T

toxic shock syndrome A systemic IMMUNE
RESPONSEto the endotoxins many BACTERIAproduce
during infections. The immune response produces
widespread, significant INFLAMMATION involving
multiple organ systems. Staphylococcal toxic
shock syndrome, resulting from Staphylococcus
aureus INFECTION, is more common and causes
milder illness. Streptococcal toxic shock syn-
drome, which results from group A beta-
hemolytic streptococcal bacteria, produces severe
illness and causes death in about 60 percent of
people who develop it.
Symptoms are those of acute bacterial infection
such as FEVER and PAIN, with HYPOTENSION (low
BLOOD PRESSURE) and RASHthat involves the entire
body, including the palms of the hands and soles
of the feet. Illness is severe enough to require hos-
pitalization, often in an intensive care unit, for
supportive medical care (including fluid replace-
ment, cardiovascular stabilization, and MECHANICAL
VENTILATION as necessary) and treatment with
intravenous IMMUNOGLOBULINand ANTIBIOTIC MED-
ICATIONS. Complications of toxic shock syndrome
are potentially life-threatening and include DIS-
SEMINATED INTRAVASCULAR COAGULATION(DIC), ACUTE
RESPIRATORY DISTRESS SYNDROME(ARDS), andNECRO-
TIZING FASCIITIS. People who recover from toxic
shock syndrome may have lingering health prob-
lems and are at risk for RECURRENCE.
Toxic shock syndrome first emerged as a signifi-
cant health issue in the 1980s when superab-
sorbent tampons new on the market caused an
outbreak of toxic shock syndrome among other-
wise healthy women. The superabsorbency of the
tampons meant women could change them less
frequently, an unexpected SIDE EFFECTof which
was a spike in bacterial infections. Changes in
tampon materials and widespread education

efforts have significantly reduced toxic shock syn-

drome due to tampon use, although tampon use

remains a risk factor. Other risks for toxic shock

syndrome include surgical packing (such as after

an OPERATIONon the NOSE) and illness due to com-

mon bacterial infections.

See also SCARLET FEVER; STREP THROAT; SEPTICEMIA.

toxoplasmosis An illness that results from INFEC-

TIONwith the PARASITEToxoplasma gondii. Health

experts in the United States estimate that about 60

million Americans are infected with T. gondii,

though only a small percentage of them become

ill. T. gondii may migrate into body tissues, forming

cysts.

Domestic cats carry T. gondii; cat feces in litter

boxes and outdoors in garden areas are the most

common source of infection. Outdoor cats are

more likely to have T. gondii. Other sources of T.

gondiiinclude undercooked or raw meats, espe-

cially pork and lamb. People acquire the infection

through touching contaminated objects and then

transmitting the parasites to food or drink. Chil-

dren may acquire T. gondiiinfection through play-

ing in outdoor sandboxes.

Toxoplasmosis is often an OPPORTUNISTIC INFEC-

TIONthat causes illness in people who are IMMUNO-

COMPROMISED, such as people who have HIV/AIDSor

who are taking IMMUNOSUPPRESSIVE THERAPY after

ORGAN TRANSPLANTATION. Toxoplasmosis, whether or

not it produces symptoms, is a particular risk for a

pregnant woman because she can pass the infec-

tion to her unborn child. The cysts that T. gondii

form in the tissues can cause serious BIRTH DEFECTS

in the developing fetus, including damage to the

eyes that results in permanent loss of vision.

HEARING LOSSand neurologic injuries are also com-

mon.

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