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James K. Todd, MD
Children's Hospital Denver

JAMA. 1987;257(22):3070-3071.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

The recent reports of toxic shock syndrome (TSS) during influenza outbreaks^1,2 may not imply a unique association with the influenza virus, but are more probably due to secondary focal staphylococcal infections including sinusitis—a frequent complication of influenza. The patient reported by Sperber and Francis¹ had clear-cut pneumonia, as did two of the nine patients reported by MacDonald et al²; the remainder could have had occult sinus infection. In either situation, it would not be unusual to culture Staphylococcus aureus from respiratory secretions. Such focal infections appear to be linked both epidemiologically and microbiologically to the pathogenesis of TSS.³ During the last two influenza outbreaks in Denver, we have noted a large number of patients with secondary sinusitis. Growth of a toxin producing S aureus in a sinus (or in a lung) may provide conditions for toxin production that may not ordinarily be present . . . [Full Text PDF of this Article]

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