TOXIC SHOCK SYNDROME, A NEWLY RECOGNIZED DISEASE ENTITY - REPORT OF 11 CASES

Abstract

Eleven female patients aged 13-43 yr (median 17) with toxic shock syndrome were observed at a clinic since Aug. 1975. One patient died. Seven patients had 1 or more recurrences. The syndrome was often life-threatening, afflicted mostly menstruating females, and was characterized by a very brief prodromal illness consiting of high fever, vomiting, diarrhea, conjunctivitis, headache, irritability, sore throat, myalgias, abdominal tenderness and erythematous rash. The disorder can progress to hypotension or prolonged refractory shock, adult respiratory distress syndrome, diffuse intravascular coagulation with severe thrombocytopenia, and renal failure. Pancreatitis was observed in 2 cases. During convalescence, pronounced desquamation and peeling of the skin occurred. Numerous laboratory abnormalities are observed. In 5 of the 11 patients, Staphylococcus aureus was isolated from conjunctiva, oral cavity or nares, vagina or stool. A pyrogenic exotoxin was identified in the isolates of 3 patients; its etiologic role remains speculative. Therapy is mainly supportive. Antistaphylococcal therapy for the acute illness and for prevention of recurrences has not yet proved to be of any benefit. The role of vaginal tampons, if any, in the pathogenesis of this disorder remains unclear.