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The death of Samantha Comiskey, an otherwise healthy 36-year-old Dublin woman, from blood poisoning was most likely due to infection from a tampon, an inquest determined on Monday.
Coroner Dr Clare Keane noted that an infection leading to toxic shock syndrome caused by a tampon being left in place for a period of time is a phenomenon that is “more rare than common”.
What is toxic shock syndrome (TSS)?
TSS is a cluster of symptoms that involves many parts of the body. Certain bacterial infections release toxins into the bloodstream, which then spreads the toxins to body organs. This can cause severe damage and life-threatening illness. It comes on suddenly and is characterised by fever, low blood pressure, a sunburn-like rash and severe damage to organs throughout the body.
What causes toxic shock syndrome?
Two types of bacteria commonly cause TSS: Staphylococcus aureus and Streptococcus pyogenes. TSS from Staphylococcus infections was identified in the late 1970s and early 1980s when highly absorbent tampons were widely used by menstruating women. Due to changes in how tampons are made, the incidence of tampon-induced TSS has declined. TSS from streptococcus infections is most commonly seen in children and older people. Others at risk include those with diabetes or a weak immune system.
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Other than menstruation, what other situations can lead to TSS?
Soft-tissue infections, post-surgical infections, burns, retained foreign bodies such as nasal packing, and dialysis catheters are among the known causes of TSS. Staphylococcal TSS is typically the result of a localised infection such as an abscess, whereas streptococcal TSS may result from septicaemia or a skin infection called cellulitis.
How common is TSS and is it contagious?
It is a rare disease, with an incidence in the developed world estimated to be about 0.8 to 3.4 per 100,000 people. TSS is not considered contagious.
What are the signs and symptoms of TSS?
Symptoms of TSS involve many systems and may look like other infections. It typically presents with a rapid onset of fever (temperature in excess of 38.9 degrees), a red and flat rash that covers most of the body, and markedly low blood pressure. It may be preceded by a prodrome of fever and chills with nausea and vomiting as well as non-specific symptoms such as muscle pains and headache. As the toxins continue to damage body organs, signs of liver and kidney failure emerge.
How is TSS treated?
Broad spectrum intravenous antibiotics and intravenous fluids are required. Any potential source of infection, such as a tampon or nasal packing, must be quickly removed. The patient will likely be admitted to an intensive care unit to receive maximum supported care.
Should women avoid using tampons to prevent TSS?
No. Modern tampons, that are not highly absorbent, are considered safe. However, it is important that tampons are not left in situ for long periods of time. They should be changed every four to eight hours during menstruation.