Risk involvement with Staphylococcus aureus exotoxins among pyogenic skin infections with special reference to toxic shock syndrome.

The sera of three patients involved in a non-menstrual toxic shock syndrome outbreak showed TSST-1 at a concentration above 40 ng/ml and no antibodies of IgG class against the toxin. A Staphylococcus aureus strain producing TSST-1 was isolated from one of the patients. S. aureus strains showing similar phage type and biotype patterns were isolated from 473 out of 876 close contacts with the patients involved in this outbreak. This carriage and spread was traced to pyogenic skin infections (mainly "folliculitis") among this population. Serological studies indicated that during the early phase of the outbreak anti TSST-1 titres were low then rose gradually. In a further related study the frequency of enterotoxin production was found 48.5% among staphylococci isolated from pyogenic skin infections. Our data indicated that pyogenic skin infections are potential source for toxic shock syndrome.