When Olivia Massey had to crawl to her parents' room for help, she realized that her symptoms of nausea, dehydration, raging fever and chills were more than just a severe cold.
By 4 a.m. on Sept. 17, the 25-year-old Lanham market researcher was in the emergency room of Walter Reed Army Medical Center, where doctors worked around the clock to keep her alive.
Massey is the area's latest victim of Toxic Shock Syndrome, the rare, life-threatening disease that strikes at least several hundred people each year. Although publicity about the disease has faded, the infection has not.
It has afflicted 2,492 women and 133 men since the federal Centers for Disease Control in Atlanta began recording it as a unique infection in 1979. Of those stricken, 114 have died.
Olivia Massey was lucky. After 16 days in the hospital, she is at home, still weak, but recovering.
"I heard a nurse say, 'She has no blood pressure. Her heart has stopped beating,' " said Massey, whose skin is peeling as a reaction to the toxins. She has scars from the six tubes inserted in her chest, thigh, arms and nose.
"Fortunately, she responded to the agents we gave her to stablize her blood pressure," said Dr. Robert Decker, the medical resident whose experience with three other toxic shock cases helped in diagnosing Massey's condition in the emergency room. "Hers was the classic case with vomiting, muscle aches and her heart beating fast and her blood pressure low, signifying shock."
The disease made headlines in 1980 when researchers found that it most often struck young women during or just after their menstrual periods. Tampons, particularly those of high absorbency and ones that were not changed frequently, were implicated. One national brand, Rely, was removed voluntarily from the market by its manufacturer, Procter & Gamble.
In the years that followed, scientists have found the culprit is a blood toxin produced by a bacterium called staphylococcus aureus. The patient profile expanded as several older women and some men contracted Toxic Shock Syndrome, many from infections of surgical wounds.
But most of its victims are young women who use tampons. Recently, according to federal researchers, contraceptive sponges have been implicated in cases of Toxic Shock Syndrome.
A debate also has continued on the labeling of tampons, as the CDC and others have found highly absorbent tampons create more of a risk, perhaps by encouraging the production of the blood toxin.
A two-year effort by the FDA to persuade manufacturers to create a voluntary plan failed. The agency now is developing rules to force the nation's five tampon manufacturers to tell consumers the absorbency of their products. The rules are expected to be final next year.
In the meantime, the CDC has found that when the publicity surrounding the disease diminished, so did the number of doctors who reported it.
Margaret Oxtoby, an epidemiologist in the CDC division of bacterial diseases, said that only Wisconsin, Minnesota and Utah "have maintained strong interest in an active surveillance." As a result, the CDC determines the nation's incidence rate from those three states.
Decker said that an infection control committee at Walter Reed reports its cases of Toxic Shock Syndrome to federal authorities. But Oxtoby said the government's records show that only one case of Toxic Shock Syndrome has been reported to the CDC from the District of Columbia since 1979.
Virginia doctors and hospitals have reported 39 cases in those same years, and Maryland has noted 24 cases.
"We had much better case-finding in the past," said Oxtoby. "But it certainly is a continuing problem."
The problem remains rare, with an estimated 5 to 15 cases each year per 100,000 menstruating women, slightly fewer than the 6 to 17 cases per 100,000 estimated in previous years.
But many experts think that underreporting is a serious problem. Jill Wolhandler of Boston, a participant in the tampon task force of the American Society for Testing and Materials, which is working with the manufacturers on absorbency ratings, said exact incidence cannot be determined "when we think only 10 percent of the cases are sent on to the federal government."
Whatever the numbers, for those who are stricken it is one case too many.
"This has ravaged me from head to toe," said Massey, a former overseas Army communications specialist who plans to return to Germany in January after she and her fiance are married. "I hadn't heard anything about toxic shock for a while and felt that if I've been using tampons all this time, they won't hurt me."
Massey was using Playtex Super Plus tampons when she became ill. They are the most absorbent brand on the market, according to a chart prepared by the manufacturers for the American Society for Testing and Materials.
Because the disease recurs in 30 percent of the cases, Massey has been instructed never to use tampons.
Her mother, Betty Massey, was so upset about her daughter's experience that she stood up in her church the following Sunday and urged the women in the congregation to give up tampons.
The experience of surviving such a serious threat has given Massey a new respect for emergency medicine.
"I will never forget those four days in intensive care," Massey said.
"I am so grateful to the doctors for saving my life. I was born at Walter Reed and they kept me alive, too."