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Usually caused by staphylococcal exotoxin associated with high-absorbency tampon use. Strep. pyogenes can also cause it. The rare syndrome usually begins within 5 days of the onset of the period and may be related to prolonged retention.
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Clinical features include sudden-onset fever, vomiting and diarrhoea, muscle aches and pains, skin erythema, hypotension progressing to confusion, stupor and sometimes death.
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Active treatment depends on the severity of the illness. Cultures should be taken from the vagina, cervix, perineum and nasopharynx. The patient should be referred to a major centre if ‘shock’ develops. Otherwise the vagina must be emptied, ensuring there is not a forgotten tampon, cleaned with a povidone-iodine solution tds for 2 d, and di(flu)cloxacillin or vancomycin antibiotics administered for 8–12 d.