Toxic Shock Syndrome

What Is It?

Toxic shock syndrome is a rare, life-threatening illness triggered by certain bacteria (group A streptococcal and Staphylococcus aureus). In toxic shock syndrome, toxins (poisons) produced by the bacteria cause a severe drop in blood pressure (hypotension) and organ failure. In some patients, these bacteria enter the body through an obvious break in the skin, such as a wound or puncture. Other cases are related to the use of tampons. Sometimes, however, toxic shock develops after a relatively mild injury, such as a bruise or muscle strain, or no cause is identified at all.


The majority (80%) of patients with group A streptococcal toxic shock syndrome have symptoms of a soft-tissue infection (pain, redness, warmth, swelling) in an area just below the skin or in a muscle. Patients with staphylococcal toxic shock syndrome may have a staphylococcal infection anywhere in the body and the site of infection may not be immediately apparent.

Symptoms of toxic shock include:

  • Flu-like symptoms such as fever, chills, muscle aches, nausea, vomiting and diarrhea

  • Hypotension (low blood pressure) with a weak and rapid pulse

  • A red rash that covers the whole body, sometimes followed by peeling skin (the rash may be difficult to see in dark-skinned individuals)

  • Decreased urine output

  • Confusion, disorientation or other mental changes

  • Swelling in the hands, feet and ankles

  • Severe breathing difficulties


Because a patient with toxic shock syndrome may be too ill to answer questions, a family member or friend may need to tell the doctor about the patient's medical history and symptoms. In general, the doctor will ask whether the patient has had any recent wounds or surgical procedures or has complained about a rash or a skin infection.

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