Toxic Shock Syndrome (SCT): what is it? How to prevent?

What is toxic shock syndrome?

Toxic shock syndrome (SCT) is a fatal disease caused by exotoxins released by the bacteria Staphylococcus aureus and Streptococcus pyogenes . The main symptoms are fever , hypotension , peeling skin, myalgia, vomiting, diarrhea and headaches.

It is a very rare disease, with an incidence of 15 to 52 cases per million inhabitants, non-contagious and which can be recurrent if the patient does not take the necessary care. More than a third of cases involve women under the age of 19 and up to 30% of women who have had the disease will contract it again. It can also affect men and children of all ages, and should be treated urgently when diagnosed.

The disease was named Toxic Shock Syndrome in 1978, when Dr. James Todd described it based on a clinical case study of 7 children. At the time, identical cases had already been documented in the medical literature, long before the introduction of industrial intimate hygiene products.

However, it was in the 1980s that SCT was known to affect many women during their childbearing years, due to the use of tampons (tampons).

At that time, the absorbents were made with a synthetic material that favored the proliferation of bacteria. Nowadays, however, the absorbents are made with natural materials that hinder the development of bacteria and, therefore, more than 50% of the cases are not related to the use of the product.

Types

SCT can be divided into types according to the bacteria that release exotoxins. There are two types:

Staphylococcal toxic shock syndrome

Caused by Staphylococcus aureus , it is the most common in cases of women of childbearing age. It presents symptoms of involvement of the gastrointestinal and muscular systems.

Streptococcal toxic shock syndrome

This type is caused by Streptococcus pyogenes , presents symptoms such as the staphylococcal type, however it favors the appearance of necrosis, such as necrotizing fasciitis and gangrene .

Causes and risk factors

The bacteria that cause SCT naturally exist on the skin and, in general, present no risk to human health. Problems arise, in fact, when bacteria enter the body and release their toxins into the bloodstream.

Most people have antibodies that act against these toxins and, therefore, the disease is hardly developed. However, it can still occur when there is abnormal proliferation of bacteria, which enter the body through an open wound or burn. In such cases, it is possible that the antibodies do not take care of the toxins, giving rise to the syndrome.

Some risk factors are:

Tampons

Plugs filled with blood are conducive to the proliferation of bacteria, especially those made of synthetic materials. Fortunately, most of the absorbents produced today use cotton or other materials that hinder the development of bacteria.

However, there is still the possibility of contracting the syndrome through the incorrect use of these tampons. Poor placement is a risk factor, as a poorly housed pad can open sores on the vaginal walls, where the bacteria can enter. Other risk factors are the use of a tampon larger than necessary and spending 8 hours with the same absorbent.

Intravaginal contraceptives

Placing intravaginal contraceptives, such as the vaginal ring, diaphragm, or cervical cap, can cause injuries, as can tampons. The possibility of bacteria proliferation is less than with tampons, but the vagina is an area naturally prone to such events and, therefore, there is a risk of infection.

Post-surgical

The cuts left by surgical procedures are a means of entry for the bacteria. Although this happens rarely, this is the main cause of contraction of SCT today.

The risk is even greater in patients with diabetes , due to the extended time for healing.

Post childbirth

Combining post-surgical wounds with the natural propensity of the vagina to assist the proliferation of bacteria, it is also common for the disease to contract during the postpartum period.

Skin wounds and burns

Simple wounds and burns can also be a means of entry for bacteria. It is the most common cause of the disease in children, when they get hurt and do not take measures, such as asepsis (sterilization) of the wound site.

Other earplugs

Like tampons, other types of tampons, such as nasal tampons, can help with the development of bacteria.

Other risk factors

It is not known exactly why, but some other risk factors for the contraction of the disease are:

  • Diabetes;
  • Alcoholism;
  • Viral infections like flu and chicken pox (chickenpox).

Symptoms

The symptoms of SCT can vary from person to person, and also according to the bacteria responsible for the exotoxins. However, there are some more common symptoms.

Are they:

  • Sudden fever, which may exceed 39 ºC;
  • Low blood pressure, which can cause fainting;
  • Headache;
  • Myalgia (pain in the muscles);
  • Mental confusion;
  • Diarrhea;
  • Nausea;
  • Vomiting;
  • Skin rashes, such as flaking of the palms and soles of the feet;
  • Redness in the eyes, mouth and throat.

The body may go into shock after 48 hours of the appearance of the first symptoms. The skin on the hands and soles begins to loosen between the third and seventh day. It is also during this period that SCT can cause damage to the kidneys, liver and muscles, in addition to causing anemia .

Often, wounds can have characteristics of infection, but this is not a rule and the injury that served as an opening for the bacteria may show nothing.

In the case of streptococcal shock, it is common to have lesions on the skin that can progress to necrosis and gangrene.

Diagnosis

To make the diagnosis of SCT, the doctor needs to have the right skills. The professionals able to diagnose and treat the disease are general practitioners, infectious diseases and critical care doctors.

There is no specific test to diagnose the syndrome and a battery of tests may be required to do this. Some tests that the doctor may order are:

Samples of blood, urine and other secretions

Blood, urine and secretions from the throat or vagina can help your doctor check for a bacterial infection.

Other exams

To check the progress of the disease, the doctor may order other tests, such as CT scan, lumbar puncture to remove cerebrospinal fluid or chest X-ray .

Can toxic shock syndrome be cured? What is the treatment?

Fortunately, SCT is curable, but women who have had the condition before should not use tampons or intravaginal contraceptives, as the disease may return.

This is a medical emergency and your treatment should be done as soon as possible. It is common that, right after the diagnosis, the patient is taken to the Intensive Care Unit (ICU) for constant monitoring.

Some treatments received by patients in the ICU are:

Antibiotic treatment

This type of treatment seeks to kill or slow down the development of bacteria. Its administration is usually intravenous, as it guarantees more results in less time, in addition to the difficulty in absorbing some antibiotics orally.

Antibiotic treatment lasts 10 to 14 days if there are no complications.

Liquids

To treat dehydration, liquid solutions can be administered intravenously.

Surgery

Surgical procedures to treat SCT are the removal of dead (necrotic) tissues and, in extreme cases, amputation of the affected area can be performed.

Intravenous immunoglobulin

In some cases, an injection of immunoglobulin, a mixture of antibodies made from human plasma, taken from donated blood in blood banks may be necessary. This medication helps the immune system, increasing resistance against bacteria.

Other treatments

Because of the variety of symptoms and complications that the syndrome can cause, other treatments are offered, such as:

  • Medicines to stabilize the pressure;
  • Anti-inflammatories to relieve inflammation and pain;
  • Dialysis in case of renal failure.

Medicines for toxic shock syndrome

Antibiotics

Doctors usually prescribe clindamycin in conjunction with penicillin G (benzetacil).

Blood pressure

Some medications that can help stabilize blood pressure in case of hypotension are:

  • Fludrocortisone ;
  • Dihydroergotamine.

Anti-inflammatories

To relieve possible inflammation and pain, non-steroidal anti-inflammatory drugs are recommended, such as:

  • Ibuprofen ;
  • Nimesulide ;
  • Diclofenac .

Due to the possibility that SCT affects the functioning of the kidneys, treatment with these drugs is often not recommended. However, it is up to the doctor to prescribe these substances.

Complications

If it is not treated quickly, toxic shock syndrome can cause several complications, as it affects several vital organs and can trigger delicate conditions, such as insufficiencies. The mortality rate of the staphylococcal type is 3%, while in the streptococcal type this rate rises to 30%.

Some complications are:

Hypovolemic shock

It happens when the heart and blood vessels are unable to irrigate all tissues in the body due to the low volume of blood, which causes hypoxia in the cells (lack of oxygen). This condition can quickly lead to death and is often fatal to the individual.

Renal insufficiency

The kidneys are the filters of the body and it is through them that unwanted fluids and substances are expelled. However, if SCT attacks these organs, it is possible that their ability to filter is altered, causing what is called renal failure. The main symptoms are urinary disorders, nausea, swelling in the feet and ankles, chest pain, among others.

In 70% of cases, this failure is reversible, and normal kidney function is restored. However, in another 10%, patients end up with chronic renal failure.

Liver failure

Related to the health of the liver, liver failure occurs when the organ is no longer able to perform its normal functions, such as regulating glucose, synthesizing and metabolizing proteins , among others. Being one of the main glands in the human body, the organism is completely unregulated in case of insufficiency.

Some symptoms of this condition are yellow skin and eyes (jaundice), pain, nausea and difficulty concentrating.

Cardiac insufficiency

When the heart is no longer able to pump blood to organs and tissues, it is called heart failure. Some symptoms are palpitations, chest pain, wheezing, coughing , fatigue and weakness.

Attention! 

NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained on this site is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.

How to prevent toxic shock syndrome?

SCT is easily prevented through simple measures, which even protect against other diseases. Some tips are:

  • Wash your hands before handling injuries or before inserting a tampon;
  • Change the bandages and clean the post-surgical wounds frequently;
  • When you notice small cuts or scratches, clean them with antiseptic to avoid infections;
  • If there are signs of infection, see a doctor urgently.

For women of childbearing potential, some tips related to the menstrual cycle can help:

  • Change the tampon every 4 hours, preferably, and never exceed 8 hours with it;
  • Use absorbents suitable for the flow. There is no need to use a superabsorbent when there is a normal or weak flow;
  • Use sanitary pads when you go to sleep;
  • Menstrual collectors can be a good alternative to tampons, as their material hinders the proliferation of bacteria;
  • Do not forget to remove the tampon before inserting another one, as well as removing it at the end of menstruation;
  • When using intravaginal contraceptives, always follow the manufacturers’ instructions and obey the maximum time that the product can stay in the vagina.
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