Toxic Shock Syndrome

This rare and dangerous disease can strike anyone, as a local teenager attests

‘An incredible kid’

That’s how her mother describes Stephanie Heater, who recently graduated from Lehigh Valley Charter High School for the Performing Arts. Stephanie loved school so much, she listened to her teachers’ lectures over the phone while she was recovering from TSS. She dreams of becoming a performer and an advocacy lawyer.

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‘Eye in the Sky’

While Stephanie was in a coma, her parents were comforted knowing the “eye in the sky,” as they call it, was watching their daughter. The eye is a camera mounted in the ICU, feeding high-resolution video to specially educated doctors called tele-intensivists located off-site. Using video, audio and electronic charting, they monitor patients around the clock, interacting closely with caregivers at the bedside and responding immediately to any concerns. “We were on top of her care every minute, day and night,” says tele-intensivist Matthew McCambridge, M.D., shown here. “This incredible technology helped save Stephanie’s life.” With him onscreen is Shannon Woznick, R.N., in the ICU at Lehigh Valley Hospital—Cedar Crest.

Instead of daydreaming the morning before her school’s big January dance, 17-year-old Stephanie Heater of Bethlehem was vomiting, sweating and fighting a fever of almost 104 degrees. Her mother, Michele, suspected the flu. Stephanie slept the rest of that day and most of the next, missing the Snowball Dance.

“I thought I’d eaten bad chicken or something,” Stephanie says—but she wasn’t getting better. When Michele asked her son, Troy, a trained emergency medical technician, to check his sister’s condition, he noted that blood didn’t seem to be flowing to her extremities. Michele and her husband, Dave, took Stephanie to a health center. The doctor sent her straight to the Lehigh Valley Hospital emergency department.

“Stephanie was in a state of shock—mental confusion, extremely low blood pressure and a racing heartbeat,” says emergency physician Sarah Finnerty, M.D. Having seen a similar case, Finnerty knew what to look for. Sure enough, Stephanie had just had her period and was a tampon user. Tests showed she had toxic shock syndrome (TSS), a rare infectious disease that resembles a bad case of the flu and worsens quickly.

In intensive care, Stephanie received a massive dose of antibiotics, and machines took over her vital functions. Specialists used the latest technology to monitor her around the clock (see ‘Eye in the Sky,’ at right). Over the next week, her condition improved and she was brought out of her medically induced coma. By the time Stephanie went home a few days later, she’d beaten the odds—just 50-50—and recovered fully.

The Heaters couldn’t believe their daughter had TSS. “I thought it was caused by leaving tampons in too long, and Stephanie was careful about changing them,” Michele says. Mother and daughter learned there was more to the story, and they’re now spreading the word.

“TSS is random about whom it attacks—and it’s not exclusive to menstruating females,” says infectious diseases specialist Jaan Naktin, M.D., of Lehigh Valley Hospital and Health Network. The underlying culprit is staphylococcus aureus, a bacteria that may live on the skin. “Certain strains can produce the toxins that cause TSS,” Naktin says. “Tampon use has been linked to TSS, although the exact mechanisms aren’t known.”

Awareness of TSS has faded since 1980, when 38 American women died. Their cases were linked to a specific brand of highly absorbent tampon, now off the market. While there’s some speculation that TSS is on the rise again, it remains a rare disease, with only about 300 cases (1 in 100,000 women) reported yearly.

“The best thing you can do is minimize your risk,” says Naktin’s colleague, gynecologist Joseph DeFulvio, D.O. His suggestions:

• Wash your hands before and after inserting a tampon.
• Change tampons every four to six hours.
• Select tampons based on your flow. A tampon is too absorbent if it’s hard to remove, causes vaginal dryness or doesn’t need to be changed after several hours.
• Alternate pads with tampons.
• Don’t use tampons between periods.
• Know the symptoms of TSS. “If you have a high fever, chills, vomiting, diarrhea and dizziness, call your doctor immediately,” DeFulvio says.
• Spread the word to relatives and friends (especially young women new to tampon use) about the dangers of TSS and how they can protect themselves.

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