Toxic shock syndrome: role of the environment, the host and the microorganism.

Toxic shock syndrome is a condition characterised by fever, rash and hypotension, and can be life-threatening. It was first described in 1978, since when many cases have been described and an association with tampon use during menstruation noted. In many cases there was concurrent infection with toxin-producing Staphylococcus aureus. It has since become clear, however, that the situation is more complex: the syndrome may occur in adults and children of both sexes, and may follow infection with bacteria other than S. aureus. Toxic shock syndrome requires a combination of susceptible host, toxin-producing bacterium and the right growth conditions within the host. The action of the toxin or toxins involved has proved difficult to elucidate. The most promising theory proposes that the toxins involved act as super-antigens, which cause massive T-lymphocyte proliferation, and production of the cytokines interleukin-1 and tumour necrosis factor.