Toxic Shock Syndrome - Symptoms, Risk factors and Treatment

Toxic shock syndrome is a rare, life-threatening condition caused by the release of bacterial toxins. It is mostly caused by Staphylococcus Aureus also known as Staph and Group A Streptococci. 


The streptococci are a group of bacteria causing different clinical diseases. They produce illnesses by releasing toxins or by a delayed antibody-mediated response, which is a condition in which your body starts hurting your own tissues while fighting off the bacteria. Streptococci are divided into different groups such as:

  • Group A Streptococci ( Streptococcus pyrogens)

  • Group B streptococci ( Streptococcus agalactiae)

  • Group D streptococci ( Enterococci and Non-enterococci)

  • Streptococcus Viridans

  • Streptococcus Pneumoniae

All these different groups produce a variety of diseases. For example, Streptococcus Pneumoniae causes pneumonia. The disease we are focusing on in this article is caused by group A streptococci. These are also called Streptococcus pyrogens which means pus-producing. This group causes a variety of diseases by local invasion or toxin release or by a delayed antibody-mediated response such as:

  • Streptococcal pharyngitis (Sore throat)

  • Folliculitis (infection of hair follicles)

  • Cellulitis ( Infection of skin cells)

  • Erysipelas (Infection of superficial skin layer)

  • Impetigo ( Blisters around the mouth)

  • Necrotizing Fasciitis ( Damage to soft tissues)

  • Scarlet fever

  • Rheumatic fever

  • Acute-post streptococcal glomerulonephritis


Staphylococci are a group of bacteria that are present almost everywhere. They are present on our skin and different surfaces and are a big source of hospital-acquired infections. They cause a variety of diseases and are classified mainly into three types:

  • Staphylococcus aureus

  • Staphylococcus epidermidis

  • Staphylococcus saprophyticus

These bacteria cause different types of diseases. Staphylococcus Aureus is a big source of hospital-acquired pneumonia, frequently encountered as MRSA (Methicillin-resistant staphylococcus aureus), and different skin infections like cellulitis, impetigo, abscesses, and wound infections. It also causes toxic shock syndrome by producing a toxin.

Risk factors for toxic shock syndrome:

Menstruating women

  • Toxic shock syndrome is often seen in menstruating women due to the use of;

  • Tampons

  • Menstrual cups

  • Sponges

  • The use of tampons, menstrual cups, and sponges provides a ground for bacteria to grow and release toxins.

However, it is not only seen in menstruating women. It can be seen in any condition in which bacteria can be introduced to your body. This could be due to:

  • Infected sutures after surgery

  • Infection after abortion 

  • Infection after childbirth

  • Skin infections

  • Open wounds

  • Burns

  • Prosthetic devices

How toxic shock syndrome occurs?

The bacteria release a toxin called Toxic shock syndrome toxin ( TSST). This toxin activates cells in your body called macrophages that in turn activate Helper T cells. These T cells play role in the inflammatory response. Due to the activation of these cells, the body produces a massive inflammatory response that can be fatal. 

Symptoms of toxic shock syndrome:

The initial symptoms of toxic shock syndrome include:

  • Nausea

  • Vomiting

  • Watery diarrhea

These symptoms are later followed by:

  • Sunburn like rashes

  • Peeling (Desquamation) of the skin

Complications of toxic shock syndrome:

The complications of toxic shock syndrome include:


Sepsis is your body's response to an infection. This can result in:

  • Fever

  • Chills

  • Fast heart rate

  • Cold skin

  • Nausea

  • Vomiting

Multi-organ damage:

The toxin can cause damage to the following organs:

  • Liver

  • Kidneys

  • Gastrointestinal system (GIT)

  • The central nervous system (CNS)

  • Muscles


Toxic shock syndrome can result in low blood pressure (hypotension) that can cause decreased blood flow to the organs, a condition known as shock.

Treatment of toxic shock syndrome

Toxic shock syndrome is treated mainly by:

  • Cleaning of infected focus

  • Drainage of the infected wound

  • Tampon removal

  • Antibiotics

Antibiotics are given to kill the bacteria if there are any. But they are not totally curative as it is the toxin that is causing toxic shock syndrome and not the bacteria itself that the antibiotics kill.


Toxic shock syndrome is a rare, life-threatening condition caused by the release of bacterial toxins. It can be fatal if left untreated and requires prompt medical attention. If you experience any symptoms of toxic shock syndrome and are using tampons, menstrual cups, or similar devices, immediately remove them and consult your healthcare provider.

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