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Symptoms Of Toxic Shock Syndrome To Watch Out For

Symptoms Of Toxic Shock Syndrome

Toxic shock syndrome is caused when bacteria such as Staphylococcus aureus and Streptococcus pyogenes release harmful toxins into your body. It can cause symptoms like a high fever, chills, muscle aches, nausea and vomiting, diarrhea, headache, cough and a sore throat. You may also experience dizziness, confusion, swelling, pain and inflammation, breathing problems, and gangrene. A red rash and peeling skin and red eyes, mouth, and vagina are also characteristic signs.

Our tussle with bacteria is a constantly raging one, often with grievous outcomes. Toxic shock syndrome (TSS) is one such rare but extremely dangerous condition caused by bacteria. Bacteria such as Staphylococcus aureus, Streptococcus pyogenes, and, less commonly, Clostridium sordellii cause toxic shock syndrome. These bacteria are usually found on the skin of the armpit, nose, vagina, or groin and live there without causing any harm. But, sometimes, they can enter your body through a break in your skin, say a cut or a wound, and release toxins into your bloodstream. These toxins then spread through your body and affect many organs.1 2

Symptoms usually appear 2–3 days after the bacteria enters your body, though this may vary depending on the kind of infection.3

The symptoms of toxic shock syndrome begin suddenly and quickly become worse, often with fatal outcomes. Spotting them in time is vital, so here’s what you need to look out for:4 5 6

High Fever

A fever with a temperature of 38.9°C (102°F) or higher can be a sign of toxic shock syndrome. However, when the condition is caused by Clostridium sordellii, you may not have fever.

Flu-Like Symptoms

Toxic shock syndrome can cause many symptoms seen commonly with the flu. So you may have:

  • Chills
  • Muscle aches
  • Nausea and vomiting
  • Diarrhea
  • Headache
  • Cough and a sore throat7 8

Low Blood Pressure

Your blood pressure can fall to dangerously low levels when you have toxic shock syndrome. Signs of low blood pressure may include:

  • Dizziness
  • Weakness and fatigue
  • Nausea
  • Confusion
  • Blurry vision

If you experience these signs, check your blood pressure. A blood pressure level which is lower than 90/60 mmHg is a cause for concern. If blood pressure continues to fall, major organs like your kidneys, lungs, liver, or heart may stop functioning properly as they don’t get enough blood.9


Toxic shock syndrome can cause the accumulation of fluid in your tissue, leading to swelling. You may find that your ankles, feet, and hands, in particular, are swollen.10

A Red Rash And Peeling Skin

A red rash which is flat and covers the entire body can be a sign of toxic shock syndrome. You may also find that your skin is peeling off in sheets, especially on the soles and palms. But this happens 1–2 weeks after the infection and is more common in Staphylococcal toxic shock syndrome.


Confusion or delirium could be a consequence of toxic shock syndrome. You may be disoriented and unable to think quickly or clearly. It may also be difficult to remember things or pay attention. Some people may even seem unsure about simple things like their age, name, or today’s date.11 But unlike in the case of a degenerative condition like dementia, confusion comes on suddenly when you have toxic shock syndrome.

Some differences in symptoms can also be observed depending on whether you have a staphylococcal or streptococcal infection. For one, toxic shock syndrome due to streptococcal infection is more serious and can be fatal for 20–60% of those affected – even when they get treatment. In contrast, less than 3% of staphylococcus infection linked toxic shock syndrome is fatal.

The following symptoms are more common in streptococcal toxic shock syndrome though they may occur with the other infections as well:

Pain, Tenderness, And Inflammation

It is estimated that about 80% of those with streptococcal toxic shock syndrome have pain, warmth, redness, and swelling in a muscle or an area just underneath the skin. These are signs of an infection in your soft tissue. The site of infection may not be so readily apparent in those with a staphylococcal infection.


Gangrene is a dangerous condition where tissues and skin near the site of the infection start to die. If gangrene sets in due to toxic shock syndrome, you’ll find that the tissue changes color from red to brown and then to purple or black before withering and falling away. The affected area may be extremely painful and you may experience a loss of sensation there. Blisters or sores that bleed or secrete bad-smelling pus are also common. The affected skin may also become pale and cold.12

Breathing Problems

Toxic shock syndrome is a medical emergency. If you spot symptoms, get immediate medical attention. Otherwise, too, see a doctor if any wound or bruise becomes warm, swollen, painful, or red.13

Breathing difficulties are common in people with streptococcal toxic shock syndrome. Your breathing may become unusually shallow and rapid. Respiratory failure is also a possibility.14

Cut Risk Of TSS: Treat Wounds Promptly And Use Invasive Devices Like Tampons Carefully

As we saw, germs that cause toxic shock syndrome enter through wounds. But an obvious wound such as a burn, boil, cut, or insect bite may not be visible in all cases. Sometimes, this condition develops after a muscle strain or a bruise, while in other cases you may not be able to identify a cause at all. The majority of toxic shock syndrome cases are seen in women during menstruation and are associated with the use of tampons. While tampons don’t directly cause this condition, they may provide an apt breeding ground for bacteria and need to be used with care. Other factors that can increase your risk of getting toxic shock syndrome include the use of contraceptive diaphragms, contraceptive sponge, childbirth, the use of nasal packing to deal with a nosebleed, or a Streptococcal or Staph infection such as cellulitis, impetigo, pneumonia, or throat infection.15 16

References   [ + ]

1, 15. Toxic shock syndrome. National Health Service.
2. About Toxic Shock Syndrome. The Nemours Foundation.
3. About Toxic Shock Syndrome. The Nemours Foundation.
4. Toxic Shock Syndrome. Merck Manual.
5. Toxic Shock Syndrome (TSS). University of Rochester Medical Center.
6. Toxic shock syndrome. National Health Service.
7, 10. Toxic Shock Syndrome. Harvard Health Publishing.
8. Tilanus, A. M. R., H. R. H. de Geus, B. J. A. Rijnders, R. S. Dwarkasing, Ben van der Hoven, and Jan Bakker. “Severe group A streptococcal toxic shock syndrome presenting as primary peritonitis: A case report and brief review of the literature.” International Journal of Infectious Diseases 14 (2010): e208-e212.
9. What Are the Signs and Symptoms of Hypotension?. National Institutes of Health.
11. Sudden confusion (delirium). National Health Service.
12. Gangrene – Symptoms. National Health Service.
13. Toxic Shock Syndrome. Harvard Health Publishing.
14. Acute Respiratory Distress Syndrome (ARDS). Merck Manual.
16. Toxic shock syndrome (TSS) – including symptoms, treatment and prevention. Government of South Australia.

Disclaimer: The content is purely informative and educational in nature and should not be construed as medical advice. Please use the content only in consultation with an appropriate certified medical or healthcare professional.