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Toxic Shock Syndrome: Clinical and Laboratory Features in 15 Patients

ROBERT W. TOFTE, M.D.; and DAVID N. WILLIAMS, M.B., Ch.B.
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▸Requests for reprints should be addressed to Robert W. Tofte, M.D.; Section of Infectious Diseases, Department of Internal Medicine, St. Paul-Ramsey Medical Center, 640 Jackson Street; St. Paul MN 55101.


St. Paul and St. Louis Park, Minnesota


© 1981 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1981;94(2):149-156. doi:10.7326/0003-4819-94-2-149
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Toxic shock syndrome is a recently recognized illness with serious morbidity and mortality that occurs primarily in healthy menstruating women who use tampons. Thirteen women and two men were evaluated; two of the women died in spite of seemingly appropriate therapy. All patients had a temperature of 38.9 °C or greater, hypotension or syncope, a skin rash with subsequent desquamation, mucous membrane inflammation, and laboratory evidence of multiple organ dysfunction. Staphylococcus aureus was isolated from the cervix or vagina in eight women and from soft-tissue infections in both men. Two patients were bacteremic. The significant heterogeneity in the clinical manifestations, laboratory abnormalities, and therapeutic requirements among patients may result in diagnostic confusion and inappropriate therapy. Although toxic shock syndrome appears to be associated with tampon usage and S. aureus, the pathogenesis remains unknown.

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