A B.C. teen passed away last year while on a class field trip due to what was later diagnosed as toxic shock syndrome (TSS), caused by the staphylococcus aureus bacteria.
The infection has been associated with tampons, though it can be caused by a number of things. Some ways it can be contracted include leaving a tampon inserted in the vaginal cavity for an extended period of time (often 30 hours) over the recommended number of hours (usually four to eight hours), or by using super-absorbent tampons.
Upon inspection, it was discovered that Sara Manitoski, who died in her sleep on a class trip with with Georges P. Vanier Secondary School to Hornby Island on March 15, 2017,was wearing a tampon at the time of her death.
The coroner’s report states “microbiology cultures completed on a tampon found in place identified the presence of staphylococcus aureus. Both findings are consistent with toxic shock syndrome.”
WATCH: Coroner’s report finds Comox Valley teen died from toxic shock syndrome while on school trip
TSS is caused when toxins made by certain strains of staphylococcus or steptococcus bacteria get into the bloodstream, the government of Canada website explains. It’s important to note, first and foremost, that TSS is an extremely rare condition, often associated with tampons because the blood accumulation that happens in the tampon can create an environment where the infection can spread — though it can also be caused by open wounds, childbirth, surgery, the flu and other complications.
According to the toxicology report, this appears to be the case with Manitoski, as well as model Lauren Wasser who contracted the infection back in 2012, resulting in the amputation of both her legs. For this reason, it’s often found in young women who use tampons. Toxic shock syndrome, though, can affect anyone, including men, women and children of any age.
WATCH: B.C. teen dies from toxic shock syndrome
What causes TSS?
TSS can be caused by either the staphylococcus (staph) or streptococcus (strep) bacteria.
According to B.C.’s provincial health line, TSS caused by strep occurs most frequently after childbirth, the flu (influenza), chickenpox, surgery, minor skin cuts or wounds, or injuries that cause bruising but may not break the skin.
TSS caused by staph occurs most often after a tampon is kept in too long (menstrual TSS) or after surgery (non-menstrual TSS). TSS has occasionally been linked to insect bites as well.
TSS can also be caused by certain kinds of female contraception, such as a contraceptive diaphragm or a contraceptive cap.
Those who contract TSS once are more likely to get it again.
What are the symptoms of TSS?
If someone you know begins experiencing the following symptoms, you should immediately call a doctor, as TSS is a fast-acting, life-threatening infection.
- Sudden fever over 39°C.
- Low blood pressure and rapid heartbeat.
- Nausea or vomiting.
- Fainting, feeling light-headed, or feeling restless or confused.
- A rash that looks like a sunburn. It may be on several areas of your body or just in certain places, such as the armpits or the groin.
- Severe pain in an infected wound or injury.
- Severe flu-like symptoms, such as muscle aches and pains, stomach cramps, a headache, or a sore throat.
- Redness inside the nose and mouth.
- Pink eye (conjunctivitis).
- Scaling, peeling skin, especially on the palms of the hands and soles of the feet.
How can you prevent TSS?
According to the National Health Service, and to B.C.’s provincial healthline, TSS can be prevented by taking a number of precautions.
- Treat burns quickly, and seek medical help if redness or swelling occurs.
- Women should use tampons with the lowest absorbency possible as per their menstrual flow.
- Women can also alternate tampons with sanitary napkins or pantiliners.
- Wash hands before and after inserting a tampon.
- Change tampons regularly — as often as directed on the pack (usually at least every four to eight hours) — and never insert more than one tampon at a time.
- When using a tampon at night, insert a fresh tampon before going to bed and remove it upon waking.
- Remove a tampon at the end of your period.
- When using female barrier contraception, follow the manufacturer’s instructions regarding how long you can leave it in.
- Prevent children from scratching chicken pox.
Women who have had TSS before should also avoid using tampons and barrier contraception going forward to reduce the risk of contracting it again.