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Toxic Shock Syndrome

Toxic shock syndrome (TSS) is a potentially deadly illness that is caused by toxins (poisons) made by 2 types of bacteria, Staphylococcus aureus and Streptococcus pyogenes (GAS). It was first recognized in 1978 in children and adults. The vast majority of early cases were associated with S aureus in menstruating teenaged girls and young women who used highly absorbent vaginal tampons.

Although the use of tampons (particularly extended use) can still increase the chance of getting TSS, there are now fewer cases associated with tampons. Other risk factors have been identified, including recent use of barrier birth control methods (eg, diaphragm, vaginal sponge), surgical procedures, recently giving birth to a baby, and a current infection with bacteria such as S aureus. When TSS occurs in young children, it is sometimes present at the same time as a varicella infection (the virus that causes chickenpox).

Signs and Symptoms

The signs and symptoms of TSS develop rapidly, often beginning with a high fever (at least 102°F or 38.9°C) that sometimes includes chills.

Other signs and symptoms can vary, depending on the type of bacteria involved. They may include

  • Red skin rash that looks like sunburn
  • Red eyes (conjunctivitis)
  • Watery diarrhea
  • Vomiting
  • Severe muscle aches
  • Confusion
  • Low blood pressure

A week or more after the beginning of the skin rash, the skin around the nails may begin to peel. Then, as the infection progresses, the skin around the soles of the feet and palms of the hands also begins to peel.

Toxic shock syndrome can affect many organs in the body, including the lungs, bowel, brain, and kidneys. Complications are caused by a decline in blood pressure (hypotension) as well as the direct action of the toxin, which makes organs of the body more likely to fail, leading to the need for respirators and dialysis. Some people die from TSS, but the overall mortality rate is less than 5%. The risk of death is higher in adults than children and depends on which organs in the body are involved.

When to Call Your Pediatrician

Toxic shock syndrome is a serious condition that requires a doctor’s prompt attention. If your child has these symptoms, contact your pediatrician immediately.

How Is the Diagnosis Made?

Your doctor will evaluate your child’s signs and symptoms. The pediatrician will order blood tests and cultures to look for the effects of the toxin and presence of the bacteria (S aureus and S pyogenes) responsible for TSS.


If your child develops TSS, she will need to be hospitalized. She will be treated with antibacterials such as nafcillin, penicillin, or clindamycin for at least 10 to 14 days.

Supportive treatment, such as giving intravenous fluids and stabilizing blood pressure with medicines, will be necessary. Kidney dialysis may be required in cases of kidney failure and ventilators (respirators) are used for failure of the lungs.

Intravenous immune globulin treatment may be given to get rid of bacterial toxins in the bloodstream and help speed up recovery.


If your teenaged daughter uses tampons, she should choose them with care. Tampon manufacturers have changed the way they make their products to decrease their absorbency, and this has significantly lowered the number of TSS cases associated with tampon use. Make sure your daughter uses tampons with low absorbency and changes them often.

Last Updated
Immunizations & Infectious Diseases: An Informed Parent's Guide (Copyright © 2006 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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