Disease Description (Causes and Symptoms)
- Definition and causes: Toxic shock syndrome (TSS) is a systemic toxic reaction caused mainly by toxins produced by Staphylococcus aureus ( 대표적으로 TSST-1) or, more rarely, toxins secreted by streptococci. Superantigens produced through bacterial invasion itself or at a localized infection site excessively activate the immune system, causing a systemic inflammatory cytokine storm. According to the provided material, prolonged use of highly absorbent tampons during menstruation increases the risk in many cases (more than half of cases), and burns, wounds, surgical sites, and childbirth-related devices can also be causes.
- Pathophysiology summary: Massive T-cell activation by superantigens → massive cytokine release → vasodilation, capillary leakage, hypotension, and multiple organ failure. Early findings may include a skin rash and mucosal bleeding, followed later by desquamating erythema and peeling of the cornea or the palms and soles (after several weeks).
- Main symptoms: High fever (acute), hypotension (dizziness and fainting), generalized rash (sunburn-like erythema), vomiting and diarrhea, muscle pain, headache, mucosal bleeding, acute kidney failure, abnormal liver function, coma, and other signs of multiple-organ involvement. It may worsen to septic shock as it progresses.
Treatment
- Emergency principles: Prompt supportive care (fluids and hemodynamic stabilization), removal of the source of infection (removal of tampons, packing, and infected devices; drainage of wounds and abscesses, etc.), administration of appropriate antibiotics, and intensive care management when necessary.
- Antibiotics:
- Empirical treatment: Begin treatment to cover Staphylococcus aureus and streptococci. Considering the local prevalence of MRSA, determine whether to include vancomycin (or another MRSA-covering drug).
- Combination treatment with clindamycin is recommended to suppress toxin production (reduces toxin production by inhibiting protein synthesis).
- When MSSA is identified, switch to a β-lactam such as nafcillin/oxacillin/cloxacillin.
- Immunotherapy: IVIG (intravenous immunoglobulin) may be considered in severe cases (the evidence is partly positive, and the risks and benefits must be assessed for each patient).
- Surgical treatment: When there is an infectious focus (an abscess or necrotic tissue), promptly remove it through drainage, irrigation, excision, or other procedures.
- Other supportive treatments: Vasopressors (such as NE) for hypotension, mechanical ventilation for respiratory failure, hemodialysis for acute kidney failure, and so on.
- Steroids: Not generally a standard treatment (they may be used as an adjunct in specific situations, but consistent evidence is lacking).
- Lifestyle management and precautions:
- Hospitalization and observation are recommended initially (symptoms may worsen rapidly).
- People with a history of TSS are advised to consult a doctor before using tampons; avoid prolonged use of highly absorbent tampons, and replace tampons regularly (every few hours).
- Carefully manage wounds and burns, and seek medical attention early if infection is suspected.
Checklist Before an Outpatient Visit (Items to Bring and Example Questions)
- Items to bring (recommended)
- A list of currently used medications (including prescription drugs, OTC drugs, and supplements)
- A record of medication allergies
- Information on recent surgeries, childbirth, dental procedures, and inserted devices (such as an IUD)
- Information on tampon or packing use (duration and type) and menstruation-related information
- Information about and photographs of any recent wounds, burns, or abscesses (if possible)
- Copies of recent test results (blood tests, cultures, and imaging)
- A record of when symptoms began and how they progressed (fever, changes in urine output, blood-pressure-related symptoms, etc.)
- Things to check for yourself before the outpatient visit
- Your temperature over the past several days and the frequency of gastrointestinal symptoms (vomiting and diarrhea)
- Any changes in consciousness, dizziness, or decreased urine output
- Any shortness of breath, chest pain, or severe pain
Examples of General Questions to Ask the Doctor
- “What type of antibiotic will I be prescribed, and what possible side effects can it have?”
- “Do I need hospitalization or intensive care? How long will treatment take?”
- “What is the prognosis of this disease, and how likely is it to recur?”
- “Are there any medications or activities (exercise, sexual intercourse, etc.) I should avoid during treatment?”
- “Can I use tampons again? How can I prevent recurrence?”
Examples of Disease-Specific Questions
- Related to tampons: “If I have a history of TSS, can I use tampons during my next menstrual period? What is the safe way to use tampons (including product selection and replacement intervals)?”
- Related to wounds/surgery: “What tests should be performed to determine whether my current wound (or burn) is related to an infection? What specific instructions should I follow for wound care and infection prevention?”
Additional References (Summary Based on the Provided Information)
- Incidence: Based on the provided material, approximately 2 cases per 10,000 people per year are reported.
- Major risk factors: Prolonged use of highly absorbent tampons (during menstruation), burns, wounds, surgery, childbirth, immunosuppression, and foreign bodies (such as hemostatic materials and devices).
- Prognosis: With appropriate early treatment, most people can recover within several weeks. When it progresses to severe sepsis or shock, the reported mortality rate is approximately 10–15%. Because recurrence is possible, people with a previous history should take precautions.
(This information is a summary based on general medical knowledge. Consult your healthcare provider regarding your individual symptoms and condition.)