title: A cluster of blister-associated toxic shock syndrome in male military trainees and a study of staphylococcal carriage patterns.
abstract: In March-April 1985, toxic shock syndrome (TSS) developed in three male military trainees at one base secondary to infected blisters acquired while marching during basic combat training. One trainee died. Staphylococcus aureus was isolated from the blisters in all three patients, and the two strains available for testing both produced toxic shock syndrome toxin-1 (TSST-1). A culture survey identified carriage of S. aureus in 44% (145/333) of the trainees; carriage rates did not differ between the company with two ill trainees and a control company. Carriage was more frequent in the nose than foot (41% versus 9%, p less than 0.0001). White trainees were more likely to carry S. aureus than black trainees (47% versus 28%, p = 0.013), although the same proportion of strains was positive for TSST-1 in both races. The two strains obtained from the patients had similar but not identical phage typing patterns, but had identical antibiograms, and neither strain carried any plasmids. Based upon phage typing of the TSST-1 positive S. aureus strains isolated in the study, widespread carriage of the case strain(s) in other trainees was not found nor was clustering noted by barrack room. It is possible that differences in carriage rates may partially explain the low rate of TSS in blacks.
authors.forename: S F
authors.initials: SF
authors.lastname: Berkley
authors.forename: J G
authors.initials: JG
authors.lastname: McNeil
authors.forename: A W
authors.initials: AW
authors.lastname: Hightower
authors.forename: L M
authors.initials: LM
authors.lastname: Graves
authors.forename: P B
authors.initials: PB
authors.lastname: Smith
authors.forename: C V
authors.initials: CV
authors.lastname: Broome
mesh_terms: D000328:Adult; D001768:Blister / Q000150:complications*; D002353:Carrier State; D004196:Disease Outbreaks; D006801:Humans; D008297:Male; D008889:Military Personnel; D009515:New Jersey / Q000453:epidemiology; D012772:Shock, Septic / Q000453:epidemiology / Q000209:etiology*; D013207:Staphylococcal Skin Infections / Q000150:complications*