Teen Dies From Toxic Shock Syndrome On Overnight School Trip

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Sara went for an overnight outdoor education trip to Hornby Island, near Vancouver Island, with her high school classmates last year. 

According to the report from the British Columbia Coroners Service, the 16-year-old spent the day taking part in activities but later complained to her friends that she felt ill.

She didn’t eat much at dinner and went to sleep in her cabin. 

The next morning, her friends assumed she was still sleeping and went to breakfast but when they returned, Sara was unresponsive. 

Teachers and paramedics attempted to revive her with CPR, but sadly they were unsuccessful.

The coroner’s report said that a strain of Staphylococcus aureus bacteria was found on a tampon left in her body, and her death was consistent with toxic shock syndrome (TSS).

“My sister complained of stomach cramps before going to bed and then she never woke up. My beautiful, incredibly healthy sister died because of this so please share, educate yourselves and be cautious whenever using tampons,” Sara’s sister Carli Manitoski wrote in a post on Facebook. 

“Toxic shock syndrome is a situation where a particular bacteria, Staphylococcus aureus, colonizes in an area and releases a toxin,” Dr. Alyssa Dweck, an OB-GYN in New York, told BuzzFeed News. 

S. aureus is typically the problem, but another type of bacteria, group A Streptococcus, amy also cause toxic shock-like syndrome or TSLS.

TSS is rare either way. Since the 1980s the annual rate in the US has hovered at around 1 per 100,000 people, according to the US Centers for Disease Control and Prevention (CDC).

Once toxins are released by the bacteria, they can enter the bloodstream, triggering an immune response that damages other tissues and organs in the body. 

Symptoms include a sudden high fever, low blood pressure, and a sunburn-like rash covering the body. It may progress rapidly and lead to kidney failure, shock, sepsis, or death in a matter of hours after the onset of symptoms.

The bacteria has to be present in or on the body for TSS to occur. 

S. aureus normally lives on the skin or in the respiratory tract, nose, vagina, and rectum and about half the population carries the bacteria without any symptoms or problems. Not all staph or strep infections will lead to TSS.

Why is TSS linked to tampons and what does this mean for menstruating women?

Tampons alone don’t cause TSS. They are not contaminated with bacteria or toxins — these come from our bodies. “The bacteria has to be a natural inhabitant of the vagina, and it’s something about the highly absorbent tampons or just having something in there for a long time that tends to predispose to those toxins being released,” Dweck said. Younger women tend to be at higher risk.

After the rise of menstruation-related TSS cases in the 1980s, many manufacturers have changed their ingredients, Dweck said. 

As a result, the number of cases of TSS have plummeted — which is partially due to increased awareness about TSS and better education about safe tampon use.

Fortunately, you can reduce your risk of toxic shock syndrome, which is treatable if caught early.

If you take a few simple precautions during your period, you will be able to reduce your risk of developing TSS. “Use the least absorbent tampon for your flow, change it frequently during the day, and leave it in no longer than 8 hours — which is long enough to wear it during a full night of sleep,” Dweck said. If you are bleeding heavily, change your tampons even more often.

Additionally, you should only wear tampons when you are on your period. “A lot of women will come in who wear tampons every single day of the month because they don’t want discharge — do not do this,” Dweck said. The risk of TSS is still there when you have something in your vagina for a long period of time — including menstrual cups.

If caught early, TSS can be treated with antibiotics and IV fluids, Dweck said. So it’s so important to look out for symptoms. “If you have a rash that looks like a sunburn, or a sudden high fever and drop in blood pressure with an associated menstrual period and tampon, go to the ER or seek medical care immediately,” Dweck said