Toxic-shock syndrome: a commentary and review of the characteristics of Staphylococcus aureus strains.

Toxic-shock syndrome (TSS) was first identified in 1978 in children as a toxin-mediated illness associated with Staphylococcus aureus. Extensive publicity ensued when the strong association of this disease with menses and tampon use was recognized in 1980. Since that time, investigation into the epidemiology, clinical manifestations and pathogenesis of TSS has coincided with a decreasing incidence of disease. A unique exotoxin has been isolated under varying physico-chemical conditions from TSS-associated strains of S. aureus and its effect on immune function and other parameters both in vitro and in vivo described. In addition, TSS-associated S. aureus strains have been found to have characteristic heavy metal susceptibility patterns, to be lysogenized and to show decreased hemolysis on sheep blood agar. Preliminary results of the prevalence of TSS-associated strains of S. aureus and of the theories of pathogenesis are reviewed.