Toxic Shock Syndrome (cont.)

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What are the risk factors for toxic shock syndrome?

In the U.S., the incidence is approximately 1/100,000 women 15-44 years of age, with the overall incidence estimated at about twice that number.

Risk factors are the use of tampons (especially when left in place for an extended time period) and barrier contraceptive devices in women (diaphragm or sponge), surgery (especially nasal surgery), the use of wound packings (such as nasal packings), and postoperative wound infection.

What are toxic shock syndrome symptoms and signs?

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Patients may experience a few days of mild flu-like symptoms before the TSS develops, but TSS itself is characterized by the rapid onset of specific symptoms, including high fever, nausea, vomiting, diarrhea, low blood pressure, and widespread skin rash. This will usually progress to a worsening of low blood pressure, dizziness, confusion, peeling of the skin of the palms and soles of the feet (which develops after one to two weeks of rash), headaches, and occasionally seizures. Ultimately, multiorgan failure may develop, and this leads to death in approximately 5% of all those affected.

How is toxic shock syndrome diagnosed?

There is no one specific test that establishes the diagnosis of TSS. The diagnosis of TSS is difficult until the characteristic symptoms evolve and a source for the infection is identified. Besides a thorough physical examination (which includes a pelvic examination in women), blood tests will usually be ordered and might include a white blood cell count (to look for signs of infection), blood cultures (evaluating for possible bacteria in the bloodstream), and evaluation of kidney and liver function. Blood tests to exclude other diseases may also be ordered.

Chest X-rays or CT scans of the abdomen or pelvis can be ordered to evaluate the internal organs, depending on the results of the initial evaluation.

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