Toxic shock syndrome: diagnosing recurrence

Toxic shock syndrome (TSS) is not easily recognized, despite explicit criteria for diagnosis. These include fever, rash, desquamation of palms and soles, and hypotension, plus involvement of up to seven other organ systems. The disease is associated with tampon use; Staphylococcus aureus is the most likely causative organism. Recurrence with menstruation is unique to this disease, although recurrences have been reported without the use of tampons and efforts to isolate Staphylococcus aureus from cultures may prove fruitless. In this case, a 27-year-old woman experienced recurrences which could be diagnosed only by hindsight. All suspected cases should be reported to the Laboratory Centre for Disease Control in Ottawa so that a true picture of this disease may be obtained.