The Disease Spectrum, Epidemiology, and Etiology of Toxic-Shock Syndrome

Abstract

From this composite picture of the history and recent developments related to TSS, several points are clear. TSS is not a new disease, and TST-producing strains of S. aureus are not new. What is new is the recent dramatic increase of this disease in young women who use tampons during menses and who lack antibody to TST. What is also new is the recognition that the disease commonly recurs but only in menstrually associated cases. What remains to be determined are the precise role of tampons, the factors leading to toxin induction, and the mechanism of action of this potent toxin. In order to better determine what these factors and mechanism of action are, and to determine if the TST marker protein is in fact the critical toxin, a reliable animal model is badly needed. Finally, a reliable laboratory test to confirm the clinical diagnosis is another high-priority need. The further unraveling of the secrets of this complex disease may greatly enhance our understanding of the disease associated with this toxin, of the intricacies of toxin production by other bacteria, and of the role that exogenous cofactors play in disease processes.

Enterotoxins and toxic-shock syndrome toxin-1 in non-enteric staphylococcal disease

“…Later, some latitude was permitted [5] but the definition was clearly breached when burns patients without a rash were included [13]. In this study strict adherence to the CDC criteria was the first approach.…”

“…The syndrome had already been recognized [4] but strict criteria were not established until the outbreak. Although the outbreak appeared to be associated with menstruation, non-menstrual TSS was accepted [5].…”

“…Patients were classified on the available information using the revised CDC Atlanta criteria [5] which permit staphylococcal bacteraemia, into: sudden infant death syndrome. In the first five groups and to a degree in the last group, data was available but in group 6 the referral letter might state only 'Clinical TSS' and the questionnaire was not returned.…”

Role of surface proteins in staphylococcal adherence to fibers in vitro.

“…Toxic shock syndrome (TSS)' is an acute, severe, multisystem disorder that is characterized by the rapid onset of fever, hypotension, erythroderma, and delayed desquamation of the palms and soles (1). The syndrome has been recognized to occur in a variety of clinical settings.…”

“…Epidemiologic studies of TSS have implicated colonization with Staphylococcus aureus (S. aureus) and the use of tampons or surgical gauze pads as risk factors for the development of the syndrome (1,3,4). An extracellular protein of S. aureus, TSS toxin-l (TSST-1), with a mol wt of 22,049 D has been isolated (1,5) and was shown to produce a TSS-like picture in rabbits (6).…”