title: Recurrent nonmenstrual toxic shock syndrome: clinical manifestations, diagnosis, and treatment.
abstract: We report 3 cases of recurrent nonmenstrual toxic shock syndrome (TSS) and review the clinical manifestations, diagnosis, and treatment. The primary sites of infection were the genital tract (in a patient who underwent cesarean delivery), the upper respiratory tract, and a breast abscess. In all 3 patients, the initial illness was not recognized to be TSS; only after development of recurrent illness with desquamation was this diagnosis entertained. Strains of Staphylococcus aureus that were isolated from 2 patients produced TSS toxin-1, whereas the third strain produced staphylococcal enterotoxin B. All 3 patients lacked antibody to the implicated toxins at the time of presentation with recurrent illness. Nonmenstrual TSS can occur in a variety of clinical settings and may be recurrent. The presence of desquamation during a febrile, multisystem illness could suggest this diagnosis and should prompt the clinician to obtain appropriate cultures for S. aureus.
authors.affiliation: Infectious Disease Section, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA. mary-margaret.andrews@hitchcock.org
authors.forename: M M
authors.initials: MM
authors.lastname: Andrews
authors.forename: E M
authors.initials: EM
authors.lastname: Parent
authors.forename: M
authors.initials: M
authors.lastname: Barry
authors.forename: J
authors.initials: J
authors.lastname: Parsonnet
mesh_terms: D000328:Adult; D001427:Bacterial Toxins; D002648:Child; D004768:Enterotoxins / Q000032:analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012772:Shock, Septic / Q000188:drug therapy* / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000188:drug therapy* / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification* / Q000378:metabolism; D018089:Superantigens
chemical_list: D001427:Bacterial Toxins; D004768:Enterotoxins; D018089:Superantigens; C030107:enterotoxin F, Staphylococcal; C031818:enterotoxin B, staphylococcal