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TOXIC SHOCK SYNDROME: THE
EXHIBIT Toxic Protection / Confidence
Shock / Why Am I Sick? / Etiologies |
Despite considerable attention
being given to such matters, mistakes continue to be made...
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Research has shown that the "peak incidence" of
tampon-related toxic shock syndrome occurs on the fourth day of the menstrual
cycle. As "most menstrual cycles
last from three to five days," the last tampon to be removed before
falling ill will sometimes contain little blood, be dried out, and/or stick
to the vaginal walls. Click
here to read of a 2005 case, that began at the end of a period. |
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Graph
showing tapering of flow during menses, (in this case, a 5-day period), far
left. From wisc.edu. |
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However,
"removal of the last tampon before I got sick" is only a scenario, and not an etiology
for tampon-related toxic shock syndrome. 'Etiology' is just a
fancy word for 'cause.' So, what
causes tampon-related toxic shock syndrome?
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"FIGURE 2.
Virulence determinants of Staphylococcus aureus" from Ken Todar's Microbial World, University of
Wisconsin. TSST
"superantigen" within dotted area. |
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The simple answer is an acute bacterial infection with
Staphylococcus aureus. As seen in the
above diagram, though, such infections are actually complicated. (The aqua circle with the lavender border
represents the Staph aureus bacteria.) TSST, or Toxic Shock Syndrome Toxin-1, is a superantigen
produced by Staph aureus. As TSST
pours into the bloodstream, the immune system's response is cataclysmic,
usually resulting in vomiting, diarrhea, low blood pressure, conjunctivitis
("pink eye"), fever, rash, and (a week or two later) peeling of the
skin on the hands and/or feet. If
proper and timely medical care
is not obtained, trTSS can be fatal. Only tampon users who lack antibodies to Staph aureus can
develop trTSS. Studies have found that only a small percentage of people lack
such antibodies, although estimates vary somewhat. |
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In 1985, a
Tambrands-funded team led by Edward
Kass made two discoveries:
(1) That superabsorbent fibers
are highly absorptive of magnesium; and (2) Staph areus greatly increases
TSST production in low-magnesium environments. A June
1985 TIME article by Claudia Wallis explains: "The magnesium link may
help explain why toxic shock typically occurs on the fourth day of a woman's
period, when the menstrual flow has diminished. During the previous days, the
volume of fluid is greater, and, Kass believes, there is probably enough
unabsorbed magnesium present to keep toxin production in check." Although Kass's
research (as well as lawsuits), prompted Tampax and Playtex to suspend use of
polyacrylate rayon in their tampons (the Rely brand had been discontinued in
September 1980), subsequent
studies have failed
to find a relationship between low
magnesium and high TSST production. * *Note: 3 separate
links in above blue text. |
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"Super-absorbent
rayons [...] are obtained by including water-holding polymers (such as
sodium polyacrylate or sodium carboxy methyl cellulose) in the viscose prior
to spinning..." Praveen Kumar Jangala
and Haoming Rong (Textile Science, University of TN) |
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Composite scanning micrograph of
Staphylococci adherent to different sutures.
Full caption at: "Bacterial
adherence to surgical sutures. A possible factor in suture induced infection,"
Annals of Surgery 1981, Katz S, Izhar M, Mirelman D. Where
is the scanning micrograph of Staphylococci aureus adherent to tampon fibers? |
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Perhaps we can "build a better etiology" of trTSS by recalling
that tampons are classified as medical devices by the FDA, and therefore, are
composed of biomaterials. Today's tampons are made of cotton or cotton-rayon blends,
fibers usually associated with clothing, not medicine. But if we compare tampons to "medical
thread," that is, sutures, we again find a similar issue with
bacterial infection – what we might term suture-related TSS, or srTss. A 1999
FDA study found that multifilament sutures carried greater infection risk
than monofilament sutures. That is,
sutures with greater surface area carry an increased risk of infection than
sutures with lesser surface area. Similarly (and 20 years ago)
researchers Reiser, Hinzman and Bergdoll noted that: "...tampons
provide increased surface area for the staphylococci to grow..." And in Philip Tierno's 2005 article,
Reemergence
of Staphylococcal Toxic Shock Syndrome in the United States since 2000, he
points out that higher-absorbency tampons can be worn for longer periods of
time - giving Staph aureus not only more space, but time, to grow. On Ken Todar's extensive
bacteriology web site, we are told:
"Foreign bodies, including
sutures, are readily colonized by staphylococci, which may make infections
difficult to control...." Perhaps that should read: "Foreign bodies, including
sutures and tampons, are readily
colonized, which may make infections difficult to control..." |
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