Toxic Shock Syndrome: Staphylococcal and Streptococcal
Reportable by Providers and LaboratoriesAbout this Reportable Disease
Infectious agent: Staphylococcus aureus and Streptococcus pyogenes (group A Streptococcus)
Description of illness: Toxic shock syndrome (TSS) is a serious and potentially fatal disease caused by toxins produced by either Staphylococcus aureus (non-streptococcal TSS) or group A Streptococcus (streptococcal TSS) bacterium. Both can present suddenly with fever, chills, and rapidly progress to a severe drop in blood pressure and multi-system organ failure. Staphylococcal TSS often includes a sunburn-like rash, which is only occasionally seen in streptococcal TSS. Streptococcal toxic shock syndrome (STSS) fatality rate may exceed 50%.
Interactive Disease Data
Laboratory Reporting for this Disease
Reporting requirements apply to all laboratories located within Tennessee, as well as laboratories outside of Tennessee that test residents of Tennessee, including laboratories located within healthcare facilities. Healthcare providers and laboratories in the same healthcare facility both have a duty to report. The type of organisms and analytes laboratories must report to TDH for 2026 are indicated, and there are several ways laboratories can report results to TDH.
- Manually report results to TDH by faxing or mailing a completed PH-1600 form to your local health department, or faxing to the state health office at (615) 741-3857
- Automatically submit results to TDH via electronic laboratory reporting (ELR), which automates the process of sharing data with TDH using interoperability standards.
- See the ELR Onboarding Handbook for details on the onboarding process, checklist, frequently asked questions, business rules, message format, and vocabulary.
- To initiate the ELR onboarding process with TDH, register in the Trading Partner Registration (TPR) system TPR provides documentation for Promoting Interoperability (PI) attestation and milestone letters to document onboarding progress. Contact MU.Health@tn.gov for assistance.
- Submit online via NBS. NBS is TDH's reportable disease system. To request an NBS account for reporting Complete this user survey to request an NBS account for reporting.
- Blood lead levels can be sent via fax ( (615) 741-3857), entered online, or reported using the instructions at this link.
Information about this Reportable Disease for Healthcare Providers
Clinical Summary
- Toxic shock syndrome (TSS) is a rare but serious complication of certain bacterial infections.
- It is most often caused by Staphylococcus aureus bacteria, though toxins from Streptococcus (group A) can also trigger it.
- Risk factors include skin wounds, recent surgery, and use of tampons, menstrual cups, diaphragms, or sponges if left in place too long.
- Symptoms typically onset suddenly and may include high fever, low blood pressure, rash, vomiting/diarrhea, confusion, and muscle aches.
- Rapid progression is possible, and complications can include organ failure (kidney, liver, heart) and shock, which can be fatal.
Healthcare Provider Reporting
Healthcare reporting requirements apply to all providers located within Tennessee, as well as providers whose patients reside in Tennessee.
Providers must report cases of all diseases and conditions listed through one of these methods:
• Mail or fax a completed PH-1600 form to your local health department or fax to the state health office at (615) 741-3857
• Send automatically via electronic case reporting (eCR). See this TDH webpage for more information on eCR, register at the Trader Partner Registration website, or contact MU.Health@tn.gov for assistance.
• Submit online via NBS. NBS is TDH's reportable disease system. To request an NBS account for reporting Complete this user survey to request an NBS account for reporting.
• Blood lead levels can be sent via fax ( (615) 741-3857), entered online, or reported using the instructions at this link.
Information about this Reportable Disease for the Public
What It Is
Toxic shock syndrome is a rare but life-threatening condition caused by toxins produced by Staphylococcus aureus or Streptococcus pyogenes bacteria. It leads to a rapid drop in blood pressure and can damage multiple organs.
Types
There are two main types—staphylococcal TSS (linked to tampon use or skin wounds) and streptococcal TSS (often following skin infections or surgery).
Signs and Symptoms
Symptoms develop suddenly and may include high fever, low blood pressure, vomiting, diarrhea, rash resembling sunburn (especially on palms and soles), muscle aches, confusion, and sometimes seizures.
Treatment
Immediate hospital care is essential, involving IV antibiotics, fluids to stabilize blood pressure, removal of any infection source (such as tampons or wound packing), and supportive care for affected organs.
This Page Last Updated: March 25, 2026 at 8:53 PM