Toxic shock syndrome is a staphylococcal disease caused by toxins produced by the staphylococci, toxic shock syndrome toxin-1 and enterotoxin B. The disease results from staphylococci growing in the vagina with the use of tampons during menstruation, primarily in young women. However, any staphylococcal infection can result in toxic shock syndrome if the staphylococci produce the appropriate toxins and the individual has no antibodies to the toxins. The symptoms can be quite severe, with high fever, low blood pressure, diffuse macular erythroderma, orthostatic dizziness, vomiting and or diarrhea at the onset, severe myalgia, peeling of the skin of the palms of the hands and the soles of the feet after seven to ten days, and death in some cases. The disease is not contagious as it is necessary for the toxin producing organisms to infect a cut or incision or be inserted into the vagina with a tampon. A high percentage of individuals have protective antibody titers to the toxins, with the percentage of individuals with titers increasing with age. Anyone colonized with a toxin-producing staphylococci will have a protective antibody titer. The source of the disease causing staphylococci is difficult to determine although it can be transferred from other family members or from a surgeon during operations. The disease is more or less accidental. The toxins are classed as superantigens because they react with many more T-cells than do conventional antigens. They stimulate the production of cytokines which may be directly involved in toxic shock syndrome.
toxic shock syndrome; toxic shock syndrome toxin; staphylococci; enterotoxins; antibodies
