It was supposed to be a fun overnight school trip, but 16-year-old Sara Manitoski never woke up the next morning — a sudden death that authorities blame on toxic shock syndrome.
The Canadian teenager died of TSS as a consequence of staphylococcus aureus, CTV News reported, citing a report by the Coroners Service of British Columbia. Tests on a tampon found inside the girl's body detected the presence of the bacteria, the report said, though the coroner noted that while tampon use increased the risk for TSS, it was not the only cause of it.
Sara died in March of 2017, but the official report was only released to the public last week.
"Sara was the sweetest, happiest, most charismatic little girl who had had such a bright wonderful future ahead of her," her sister Carli Manitoski told TODAY. Sara never expressed any concerns about TSS and tampon use, she added. The teenager loved to travel and explore the world.
Manitoski has posted a warning to others on her Facebook page: "Women need to be more educated on this subject, some of you might not even know what TSS is… My beautiful, incredibly healthy sister died because of this so please share, educate yourselves and be cautious whenever using tampons."
The incident happened at camp on Hornby Island, British Columbia, where Sara — who attended school in Courtenay, British Columbia — traveled for an overnight school trip, according to a fundraising page set up for her family. She had complained of stomach cramps before going to bed, her sister wrote on Facebook. Sara was found unresponsive in her cabin the next morning and could not be revived.
An autopsy found redness on Sara's neck, upper arms, upper chest, lower abdomen and thighs, the Vancouver Sun reported. A widespread red rash that looks like a sun burn is one of the symptoms of TSS.
What is toxic shock syndrome?
TSS is a life-threatening complication of a bacterial infection. The earliest cases involved women who used tampons during their periods, but today less than half of cases are linked to tampon use, according to the National Institutes of Health.
TSS first garnered national attention in 1980 after an "epidemic" of cases that coincided with the introduction of super absorbent tampons, the Centers for Disease Control and Prevention noted. The number of cases dropped significantly by 1986 after the U.S. government began to require standardized labeling for the products. A decrease in tampon absorbency, tampon package inserts and greater awareness of TSS among women also drove down the number of cases, CDC said.
TSS now occurs in up to three per 100,000 menstruating women, the National Organization for Rare Disorders estimated. Menstrual TSS most commonly occurs in girls and women 15 to 25 years old who are using tampons.
Dr. Lauren Streicher, professor of obstetrics and gynecology at Northwestern University's Feinberg School of Medicine, has only seen one case in her almost 30 years of practice.
"It's extraordinarily, extraordinarily rare," Streicher told TODAY. "I certainly would not tell my daughters or my patients that they should be concerned about using tampons."
TSS can affect anyone — men, non-menstruating women and children — because it can also occur with skin infections, burns and after surgery, NIH said.
TSS symptoms include:
general ill feeling
high fever, sometimes accompanied by chills
low blood pressure
nausea and vomiting
To lower the risk for menstrual toxic shock syndrome:
The government advises these steps:
Avoid highly absorbent tampons.
Change tampons frequently, at least every four to eight hours.
Only use tampons once in a while during menstruation, alternating with pads.
Still, Streicher doesn't advise her patients against the overnight use of tampons.
"It's terrifying when you hear about [cases like Sara's] because these are young healthy women," she said.
"But when you look at the number of women who use tampons on a regular basis and keep them in overnight — this is one case. Think about the millions of nights that people spend with tampons in place… what this tells you is it's extraordinarily rare."
Use common sense when using tampons, she advised. If you do have symptoms of TSS, treat it as a medical emergency and seek help immediately.
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