What should you know about pathophysiology of toxic shock syndrome?

Toxic shock syndrome is linked to toxin-producing bacteria, including some strains of Staphylococcus or Streptococcus. The bacteria may enter through a wound, skin infection, surgical site, vaginal infection or another damaged area. The toxins can activate many immune cells at once rather than producing only a local response.

This immune activation may cause fever, rash, vomiting or diarrhoea, muscle aches, confusion and a sharp fall in blood pressure. Reduced blood flow can impair organs such as the kidneys, liver, lungs and heart. Menstrual products have been associated with some cases, but toxic shock syndrome can affect anyone and can arise from several sources.

Treat suspected toxic shock syndrome as an emergency. Remove a tampon or menstrual cup if one is in place, but do not delay emergency help while trying to identify the source. Clinicians may take samples, give intravenous fluids, antibiotics and other supportive treatment, and inspect or treat an infected wound. Antibiotic Treatment for Pelvic Infection is one treatment topic a clinician may discuss when a pelvic source is suspected; the exact treatment depends on the infection and the person’s condition.

Call emergency services for sudden fever with faintness, confusion, severe weakness, breathing difficulty, repeated vomiting, a widespread rash, cold or clammy skin, or very little urine. Symptoms can worsen quickly. Tell the team about recent surgery, wounds, skin infections, childbirth, vaginal products and medicines.

What source of infection is most likely? Which organs need monitoring? What treatment is being started, and how will you know it is working? When is it safe to use tampons or menstrual cups again? How should wounds or pelvic infections be managed afterward?