A cause of death has been determined for the 16-year-old Comox teen who passed away during a class trip to Hornby Island in 2017.
Sara Manitoski, a Grade 11 student who attended Georges P. Vanier Secondary School in Courtenay, died in her sleep while on a school trip to Hornby Island’s Tribune Bay Outdoor Education Centre. She was found unresponsive on the morning of March 15, 2017 by other students sharing a cabin with her.
The BC Coroners Service has found the immediate cause of Manitoski’s death was toxic shock syndrome (TSS) due to Staphylococcus aureus. The coroner classified the death as natural.
The report links tampon use to Manitoski’s death but notes that tampon use is not the only cause of TSS.
“Microbiology cultures completed on a tampon found in place identified the presence of Staphylococcus aureus. Both findings are consistent with toxic shock syndrome,” reads.
“Toxic shock syndrome is an acutely life-threatening illness. The risk for toxic shock syndrome is increased with tampon use, however, tampon use is not the sole cause. Therefore, it is not possible to definitely exclude the tampon as causative.”
The BC Coroners Service report also said Manitoski had participated in daily activities with her fellow students on March 14, 2017 but did complain about feeling unwell and having cramps. She did not eat much at dinner and retired to her shared cabin at approximately 9:50 p.m.
The report said Manitoski was heard breathing rapidly and shallowly in the middle of the night for a short period of time and then stopped. At approximately 7 a.m. on March 15, the other students in the cabin went for breakfast. They returned at 7:30 a.m. to find Manitoski’s alarm sound and Manitoski unresponsive. Teachers and paramedics initiated CPR but were unable to “re-establish vital signs and resuscitation was discontinued.”
Skin redness on the neck, upper arms, upper chest, lower abdomen and medial thighs was found during the autopsy. No injuries were found. The toxicology exam was negative for alcohol, prescription and illicit drugs.
“Autopsy and microbiology findings, as well as the symptoms Sara exhibited immediately prior to her death, are all consistent with the effects of toxic shock syndrome,” the report reads.
Manitoski and 35 other students were part of the Explore Program, an outdoor education and leadership program for Grade 11 students.
According to HealthLinkBC, TSS is a rare illness that happens suddenly after an infection. It quickly can harm several different organs, including the lungs, the kidneys, and the liver, and it can be deadly. Since toxic shock syndrome gets worse quickly, it requires medical treatment right away.
TSS is caused by strep or staph bacteria can lead to toxic shock syndrome. These bacteria are common and don’t usually cause problems. But in rare cases, the toxins enter the bloodstream and cause a severe immune reaction. This reaction causes the symptoms of TSS. TSS caused by strep most often occurs after childbirth, the flu (influenza), chickenpox, surgery, minor skin cuts or wounds, or injuries that cause bruising but may not break the skin. Toxic shock syndrome caused by staph most often occurs after a tampon is kept in too long (menstrual TSS) or after surgery (non-menstrual TSS).
TSS symptoms include:
- Sudden fever over 39 C (102 F).
- Signs of shock, including low blood pressure and rapid heartbeat; nausea; vomiting; or fainting or feeling light-headed, restless, or confused.
- A rash that looks like a sunburn. The rash can be on several areas of your body or just in certain places, such as the armpits or the groin.
- Severe pain in an infected wound or injury.
- Severe flu-like symptoms, such as muscle aches and pains, stomach cramps, a headache, or a sore throat.
- Redness inside the nose and mouth.
- Pink eye (conjunctivitis).
- Scaling, peeling skin, especially on the palms of the hands and soles of the feet.
The Government of Canada said while TSS is rare, tampon use may also cause an increased risk of vaginal dryness and vaginal ulcers, especially if the tampons used are more absorbent than is needed to control menstrual flow. There can also be serious hygiene problems if tampons are forgotten and not taken out in time.
To minimize health risks while using tampons, the Government of Canada has the following recommendations:
- Do not use tampons if you have ever been diagnosed with TSS.
- Use the lowest absorbency that will meet your needs. All tampons licensed for sale in Canada use a standardized, absorbency-labelling system. This means that any tampon of a stated absorbency, no matter which brand, will absorb the same amount of fluid.
- Read the information pamphlet that comes with tampons, and follow all directions.
- Do not use tampons until your period begins. Do not use them as a precaution because you expect your period to start on a given day, or to control other types of discharge.
- Wash your hands before and after inserting a tampon.
- Change your tampon every 4 to 8 hours, and do not use tampons overnight.
- Remember to remove each and every tampon.
- Alternate the use of tampons with external protection, like pads and liners.
- Anyone who has symptoms of TSS while using a tampon should remove it and get immediate medical help. If you can’t reach your doctor, go to the nearest emergency care facility. Make sure the healthcare professional treating you knows that you were using a tampon when the symptoms started.