Toxic Shock Syndrome, Streptococcal Toxic Shock Syndrome, (STSS)
Roger Ross DVM
This is an interesting and often fatal disease cause by the bacteria Streptococcus. I’m not sure about the micro-biological details but some types of strept are considered harmless and normal in dogs (and people too for that matter), but some strains of strept ... or under certain conditions... strept can cause disease (severe throat disease and heart disease in people) and death.
The disease is interesting because the symptoms often fool us ... they’re similar to other emergency diseases such as heat stroke, respiratory diseases, and poisoning.
Another interesting thing about the disease is that it’s a fairly newly discovered disease. For a while it was confused with a similar tissue destructive disease caused by staph bacteria.
Okay, here’s an introduction to the disease:
First; quick diagnosis and treatment is critical for survival
Initial symptoms include: high fever, often over 105, twitching of the face muscles, extreme weakness or collapse, and possible convulsions. Further symptoms include fluid in the lungs, coughing up of blood, nose bleeds, bloody diarrhea, and other types of internal hemorrhage.
Treatment needs to be quick and aggressive. Here’s what to expect when you go to the vet: (of course, your vet may treat this differently)
History: Your vet will want to know if there was any exposure to strychnine, antifreeze, or other poisons.
Exam: Because your pet is so obviously sick, your vet will probably start symptomatic treatment almost immediately, but will notice the little hemorrhages on the gums, the fluid in the chest, the high fever, the weakness, the bloody diarrhea, if present, and the muscle quivers.
Your vet may not know or even suspect strept at this stage, but our training will let us know that we are dealing with one of several things, all of which share some basic treatments. Those rule outs are parvo virus, auto-immune vascular diseases, vascular inflammation associated with heat stroke, rat poison, anti-freeze poisoning, and the rarer hemorrhagic diseases we don’t see too often such as plague and Streptococcal Toxic Shock Syndrome (STSS), the topic of this article
Here’s what to expect:
1. A guarded prognosis. Despite heroic and proper treatment ...and probably a big bill ...your pet may very well die.
2. IV Fluids and massive doses of steroids (shock treatment)
3. Antibiotics. In the case of Strept, good old penicillin in high dose is a good choice, but at this stage, we won’t know for sure that strept is involved. But antibiotics are appropriate anyways in any hemorrhagic and high fever disease as we know that bowel and respiratory bacteria will be causing severe secondary if not primary problems.
4. Diuretics may be used to help clear out lung fluid
5. Anti-convulsive medications may be needed.
6. Your vet may wet down the patient to help reduce the fever. Later in the treatment your pet may need to be kept warm.
7. Here’s something interesting, despite the bleeding, your vet may give heparin or aspirin ...which will make the bleeding worse ... and would be a mistake if rat poison was the problem, but might be life saving if DIC is involved. DIC refers to life threatening micro clotting and embolisms that sometimes occur secondary to the inflammation caused by strept or other diseases
8. At the same time, your vet may be giving K1 injections which is the antidote to some rodent poisonings since the actual diagnosis will still be in doubt during the initial treatment.
9. If your pet survives the initial emergency treatment, then you should expect at least a few days of hospitalization, supportive care, antibiotic therapy, nutritional support, fluid replacement, frequent monitoring, and treatment of all the secondary symptoms that are likely to pop up such as diarrhea and nausea.
10. Other treatment, Alternative treatments, Herbals etc. Well, my only comment here is that I don’t know of any appropriate alternative treatments except for prayer in the initial stages of treatment. Not to put too fine an edge on this, your pet will die if you skip the antibiotics, IV fluids, and steroids.
Lab Work: You will be wanting an explanation for what happened to your dog...who was likely very normal just a day or two before, and your vet will need to do lab work to satisfy this question as well as to monitor the internal damage to the patient.
1. Blood work to include a red and white cell count and blood chemistry panel. We will be especially worried about secondary kidney and liver failure, anemia, and the white blood cell response.
2. A Parvo test may be appropriate, especially in young, unvaccinated dogs.
3. A fecal exam to rule out parasites, especially whip and hook worms, as the cause. Sound unlikely? Not at all. Here’s what sometimes happens: parvo or intestinal worms cause acute inflammation of the bowel lining. If the bowel wall is inflamed and damaged, then bacteria from the stool can enter the blood stream, which will then create all kinds of potential havoc including DIC, endotoxic shock, and toxic shock syndrome.
4. Blood culture. Because bacterial disease is suspected, your vet may want to send off blood for culture...exactly the right thing to do if the disease turns out to be from strept or other bacteria. In fact, there’s no way of proving streptococcal toxic shock syndrome without a culture. The biggest problem with culturing though is the time lag; by the time the results come back your patient will be either dead or recovering.
5. A heartworm test may be done. Heartworm disease can cause multiple sypmtoms too, especially respiratory inflammation and vascular disease.
6. A chest x-ray may be done to try to rule out other causes of severe and acute respiratory disease.
That’s it. I’m not sure about whether or not your dog could possibly spread this disease to other dogs or humans, but certainly basic sanitary measures should be taken such as cleaning up all the stool in the yard and washing all feed dishes etc. The disease does seem to be contagious, though; there have been reported outbreaks in racing grey hounds, coyote populations, and research kennels. Oh, one other thing. I just reread what I wrote and I don’t think I emphasized that this is mainly a respiratory disease in that the lungs is where the disease most likely gets started and death, if it occurs will most likely be caused due to respiratory drowning. Still, lots of other organ systems are involved too.