Poisons produced
by germs (bacteria) are called toxins. These
are among the most dangerous poisons known.
When they enter the bloodstream in other
than tiny quantities, the effects are always
serious.
The toxic
shock syndrome is an acute and dangerous
condition caused by Staphylococcus aureus
bacteria producing toxins that get into
the bloodstream. Fortunately, the condition
is very rare.
An epidemic
of the toxic shock syndrome occurred among
young menstruating women in the early 1980s.
It turned out to be associated with high-absorbency
vaginal tampons and a considerable increase
in the number of staphylococcal organisms
in the vagina.
Ninety per
cent of cases of the toxic shock syndrome
used to occur in menstruating women. The
others occurred in people with severe staphylococcal
infections of the bone or the heart valves,
burns, wounds, abscesses or bronchopneumonia
(see article on Respiratory tract infections),
or following an operation.
Since the
cause and nature of the condition and the
appropriate treatment have been understood,
the mortality has been greatly reduced and
is now no more than about two to three per
cent. The ratio of cases occurring from
vaginal infection is now much less. Fewer
than half the reported cases are now associated
with menstruation.
We now know
that high-absorbency tampons should be avoided
and that all tampons should be changed frequently.
Symptoms
There is a fever of 40° C or above, an acute
drop in the blood pressure, a rapid but
very weak pulse, a blotchy red rash that
becomes scaly (desquamated), dizziness,
vomiting and diarrhoea, muscle pain, inflammation
of the vagina, liver damage and sometimes
disorientation and confusion.
Causes
Staphylococcal
toxin produces widespread damage throughout
the body. Among other effects, it causes
the involuntary muscles in the walls of
arteries to relax so that the vessels get
wider. Also, the small blood vessels become
more leaky so that fluid passes out.
As a result,
the capacity of the circulatory system increases,
but the volume of blood decreases. The blood
vessels may not be able to keep full enough,
and the heart may be unable to keep the
blood circulating. This is what is meant
by surgical shock. The condition can quickly
lead to death unless the amount of fluid
circulating is kept up by a transfusion
of saline or blood.
Heavy staphylococcal
infection of tampons is one of the causes
of the syndrome. For this reason, manufacturers
have been discouraged from making very highly
absorbent tampons, and there is now more
emphasis on menstrual towels.
Treatment
Because the
trouble is caused by the toxins that have
already been released from the organisms,
killing the staphylococci with antibiotics
has little effect on the course of the illness.
It does, however, reduce the likelihood
of recurrence and such treatment is always
given.
However,
the most urgent requirement is to restore
the full blood volume by transfusion. This
is life-saving.
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Toxic Shock Syndrome
