Concerns regarding toxic shock syndrome on the rise

Nationally, 5 percent of all toxic shock syndrome cases are fatal.

Jerret Raffety

Concern over toxic shock syndrome is higher than it has been since the 1980s, according to a study released by a group of University researchers.

The study shows that toxic shock syndrome cases reported in the Twin Cities metro area increased between 2000 and 2003. In some cases, the instances are as high as 10 cases per month, according to the study, which appeared in the June 2004 issue of the Journal of Clinical Microbiology.

Patrick Schlievert, lead investigator in the study and professor in the microbiology department at the University, said the numbers have leveled off in 2004 and 2005 to approximately 3.5 per 100,000 nationally. This is still up from one in 100,000 during the late 1980s and 1990s.

Five percent of all cases of toxic shock syndrome are fatal, according to the Centers for Disease Control and Prevention Web site.

Timothy Tripp, a contributing researcher to the study, said reasons for the increase vary.

“It could be that people are better at detecting the bacterium or people are becoming less careful,” Tripp said. “Most likely it is some combination of reasons.”

Schlievert said another reason for the increase is newly emerging strains of the bacteria that cause toxic shock syndrome, some of which are highly resistant to antibiotics.

“For example, we are seeing a rise in skin and lung infections with highly antibiotic resistant organisms – something we had not seen before,” Schlievert said. “These make the toxins that cause toxic shock syndrome.”

He said when he analyzed more than 5,000 toxic shock syndrome cases between 1978 and 2000, he witnessed only one case of bacteria resistant to multiple antibiotics. But between 2000 and 2005, he has observed that 20 percent to 30 percent of toxic shock syndrome cases, depending on the type of toxic shock syndrome, are antibiotic resistant, Schlievert said.

Toxic shock syndrome is a disease caused by the bacterium Staphylococcus aureus, Schlievert said.

“All that is necessary to have TSS is to have a damaged body site (bleeding) where Staphylococcus aureus can make one of the three toxins,” Schlievert said.

Not everybody is at risk of getting the disease, however, because many people have antibodies that prevent them from getting it, Schlievert said.

There are two types of toxic shock syndromes: menstruation associated and nonmenstruation associated, Schlievert said. In menstruation-related toxic shock syndrome, women can contract the syndrome when not using tampons, but high-absorbency tampons increase the risk of getting toxic shock.

Menstruation-associated toxic shock syndrome happens during or within a day or two of menstruation, Schlievert said.

But approximately half of toxic shock syndrome cases are not related to menstruation, Schlievert said.

“This should not be surprising – even to guys, since the cause is a bacterium, not a tampon,” he said.

During the early 1980s, toxic shock syndrome was affecting people at a rate of 10 per 100,000, largely because of high-absorbency tampons, which were taken off the market in 1984, he said.

Women who use tampons can protect themselves from toxic shock syndrome by using them for only up to eight hours and by using the lowest absorbency tampon to control menstrual flow, Schlievert said.

Women and men can protect themselves from nonmenstrual toxic shock syndrome by being aware of the symptoms and seeking medical attention if they are developing them, he said. Symptoms include a high fever, vomiting, diarrhea, a sunburnlike rash and, most dangerously, dizziness because of drop in blood pressure.

David Golden, director of marketing, public health and new programs at Boynton Health Service, said Boynton has not seen any cases of the syndrome in the last five years.

“It’s not surprising at all that we don’t see any infections here in our clinic,” Golden said. “It does have a relatively low infection rate in the context of other infectious diseases like cold and flu.”