Genetic studies on Staphylococcal strains from patients with toxic shock syndrome.

Thirteen isolates of Staphylococcus aureus that produce the toxic shock syndrome exotoxin were screened to identify and characterize this specific determinant and understand its role in pathogenicity. These stains belong to phage group I, are sensitive to phage 29, and are similar with respect to their resistance to cadmium, arsenate, and penicillin. These three resistances, commonly found on plasmids in many strains of S. aureus, were not plasmid-associated in 13 toxic shock strains. The cadmium and arsenate resistances were cotransferred both in transduction and in protoplast fusion; penicillin resistance was unlinked. The toxic syndrome exotoxin gene was not linked to any of these three traits. We suggest that the trait is borne by a special genetic element that acts as a heterologous chromosomal insertion and is independent of the cadmium-arsenate linkage group or the penicillinase-determinant. The genetic properties of extracellular proteins in S. aureus are reviewed as possible models for the acquisition or expression of this toxic shock antigen.