viable bacteria to culture and the diagnosis may be made retrospectively on the basis of a blood test demonstrating an immune response (seroconversion) to toxins following a compatible illness.

Staphylococci are becoming increasingly resistant to many commonly used antibiotics including penicillins, macrolides such as erythromycin, tetracyclines and aminoglycosides. Penicillin resistance in S aureus is due to production of an enzyme called beta-lactamase or penicillinase.
Penicillins with a beta-lactamase-inhibitor such as amoxicillin + clavulonic acid may be used to treat Staph.
Patients who are allergic to penicillin are most reliably treated with vancomycin, although for minor infections macrolides such as erythromycin may be adequate. Due to widespread antibiotic resistance, it is better to prevent staphylococcal infections where possible.
It is also important to clear bacteria colonising the nostrils and under the fingernails with either antibiotic ointment (eg.
Author: Amy Stanway MBChB, Registrar, Department of Dermatology, Waikato Hospital, Hamilton, New Zealand, 2002.
Toxic Shock Syndrome commonly affects teens and young adults, from age 15 to 35 and majority, female. The conducive environment for the toxin is protein-rich and oxygen, which is what the use of tampons during menstruation provides.
An intravenous antibiotic will be prescribed to fight the bacteria infection, or medication to stabilize blood pressure and to prevent dehydration. If you like my blog posts, you are welcome to share via social media, but not by copying, republishing, selling or distributing the contents of this site without permission. It has long been thought that ARF only follows streptococcal pharyngitis (sore throat), however recent studies from Aboriginal populations in Australia have suggested streptococcal skin infection may precede some cases of ARF. The painless nodules are found over joints (such as the elbows, knees, ankles, and knuckles), the back of the scalp, and the vertebrae (backbone).
The most commonly used tests are the plasma antistreptolysin O and the antideoxyribonuclease B titres. Continuous penicillin is also recommended for people with established rheumatic heart disease. Staphylococcus aureus (S aureus) is the most important of these bacteria in human diseases.
The carrier sites are usually the nostrils and flexures, where the bacteria may be found intermittently or every time they are looked for.
S aureus infections are common in people with frequent skin injury, particularly if the skin is dry. This is a relatively uncommon illness usually resulting from the release of Toxic Shock Syndrome Toxin-1 (TSST-1) or enterotoxin B.
If there are difficulties in diagnosis, or firstline treatment fails, the diagnosis can be confirmed by a positive laboratory culture of a swab from the infected site or blood culture.
Methicillin (meticillin) and flucloxacillin are lactamase-resistant penicillins so are the antibiotics of choice in most staphylococcal skin infections. Macrolide resistance is also high among S aureus but macrolides may be taken by mouth whereas vancomycin requires intravenous administration. Updated by Dr Jannet Gomez, Postgraduate student in Clinical Dermatology, Queen Mary University London, UK. Tampons with higher absorbency (polyester, carboxymethylcellulose and polyacrylate) increases the risk of TSS.

I wonder if there’s increased risk since the skin of eczema patients tend to have staph bacteria colonization.
Those who have experienced one episode of ARF are more likely to suffer recurrent attacks with subsequent group A streptococcal infections. Worldwide there is an estimated 470 000 new cases of ARF annually (60% of whom eventually develop rheumatic heart disease). When present, it is found on the trunk and upper arms and legs, but almost never on the face. These criteria require evidence of a preceding group A streptococcus infection, and various combinations of the characteristic features above and other non-specific clinical features. Continuous penicillin is generally given by injection every four weeks for a minimum of 10 years. Other staphylococci, including S epidermidis, are considered commensals, or normal inhabitants of the skin surface.
Staph skin infections are seen most commonly in pre-pubertal children and certain occupational groups such as healthcare workers. They are usually facultative anaerobes, that is, they are capable of surviving at various levels of oxygenation, and are generally very hardy organisms.
These toxins are also known as superantigens as they are capable of generating a massive inflammatory response. These antibiotics have a broad range of action against several bacteria and are best reserved for patients with mixed bacterial infections. The toxins can cross the vaginal wall to the blood stream, possibly through tear when inserting the tampon.
Also the cause of the bacterial infection will be removed, for instance, removal of the tampon or draining pus from the skin wound. The most severe complication of recurrent ARF is permanent damage to heart valves, known as rheumatic heart disease. In most developed countries ARF is now rare, with a few notable exceptions; the highest documented rates of ARF in the world are in Maori and Pacific people in New Zealand, Aboriginal Australians, and those in Pacific Island nations.
The rash appears as pink or red macules (flat spots) or papules (small lumps), which spread outwards in a circular shape.
The nodules are usually only found when severe carditis is present and resolve within one month. A detailed explanation of these criteria (and modifications for the New Zealand environment) can be found on the National Heart Foundation of New Zealand website.
Previous exposure makes a patient immune to these toxins, ie they will not have a second attack.
National Heart Foundation of New Zealand and the Cardiac Society of Australia and New Zealand. The lesions can fade and reappear within hours and may persist intermittently for weeks to months.

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