Toxic shock syndrome: a retrospective study of 25 cases from Iowa

We reviewed retrospectively the clinical records of 25 women ages 13 to 41 years who had diagnosed illnesses compatible wtih toxic shock syndrome (TSS). Cases occurred between January 1976 and October 1980. Fourteen confirmed TSS cases and 11 probable TSS cases were identified. In each case initial symptoms occurred in association with menstrual bleeding and tampon use. All patients were febrile. Hypotension occurred in 20 cases, but five patients with milder illness remained normotensive. An erythematous rash occurred in 20 cases. Desquamation occurred in convalescence in all but two cases. Complications included delirium or coma, acute renal failure, and respiratory distress syndrome. Thirteen patients had recurrences of TSS. S. aureus was isolated from the vagina or cervix in 75% of cases. There is a spectrum of severity associated with TSS. Strict diagnostic criteria established heretofore for epidemiologic studies of TSS may not be met by all cases of TSS.