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It came on suddenly fever, diarrhea, swollen red hands.

"I couldn't even get out of bed," says Leslie Hudson, 33. "By the third day, I was opening a brand new package of tampons, and I took the toxic shock warning out and I read it."

Her symptoms matched those on the brochure. She called her doctor, went to the emergency room and was hospitalized for four days.

Toxic shock syndrome made headlines in the early 1980s, when scores of women around the country died from the sudden illness. Most of those deaths were attributed to tampon use, with one brand Rely taken off the market. Tampon manufacturers paid large settlements to victims and their families.

Since then, the hype that surrounded toxic shock has died down. But the illness hasn't disappeared and many women ignore the warnings inserted in tampon boxes.

"Every single one of my female friends said, `Every time I use tampons, I take the toxic shock flier out and throw it away,' " Hudson says.

In 1994, 192 cases of toxic shock were reported nationwide, and six cases were reported in Colorado. But Colorado epidemiologist Richard Hoffman says those numbers may be low.

"I would expect that there's a fair number of unreported cases," he says. "There is not really a public health response" because it isn't contagious.

James Todd, a professor of pediatrics, microbiology and preventive medicine at the University of Colorado School of Medicine, agrees. "I don't think we know the true incidence anymore. Women are a lot more attuned to this. They're having mild cases that they're not even seeking medical attention for and (they're) developing an immunity."

Todd and another doctor at The Children's Hospital in Denver originally identified the illness as toxic shock syndrome in 1978. Two years later, the Centers for Disease Control warned that using tampons could cause the illness.

But, Todd says, "toxic shock is not a, quote, tampon disease. It occurs in people who are males or nonmenstruating females." A common bacterium, staphylococcus aureus, is at the heart of toxic shock. "By the time you get into college, 90 % of Americans have been exposed to the bug and have antibodies to the toxin," Todd says.

But those who haven't developed antibodies are at risk. For women, menstruation produces protein and causes the acid level of the vagina to decline. Tampons (or any other item inserted into the vagina, Todd says) provide oxygen. If the staph bacterium is present and the person doesn't have those antibodies, the environment is right for toxic shock.

Sickness comes "very rapidly like in hours," says James McGregor, a CU professor of obstetrics and gynecology. Symptoms include fever, a rash, vomiting, diarrhea and muscle pain. Often, symptoms can be mistaken for the flu.

Todd says part of the decline in toxic shock cases reported since the 1980s does somewhat accurately portray the occurrence of the illness.

"The incidence has probably decreased," he says. "The organisms go through cycles in a community."

Dennis Stevens, chief of the infectious disease section at Veterans Affairs Medical Center in Boise, Idaho, says people who've had nose reconstructions, where gauze or other materials are packed into the nose after surgery, are also susceptible to toxic shock. Still, women using tampons should be cautious, paying attention to warning brochures and potential symptoms, Todd says. Tampons shouldn't be worn for more than about eight hours at a time.

And if symptoms of toxic shock are present, the first course of action is to remove the tampon, Todd says. Quick medical attention is also essential.

In cases where the illness is caused by a sore or other infection, doctors will lacerate the site of the infection. Antibiotics are typically used to help patients recover.

For Hudson, toxic shock occurred during her period after she had an intrauterine contraceptive device inserted. She eventually had to have the IUD removed.

Now, she's still recovering from the aftereffects.