I know what you’re thinking: tampons cause toxic shock syndrome. Well you’re on the right track. But when I saw a 16-year-old boy in the office recently with this rare but serious condition I, too, was reminded that toxic shock syndrome isn’t just a problem for some tampon users.
Toxic shock syndrome is actually caused by an infection with either staph or strep bacteria. These bacteria live on our skin normally and love to grow out of control in a blood-rich environment. Tampons left in too long (more than 8 hours) fits the bill but other things such as a laceration, skinned knee, or scabbed over bloody nose can be the perfect place for staph or strep to grow. Some strains of these bacteria can liberate a toxin, which can get into the blood stream and cause low blood pressure, fever, sun-burn like rash, and severe illness requiring hospitalization (often in an ICU).
A couple weeks ago, a 16-year-old boy came to the office with all of these symptoms. He looked sick, super sick. He was having shaking chills, fever to 105, and had developed a reddish rash on his arms and trunk. He had scraped his knee more than a week before but, starting a day or two before he came to the office, the abrasion started to look like it had some pus on it.
When we assessed him in the office, his blood pressure was low but not dangerously so and his heart rate was elevated but he wasn’t dizzy and was able to answer my questions as he laid on the couch in the exam room quietly shaking from the fever-induced chills. It was clear immediately that he was very sick and his knee wound was cultured, he headed straight to the ER for aggressive management. Over the next 24 hours his blood pressure dropped more and he needed IV meds to maintain it. He was in the PICU for almost two days and did well. Even once started on antibiotics for the wound infection that triggered everything, it wasn’t until the toxin was spent that he began to improve. You can kill the bacteria but the toxin can live on coursing through your system until it burns itself out.
This young man was lucky and has recovered fully. It was a reminder though to all of us that when wounds gets infected or tampons are left in too long, toxic shock syndrome is a real risk and early management and support can make all the difference.