Toxic shock syndrome associated with TSST-1 producing coagulase-negative staphylococci

Coagulase-positive staphylococci have been isolated from more than 95% of cases of toxic shock syndrome (TSS). Toxic shock syndrome toxin-1 (TSST-1) is produced in more than 90% of cases. A case is described of recurrent TSS in which a coagulase-negative staphylococcus was isolated from the vagina and produced TSST-1. No coagulase-positive staphylococci were isolated. Coagulase-negative staphylococci should be considered as causative agents in cases of TSS. Assay for TSST-1 should be performed on coagulase-negative staphylococci obtained from the appropriate clinical sites if no coagulase-positive staphylococci are isolated.