Toxic shock syndrome: a multisystem conundrum.

First described in 1978, toxic shock syndrome (TSS) emerged as cause for public concern in 1980 as an acute multisystem disease syndrome associated with Staphylococcus aureus. Epidemiological, clinical and microbiological studies have revealed most of the pieces of the puzzle: a new toxin TSST-1, low antibodies in susceptible individuals, the presence of a focus of S. aureus infection. In menstrual TSS, the role of tampons has generated much controversy. Exactly how the pieces fit together to explain the pathophysiology of TSS at the cellular and molecular levels remains to be elucidated.