Involvement of staphylococcal enterotoxins in nonmenstrual toxic shock syndrome

Adequate evidence is available to show that the major toxin responsible for toxic shock syndrome (TSS) is TSS toxin 1 (TSST-1). More than 90% of the staphylococcal strains isolated from TSS patients produce this toxin. However, approximately 60% of these strains produce one or more of the staphylococcal enterotoxins, with a number of them producing only enterotoxin, primarily enterotoxin B. Of 55 staphylococcal strains isolated from nonmenstrual cases, 46 produced TSST-1; 42 produced one of the enterotoxins, including 8 that produced only enterotoxin B. The fact that the enterotoxins can produce in monkeys many signs and symptoms similar to those observed in TSS in humans implicates them as the cause of some cases of TSS.