Toxic Shock Syndrome
Anyone of either sex or any age can suffer from TOXIC SHOCK SYNDROME
The Streptococcal bacteria can enter the skin through a sore or an injury or via an operation site. The bacteria produce toxins in the blood, which can lead to Toxic Shock, organ damage and in some cases death.
Symptoms include headache, sore throat, and aching muscles, vomiting, diarrhoea, high temperature, a rash and peeling skin.
Contact your CWU Safety Representative for more information.
CAMPAIGN TO INFORM THE PUBLIC ABOUT THE DANGERS OF NON-TAMPON RELATED TOXIC SHOCK SYNDROME.
By Alison Roberts-Pagent
During the last twenty years or more the awareness of Toxic Shock Syndrome (TSS) from the use of tampons and internal contraceptive devices have been greatly publicised.
The syndrome first came to the attention of the public in the 1970s, when women using tampons, especially the super absorbent types, were rushed into hospitals suffering from similar symptoms headache; sore throat; aching muscles; high temperature; vomiting; diarrhoea; dizziness; a sunburn-like rash; peeling skin and low blood pressure.
Since the 1980s, Trade Unions, have been running awareness campaigns using posters and leaflets explaining what causes TSS; informing women of the symptoms; explaining what to do if they suffer from any of these symptoms and offering advice on the precautions to be taken to minimise the risk of suffering from TSS.
These campaigns have been very successful and the incidences of tampon related TSS and the majority of the population is totally unaware that tampon-related TSS now only accounts for approximately 60% of the reported cases each year. It is well known that women can die from TSS, but how many people are aware that anyone, of either sex or any age can die from TSS?
One of the most worrying aspects is how little is known about TSS in the UK medical community at large. This was highlighted recently by the case of a young boy who received a small burn on the back of his hand after boiling water splashed from a kettle. His mother took him to the local casualty department where he was treated for a minor burn. After returning home, the child began to show the symptoms of TSS. His mother took him back to the casualty department several times over the next two days as his symptoms worsened. The child died on the third day from TSS. It transpired that if the child had been given appropriate antibiotics at his initial visit or soon after, he would have survived. The mother knew her son was seriously ill, back the lack of awareness of TSS amongst the medical staff, turned a serious illness into a fatality.
This is the reason it is so important that a campaign be launched in the same way as those that have been so successful in the past.
Tampon related TSS is caused by bacteria called Staphylococcus Aureus, which is not only found in the vagina but also on the skin. TSS occurs when toxins produced by this bacteria enter the bloodstream, which can happen when people are weakened, by surgery, injury or disease and who cannot then naturally fight off a staphylococcal infection.
Since the 1980s, however, there has been a marked increase in the recognition and reporting of highly invasive Group A Streptococcal (GAS) infections and in 1987 a new type of TSS was officially recognised in the USA, which is caused by this bacteria. These infections present themselves with or without Necrotizing Fasciitis, which is associated with shock Streptococcal Toxic Shock Syndrome (STSS) and organ failure. The incidences, so far, have been lower than the other disease but can be far more serious and fatalities are higher.
It is thought, by researchers in the USA, that these are not new bacteria but old ones who have learned new tricks in a changing environment. These have become major clinical problems because of their increased virulence or antibiotic resistance.
In the mid nineties the British tabloids coined the term "flesh eating Bacteria" to describe invasive necrotizing infections caused by GAS and have suggested that epidemics of the streptococcal infections were imminent. Researchers in the USA thought this statement was unfounded but at least served to heighten public awareness of this sporadic, but serious, infectious disease.
The more common illnesses caused by GAS include streptococcal pharyngitis ("strep throat"), scarlet fever and impetigo which are easily treatable by antibiotics.
However, the acute life threatening varieties are not so easily treatable. Since the mid 1990's the reports of severe, invasive GAS infections that are associated with TSS and organ failure have increased in North America and Europe. Those at greatest risk include children with varicella (chicken pox): people with suppressed immune systems, due to either illness or drugs, burns victims; people who have surgery such as hysterectomy or bone pinning (bone repairs) and new mothers who have given birth either by vaginal delivery of by caesarean section. It is common for an infection to have occurred without breaking the skin in cases of minor trauma such as a deep bruise to the calf or even muscle strain. The usual TSS symptoms may present themselves, but STSS cases are normally abrupt and severe on onset and include pain in extremities of the body or can mimic peritonitis and other illnesses. In some cases of minor trauma, the prescription of anti- inflammatory drugs to treat the original injury may have either masked the early symptoms or predisposed the patient to more GAS infections or shock.
Approximately 80% of patients show a soft tissue infection, which can lead to the necrotizing fasciitis. Renal dysfunction or damage precedes shock in many cases and acute respiratory distress occurs in more that 50% of patients. The GAS infection therefore can lead to shock, multi-system organ failure, and death.
Current mortality rates in the USA vary between 30% and 70% despite early diagnosis and treatments with antibiotics and surgery.
The various health authorities in the USA are now advising the general public about these infections and are promoting ways to help prevent invasive GAS infections. There are worries about the contracting of the infection from other sufferers, however little evidence has been collated to define how great a risk this actually is. Basic precautions are therefore recommended such as good hand washing, especially after coughing or sneezing, before food preparation and eating and that anyone with a sore throat should consult a doctor. The cleanliness of wounds is paramount and they should be observed for any possible signs of infection, which include redness, swelling or pain. If any of these symptoms occur, especially with a fever a doctor should be consulted immediately.
It could be argued that the mother of the child who recently died in the UK followed all this advice, but the end result was defined by the lack of awareness by the medical staff at her local casualty unit. Indeed, it has already been proven by the many patients, who have contracted MRSI (Metchillin Resistant Staphylococcus Infection) in UK hospitals, that the staff there have little knowledge about these infections. There are no real systems of nursing in force to ensure (or at least help) the prevention of MRSI infections ( and therefore GAS or STSS). The only action taken is to ' barrier nurse' the patients involved once the infection has been identified. Any risks the patients faced from their original illnesses are greatly increased and their recovery severely impeded by their infection with MRSI. This presents an ideal opportunity for GAS infections.
This is why I feel that an awareness campaign, based on the previous information system of posters, leaflets, and with full involvement of trade union health and safety representatives would help to ensure that the public are fully aware of Group A Streptococcal infections and complications such as Streptococcal Toxic Shock Syndrome.
It is a vital step forward in protecting our members and their families in providing them with this information, that may in the long term save lives.
We are still being warned to be vigilant about Meningitis, and are told to ensure we get swift and appropriate treatment, which at times means obtaining second opinions. Until these Streptococcal infections are more widely recognised in this Country, a campaign such as this could be the key to saving someone's life by increasing awareness both in the public and medical domain.
Acknowledgements and References:
Dennis L Stevens Ph.D M.D Professor of Medicine, University of Washington and Chief, Infectious Disease Section, Veterans Affairs Medical Centre, Boise, Idaho, USA
Dr Stanley Falkow. USA
Maureen Haggerty and Carol A Turkington. The Gale Encyclopaedia of Medicine.
Office of Communications and Public Liaison, National Institute of Allergy and Infectious Diseases, Bethesda, USA.
New York State Department of Health, Communicable Disease Fact Sheet.
Public and Commercial Services Union. UK
Please note that there is very little information available from UK medical or Infectious Disease Research establishments, therefore the main research source for this assignment was obtained from the USA.
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