[Ectotoxin-forming pyogenic Staphylococcus aureus (S. aureus) as a cause of toxic shock syndrome (TSS) in man]

Basing considerations on an extremely carefully examined case of toxic shock syndrome (TSS), an analysis of this phenomenon is presented from the clinical and forensic points of view. TSS is often associated with the term "tampon disease" but in the meantime it has turned out that it may also arise as a non-menstrual disorder, caused by local infections, for example after surgical interventions. The inevitable symptoms include: fever, exanthema, desquamation on the palms of the hands and soles of the feet as well as hypotension. The clinical symptoms would initially suggest a septic process, however bacteriological investigations (blood cultures) normally produce negative results. At the source, however, ectotoxin-producing staphylococci (S. aureus) are found. The present case which is described in detail involves a 17-year old woman who had contracted a crucial ligament injury at the knee of the right leg when playing football. She died a few days after the operation, her death being accompanied by high fever. In smears from the area of the operation it was possible to identify staphylococci (S. aureus) which by phagetyping determination were classified as belonging to lysogroup type II/71 and which produced ectotoxin B. It was not possible to culture bacteria from blood from the corpse. Criminal proceedings for involuntary manslaughter were in the end dismissed although the accused resident physician was sentenced to pay 30,000 DM damages to the parents of the young woman. He also had to pay the costs of the civil action incidental to the criminal proceedings.(ABSTRACT TRUNCATED AT 250 WORDS)