Nonmenstrual Toxic Shock Syndrome

Reingold, Arthur; Hargrett, Nancy T.; Dan, Bruce B.; Shands, Kathryn N.; Strickland, Barbara; Broome, Claire V.

doi:10.7326/0003-4819-96-6-871

Cited by 219 publications

(87 citation statements)

References 7 publications

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“…The illness is caused by Staphylococcus aureus bacteria that make superantigens (SAgs), usually TSS toxin-1 (TSST-1), enterotoxin B (SEB), or SEC (7); these toxins exert systemic effects on the host (2). Probable TSS has been described as the same illness but lacking one of the defining criteria of TSS (6). Parsonnet suggests that the term toxin-mediated disease be used for cases of apparent TSS in which more than one clinical feature is absent though it can be established that S. aureus is present and that the patient lacks protective antibodies (5).…”

mentioning

confidence: 99%

Reemergence of Staphylococcal Toxic Shock Syndrome in Minneapolis-St. Paul, Minnesota, during the 2000-2003 Surveillance Period

Schlievert

Tripp²,

Peterson

2004

J Clin Microbiol

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mentioning

confidence: 99%

Reemergence of Staphylococcal Toxic Shock Syndrome in Minneapolis-St. Paul, Minnesota, during the 2000-2003 Surveillance Period

Schlievert

Tripp²,

Peterson

2004

J Clin Microbiol

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“…In (8,63,132,133), often with increased frequency (122,177) compared with the early epidemiologic reports which may have selectively focused on females who were menstruating (47,153). High-risk groups appear to be postpartum women (24,30,35,67,68,187)-and patients with surgical wound infections (8,25,57,187), focal staphylococcal infections (175), and nasal surgery (78,85,162,166 Incidence It is difficult to determine the true incidence of TSS in populations for which reliance is placed on passive reporting (29,120,159).…”

Section: Epidemiology Association With Menstruation and Tampon Usementioning

confidence: 99%

“…Further epidemiologic investigations have shown that the incidence of TSS did not diminish in some states after the Rely tampon was removed from the market (114,115,177) and, in fact, increased in another (123). In addition, many nonmenstrual cases of TSS were described in increasing numbers in males as well as females (8,110,132,133,177,185), and not all of the S. aureus strains isolated TOXIC SHOCK SYNDROME 433 from these patients produced TSST-1 (45,84,132). Animal model studies suggested that under some circumstances TSST-1 was not particularly toxic (127); subsequently, other exoproteins have been described (including the previously described epidermal toxin) which may also play roles in the pathophysiology of TSS (41,65,145,151,170,173,192 Thus, after 10 years, TSS is still an important disease with many interesting clinical, epidemiologic, and microbiologic features.…”

Section: Introductionmentioning

confidence: 99%

Toxic shock syndrome

Todd¹

1988

Clin Microbiol Rev

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In the past 10 years, we have learned much about TSS and S. aureus and its toxins. A number of important biologic principles have been reemphasized in this first decade of TSS research: S. aureus is a very complex organism, one not likely to yield quick answers; in vitro observations must always be confirmed in the patient; animal models may not always be reliable replicates of human disease; and epidemiologic associations cannot be equated with causation. Toxic shock is an intricate phenomenon with many interesting scientific facets. Unraveling its mysteries will undoubtedly teach us more about the complex interaction of patients and microorganisms.

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“…Toxic shock syndrome (TSS) following staphylococcal infection was initially associated with menstruation and tampon use, but reports of nonmenstrual TSS :associated with various types of staphylococcal infections have appeared (1). A small number of patients with TSS have been described as having acute synovitis (2,3).…”

Section: Synovitis In Toxic Shock Syndrome (Tss) Is An Unusual Findingmentioning

confidence: 99%

Aseptic arthritis in a man with toxic shock syndrome

Gertner¹,

Inman²

1986

Arthritis & Rheumatism

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Synovitis in toxic shock syndrome (TSS) is an unusual finding.A 31-year-old man presented with pain and swelling in both knees and was found to have TSS, secondary to a septic bursitis caused by Staphylococcus aureus. Immune complexes were not detected in serum or synovial fluid, and the S aureus was not recovered from the inflamed joints. Antibodies against the TSS todn-1 were detected in serum and synovial fluid, but in lower levels than would be seen in a normal control serum. Complement studies implicated alternative pathway :activation by a marked diminution in C3 levels compared with C4 levels, and by lower levels of factor B than would be found in other inflammatory joint diseases. The diagnostic dilemma posed by TSS in a man is discussed.Toxic shock syndrome (TSS) following staphylococcal infection was initially associated with menstruation and tampon use, but reports of nonmenstrual TSS :associated with various types of staphylococcal infections have appeared (1). A small number of patients with TSS have been described as having acute synovitis (2,3). However, this finding has not been studied in detail. We describe the clinical features of a patient who developed an aseptic arthritis when he had TSS associated with staphylococcal septic bursitis. The report provides data about possible immunopathogenesis of the synovitis.Case report. A previously healthy 3 I-year-old white man presented to the emergency department with a 3-day history of sore throat, cough, fever, headache, dysuria, severe myalgias, and a rash. Four days prior to admission he had noted a small circular lesion over the right knee. He then experienced increasing difficulty with walking, due to pain and swelling in both knees. Two days prior to his admission, he experienced nausea, vomiting, fever, and chills. He had no history of drug ingestion, penile discharge, dysuria, alcohol abuse, or intravenous drug abuse.Examination revealed an acutely ill male in marked respiratory distress. He was confused, agitated, and disoriented. His pulse rate was 140/minute, blood pressure was 96/20 mm Hg, temperature was 3 9 T , and respiratory rate was 25Iminute. There was diffuse macular erythroderma with areas of central clearing over his trunk, arms, legs and palms. Scattered petechiae were present. Cardiovascular, respiratory, and abdominal examination results were otherwise unremarkable. His pharynx was reddened. He had no oral ulcerations and no conjunctivitis. Musculoskeletal examination revealed redness, warmth, and large effusions in both knees, but no other synovitis was present. There was a 1-cm circular crusted lesion over the right prepatellar bursa, with reddish discoloration in that area.Results of laboratory investigations showed hemoglobin 15.7 gm/dl, white blood cells (WBC) 19.5 x 103/ml, and normal electrolyte values. Urinalysis showed proteinuria (3+), 5-10 WBC, 3-5 epithelial cells, 2+ bacteria. Blood urea nitrogen level was 14.1 mmolesfliter (normal 3-7); creatinine was 237 pmoles/

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Nonmenstrual Toxic Shock Syndrome

Cited by 219 publications

References 7 publications

Reemergence of Staphylococcal Toxic Shock Syndrome in Minneapolis-St. Paul, Minnesota, during the 2000-2003 Surveillance Period

Reemergence of Staphylococcal Toxic Shock Syndrome in Minneapolis-St. Paul, Minnesota, during the 2000-2003 Surveillance Period

Toxic shock syndrome

Aseptic arthritis in a man with toxic shock syndrome

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