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Evidence for Additional Toxins

Paul L. Garbe, DVM; Robert J. Arko, DVM; Arthur L. Reingold, MD; Lewis M. Graves; Peggy S. Hayes; Allen W. Hightower, MS; Francis W. Chandler, DVM, PhD; Claire V. Broome, MD

JAMA. 1985;253(17):2538-2542.

Abstract
Although toxic shock syndrome toxin—1 (TSST-1) has been proposed as the toxin responsible for toxic shock syndrome, its role in this disease has not been proved. To study this question, we examined Staphylococcus aureus strains isolated from normally sterile sites in patients with nonmenstrual toxic shock syndrome for the presence of TSST-1 production. Only 20 (62.5%) of 32 produced TSST-1, compared with 41 (93%) of 44 vaginal isolates from patients with menstrual toxic shock syndrome. Of strains of S aureus from patients with nonmenstrual toxic shock syndrome, TSST-1—negative isolates were more likely to be associated with a fatal outcome and to not be phage group I than TSST-1—positive isolates. Seven of the TSST-1—negative strains were evaluated in a rabbit subcutaneous chamber model of toxic shock syndrome. Fifteen (60%) of 25 rabbits developed a toxic shock syndrome—like illness and nine died. Clinical signs and histopathologic findings in the rabbits were similar to those seen in rabbits inoculated with TSST-1—positive S aureus isolates. These results suggest that other, as yet unrecognized, toxins play a role in toxic shock syndrome, and that TSST-1 production may not be essential to the pathogenesis of toxic shock syndrome.

(JAMA 1985;253:2538-2542)

Author Affiliations
From the Division of Bacterial Diseases (Drs Garbe, Reingold, and Broome and Messrs Graves, Hightower and Ms Hayes), the Sexually-Transmitted Diseases Laboratory Program (Dr Arko), and the Division of Host Factors (Dr Chandler), Center for Infectious Diseases, Centers for Disease Control, Atlanta.

Footnotes
The use of trade names in this article is for identification only and does not imply endorsement by the Public Health Service or by the US Department of Health and Human Services.

Reprint requests to Respiratory & Special Pathogens Epidemiology Branch, 1-5405, Centers for Disease Control, Atlanta, GA 30333 (Dr Broome).

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