Teen Dies from Toxic Shock Syndrome on School Trip: What You Should Know

Sara Manitoski went on what was supposed to be a fun overnight school trip to Hornby Island, British Columbia. The next morning, her friends left her in the cabin when they went to breakfast, thinking she was still sleeping. When they returned, her alarm was blaring and she was unresponsive. Despite attempts by staff, students, and emergency responders to revive the 16-year-old, she did not recover and was pronounced dead.

While Manitoski's death occurred in March 2017, the official results from the coroner were only released to the public last week. Based on the strain of staphylococcus aureus found on the tampon inside her, it was determined that the teenager died of Toxic Shock Syndrome (TSS). She also exhibited other signs associated with TSS.

source: web images

What is TSS?

TSS is a life-threatening complication associated with tampon use, but that's not the only way to get it. In fact, less than 50% of TSS cases are due to tampon use. TSS is caused by three types of bacteria: staphylococcus aureus, streptococcus pyogenes, and clostridium sordelli. Sometimes they do not cause any illness, but other times they can grow rapidly and produce toxins. Conditions that can increase the risk for TSS include skin wounds, burns, surgical incisions, nasal packing, and gynecological procedures. It can affect men, children, and post-menopausal women.

Why Do Tampons Pose a Risk?

TSS is associated with menstruating women and tampons in particular because in the late 1970s, super absorbent tampons were released on the market. In fact, one tampon at the time was even advertised to be capable of absorbing an entire period's worth of blood so women could leave it in for days at a time. Since women could leave these tampons in longer and staph is normally (and harmlessly) present in the vagina, they harbored more bacterial growth in the warm, moist environment. Additionally, the tampons could cause tiny cuts inside the vagina which could then allow bacteria to enter the bloodstream. Three-quarters of TSS cases at that time were due to tampon use. Since then, the FDA regulated the tampon industry more, as well as requiring tampon manufacturers to include warning labels about TSS.

source: shutterstock

Symptoms of TSS can include:

Fever (sometimes with chills), headaches, and muscle aches

Rash (may look like a sunburn) and eyes, mouth, and vagina appearing redder than usual

Low blood pressure

Kidney problems or failure

Respiratory problems or failure


Diarrhea, nausea, and vomiting

In the case of Manitoski, it was noted that she was complaining of stomach pain before bed. In the morning, she was covered in a rash on her neck, upper chest, upper arms, lower abdomen, and thighs.

To prevent TSS, you should:

Use the lowest absorbency tampon that you can

Consider using pads instead of tampons every other day and at night when you go to sleep

Change your tampon every 4 to 8 hours

Do not use tampons when you don't have your period


Bottom Line

Remember that while TSS can be fatal, it is also very rare. In 2016, there were only 40 reported cases of TSS in the United States. Half were not related to menstruating women at all. It is estimated that only three out of 100,000 tampon users will develop TSS each year. To reduce your risk for TSS, you should make sure that you use the lowest absorbency tampon that you can, change your tampons frequently, and consider using pads instead of tampons. If you suspect you may have TSS, consult a physician right away.