Diagnosing and treating toxic shock syndrome

How is a diagnosis made?

Diagnostic procedures and treatment to be implemented must happen quickly to prevent severe complications.

A doctor will assess a person’s medical history and the nature of symptoms by asking the following types of questions:

• How long ago did symptoms begin?
• Are the symptoms being experienced severe?
• Have you tried to do anything to alleviate symptoms? (i.e. take a painkiller for a headache)
• Have attempts to alleviate symptoms worked or made you feel worse?
• Do you use superabsorbent tampons, or birth control? What do you use for menstruation and contraception? When last were these used?

A doctor will be looking for any potential infection causes in their line of questioning and will also note any medications being taken (or past reactions to those taken) as well. A doctor will then conduct a physical exam to assess the nature of symptoms. Blood pressure will be taken and if very low, and accompanied by other signs of multiorgan problems (kidneys, liver, lungs, skin or blood), a doctor will likely suspect TSS.

The doctor will then wish to have blood and urine samples analysed (in a laboratory) in order to determine the presence of bacteria and also to identify which type it is. For women, a doctor may request a swab of the throat, vagina and cervix to send to the laboratory for analysis. Blood samples will also be analysed to check the function of the liver and kidneys.

If signs of distress affecting multiple organs in the body are evident, a doctor may recommend other testing procedures in order to determine the extent of damage caused. These can include a CT scan (computerised tomography), chest X-ray or lumbar puncture.

Treatment for toxic shock syndrome

Once a doctor determines TSS is the cause of symptoms in a patient, treatment will likely be administered in hospital (usually in the ICU / intensive-care unit). If treatment is administered quickly enough, before severe damage is caused, TSS is curable. Once hospitalised, medical professionals will carefully monitor the patient’s signs and symptoms and whether treatment implemented is working over the course of a few days (sometimes longer).

Treatment for the majority of TSS cases (which may vary from one infection to another) will usually involve two or more of the following types of treatment:

• Intravenous (IV) fluids to alleviate shock and treat dehydration (further preventing more organ damage)
• Intravenous (IV) antibiotics to stop bacterial growth and help rid the body of accumulated toxins
• Immunoglobulin therapy (administered through an IV) which helps to boost the body’s immune system (against infection)
• Cardiac medications to elevate blood pressure
• Surgical cleaning of any infected wounds (removal of non-living tissue from the infection site / draining an infection of fluid or pus) or surgical removal of foreign objects, such as broken sponge pieces which may have triggered an infection
• Mechanical ventilation or oxygen (if necessary)
• Blood products via transfusion, where needed
• Dialysis (in the case of kidney / renal failure)

Once discharged from hospital, antibiotics may be prescribed to be taken for a further 6 to 8 weeks and frequent visits to an infectious diseases specialist may be required to monitor physical condition through physical examinations and blood tests.