Device-Associated Menstrual Toxic Shock Syndrome

  title={Device-Associated Menstrual Toxic Shock Syndrome},
  author={Patrick M. Schlievert and Catherine C. Davis},
  journal={Clinical Microbiology Reviews},
In the 1980s, menstrual toxic shock syndrome (mTSS) became a household topic, particularly among mothers and their daughters. The research performed at the time, and for the first time, exposed the American public as well as the biomedical community, in a major way, to understanding disease progression and investigation. Those studies led to the identification of the cause, Staphylococcus aureus and the pyrogenic toxin superantigen TSS toxin 1 (TSST-1), and many of the risk factors, for example… 
Staphylococcal TSST-1 Association with Eczema Herpeticum in Humans
It is proposed that this combination of exposures (TSST-1 and then HSV) leads to opening of epithelial and skin barriers to facilitate potentially serious ADEH, and the data suggest that ADEH is associated with production of the major TSS-associated superantigens, together with HSV reactivation.
Staphylococcal Superantigens Stimulate Epithelial Cells through CD40 To Produce Chemokines
It is shown that menstrual TSS occurs after TSST-1 interaction with an immune costimulatory molecule called CD40 on the surface of vaginal epithelial cells, and that superantigens facilitate infections by disruption of mucosal barriers through their binding to CD40, with subsequent expression of chemokines.
Kawasaki Syndrome: Role of Superantigens Revisited
The case for microbial superantigens as important causes of Kawasaki syndrome is made and a better understanding of mechanisms leading to acute KS would contribute to a more precision medicine approach for this complex disease.
Staphylococcal Enterotoxin C Subtypes Are Differentially Associated with Human Infections and Immunobiological Activities
The associations of SEC subtypes with different infections suggest that S. aureus produces virulence factors according to host niches, and there is some selective pressure for theSEC subtypes to be associated with certain human niches.
Decolonization of Human Anterior Nares of Staphylococcus aureus with Use of a Glycerol Monolaurate Nonaqueous Gel
A 5% glycerol monolaurate nonaqueous gel is safe for use in the anterior nares and may be a useful alternative or additive to mupirocin ointment for nasal use prior to surgery, noting that 80% of hospital-associated S. aureus infections are due to the same organism found in the nose.
Pathogenicity and virulence of Staphylococcus aureus
This review will give an overview of how S. aureus initiates and maintains infection and discuss the main determinants involved, to develop anti-virulence strategies to counteract the lack of an anti-S.
Pathogen Stimulation of Interleukin-8 from Human Vaginal Epithelial Cells through CD40
The data indicate that many potential pathogens, but no normal commensals, induce IL-8 to help disrupt the human vaginal epithelial barrier through CD40, thus providing a potential therapeutic target for drug development.


Prevalence of Toxic Shock Syndrome Toxin 1-Producing Staphylococcus aureus and the Presence of Antibodies to This Superantigen in Menstruating Women
It is demonstrated that the majority of teenagers have antibody titers (≥1:32) to TSST-1 and are presumed to be protected from mTSS, and the findings suggest that black women may be more susceptible to m TSS than previously thought.
Risk factors for development of toxic shock syndrome. Association with a tampon brand.
Among women using tampons, cases were more likely to have used Rely brand tampons when compared with controls and other factors studied through analysis of a follow-up questionnaire mailed five months after the first study were found to be significantly associated with the development of menstrually associated TSS.
The relationship of tampon characteristics to menstrual toxic shock syndrome.
The strong association of absorbency with risk of illness would suggest that as a public health measure the use of a low-absorbency tampon is likely to reduce the risk of TSS in the user.
Toxic shock syndrome toxin-1 (TSST-1) antibody levels in Japanese children.
Toxic-shock syndrome in menstruating women: association with tampon use and Staphylococcus aureus and clinical features in 52 cases.
To determine the risk factors associated with toxic-shock syndrome (TSS) in menstruating women, a retrospective telephone study of 52 cases and 52 age-matched and sex-matched controls found no significant differences in brand of tampon used, degree of absorbency specified on label, frequency of tampons change, type of contraceptive used, Frequency of sexual intercourse, or sexual intercourse during menstruation.
Tri-state toxic-shock syndrome study. II. Clinical and laboratory findings.
The use of antistaphylococcal antibiotics during the initial TSS episode and the subsequent discontinuation of tampon use were independently statistically significantly associated with a decreased risk of recurrent illness.
Risk factors for staphylococcal toxic-shock syndrome.
This epidemiologic investigation of toxic-shock syndrome in menstrual-age women has identified tampons generally and a single brand specifically as significant risk factors in acquiring toxic- shock syndrome.
Influence of the Vaginal Microbiota on Toxic Shock Syndrome Toxin 1 Production by Staphylococcus aureus
The findings suggest that women colonized by S. aureus and with AV, but not BV, may be more susceptible to menstrual TSS and would most benefit from prophylactic treatment.
Tri-state toxic-state syndrome study. I. Epidemiologic findings.
By multiple logistic regression analysis, the risk of TSS was more closely associated with tampon fluid capacity (absorbency) than with the use of all tampon brands.