Toxic shock syndrome (TSS) is an acute, potentially fatal disease caused by toxins produced by the staphylococci, toxic shock syndrome toxin-1 and enterotoxin B. The disease results from the bacteria growing in the vagina with the use of tampons during menstruation, primarily in young women. The symptoms include high fever, low blood pressure, diffuse macular erythroderma, dizziness, vomiting and or diarrhea at the onset, severe myalgia, peeling of the skin of the palms of the hands and the soles of the feet after seven to ten days. TSS is a very rare illness. It has not been reported from the developing countries such as Brazil. It affects 1 person in about a 100,000 population across the world.
TSS can be fatal if untreated. Intravenous antibiotics (combination of pencillins and clindamycin) are administered to treat the infection. Aggressive fluid management, ventilation, renal replacement therapy and inotropic support are essential as supportive care. Women should be advised to avoid the use of soaps, shower gels, bubble baths, shampoos and antiseptics around the genital area. Menstrual TSS can be prevented by avoiding the use of highly absorbent tampons.