Related Experiment Videos
Toxic shock syndrome: clinical and laboratory findings in 30 patients
Abstract:
Thirty patients with toxic shock syndrome (TSS) that developed between May 1980 and March 1983 in Vancouver were studied prospectively. In the 15 cases related to menstruation the illness followed a uniform and predictable clinical course. In the 15 other cases (3 in males) the disease was not related to menstruation, and the sources of the Staphylococcus aureus infections were diverse; 67% were hospital-acquired. Profound but transient lymphocytopenia associated with marked leukocytosis was the most striking laboratory finding and one not previously emphasized in the literature. S. aureus was isolated from sites of soft-tissue infection, the vagina or the endocervix in all except one case. Two patients had bacteremia. Phage types 29 and 29 + predominated among the isolates tested. All the genital S. aureus isolates tested produced the TSS marker protein, while the bacteria from wounds, throat, nose and blood were sometimes positive. Two patients (7%) died from refractory shock and multiple organ failure. All patients with a febrile, exanthematous, multisystem illness, particularly if it is associated with menstruation or a staphylococcal infection, should be evaluated promptly and treated empirically for TSS.
Insights
Toxic shock syndrome (TSS) can present differently, with menstrual-related cases having a predictable course. Non-menstrual TSS, often hospital-acquired Staphylococcus aureus infections, showed unique lab findings like lymphocytopenia.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Toxic shock syndrome (TSS) is a severe illness.
- Previous understanding of TSS clinical presentation and laboratory findings was limited.
- Staphylococcus aureus is a primary causative agent.
Purpose of the Study:
- To prospectively study patients with toxic shock syndrome.
- To describe the clinical course and laboratory findings of TSS.
- To identify sources and characteristics of Staphylococcus aureus in TSS cases.
Main Methods:
- Prospective study of 30 TSS patients over three years.
- Clinical data collection on illness course, symptoms, and outcomes.
- Microbiological analysis including Staphylococcus aureus isolation, phage typing, and toxin production.
Main Results:
- Two distinct TSS presentations were observed: menstrual-related and non-menstrual.
- Non-menstrual TSS cases were frequently hospital-acquired Staphylococcus aureus infections.
- Profound lymphocytopenia with marked leukocytosis was a key laboratory finding.
- Staphylococcus aureus isolates from genital sites predominantly produced the TSS marker protein.
Conclusions:
- TSS has varied clinical presentations and etiologies.
- Prompt empirical treatment for suspected TSS is crucial, especially with febrile, exanthematous, multisystem illness.
- Lymphocytopenia is a significant, under-recognized laboratory marker in TSS.