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Toxic shock syndrome

Toxic shock syndrome (TSS) is a rare but potentially fatal disease caused by a bacterial toxin. Different bacterial toxins may cause toxic shock syndrome, depending on the situation. The causative agent is Staphylococcus aureus. A similar condition, therefore called Toxic Shock Like Syndrome (TSLS), is the result of Streptococcus pyogenes infection more...

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The route of infection is usually through the skin (pricking accident, surgery, burns), vagina (tampon, partus) or pharynx.

The number of reported toxic shock syndrome cases has decreased significantly in recent years. Approximately half the cases of TSS reported today are associated with tampon use during menstruation, usually in young women, though TSS also occurs in children, men, and non-menstruating women. In the US in 1997 only five confirmed menstrually-related TSS cases were reported, compared with 814 cases in 1980, according to data from the Centers for Disease Control and Prevention (CDC).

Although scientists have recognized an association between TSS and tampon use, no firm causal link has been established. Research conducted by the CDC suggested that use of some high absorbency tampons increased the risk of TSS in menstruating women. A few specific tampon designs and high absorbency tampon materials were also found to have some association with increased risk of TSS. These products and materials are no longer used in tampons sold in the U.S. Tampons made with rayon do not appear to have a higher risk of TSS than cotton tampons of similar absorbency.

Vaginal dryness and ulcerations may occur when women use tampons more absorbent than needed for the amount of their menstrual flow. Ulcerations have also been reported in women using tampons between menstrual periods to try to control excessive vaginal discharge or abnormal bleeding. Women may avoid problems by choosing a tampon with the minimum absorbency needed to control menstrual flow and using tampons only during active menstruation. Alternately, women may use a silicone menstrual cup to avoid the negative side-effects of tampons.

Symptoms and diagnosis

Symptoms of toxic shock syndrome in the early phase can be hard to recognize because they mimic the flu. They include sudden high fever, muscle aches, joint pain, vomiting, diarrhea, dizziness, fainting, or a rash that looks like a sunburn. One or two weeks after initial symptoms begin, flaking and peeling of the skin occurs, mainly on the palms and soles.

The fulminant course rapidly changes general symptoms to fever, systolic blood pressure under 90 mmHg, altered state of mind. In other words, septic shock.

Therapy

Women wearing a tampon at the onset of symptoms should remove it immediately. The severity of this disease results in hospitalisation for treatment. Antibiotic treatment consists of Penicilline and Clindamycin.

Extreme infection of the skin and deeper parts is called Fasciitis necroticans, (one of the symptoms), and should be attacked surgically without delay.

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Scientists build a peptide to stop toxic shock syndrome - News - Statistical Data Included - Brief Article
From British Medical Journal, 4/8/00 by Judy Siegel-Itzkovich

A potential weapon against the virulent strains of staphylococcal and streptococcal bacteria that produce toxic shock syndrome has been developed by Israeli researchers and has been found to be effective in mice.

The research team, whose breakthrough is described in this month's Nature Medicine (2000;6:414-21) was headed by Raymond Kaempfer, professor of molecular virology at the Hebrew University-Hadassah faculty of medicine in Jerusalem.

He and Dr Gila Arad, Revital Levy, and Dalia Hillman spent four years planning and building a synthetic peptide antagonist that blocks the activity of super-antigens, which are lethal toxins secreted by bacteria in massive numbers. Mice were exposed to a range of staphylococcal or streptococcal toxins. Injection with the peptide saved not only 100% of the mice exposed to the toxins but also about half of those rodents in whom the process of toxic shock had already begun. Untreated mice died of system failure caused by toxic shock syndrome within hours or days.

The researchers expect that the peptide will work equally well in pigs and monkeys. It will then be assessed in clinical trials at several Israeli centres next year.

The research is being financed by the US Department of Defense, which is eager to save soldiers and civilians exposed to deadly toxins in bacteriological warfare.

Toxic shock, caused mainly by bacterial infections, has until now defied medical treatment. Some people die within days or even hours, giving doctors no time to identify the pathogen and fight it with antibiotics.

Moreover, strains of the bacteria are often resistant to antibiotics. In the United States more than 325 000 people are hospitalised each year with food poisoning, and about 5000 die from toxic shock. It can also be brought on by infections that spread in hospitals, complications of pneumonia, and the use of tampons.

The synthetic molecule that the Israeli team designed blocks the ability of the bacterial toxins to activate T cells which introduce cytokine molecules and induce the toxic shock phenomenon.

Professor Kaempfer noted that "hundreds of millions of dollars have been invested by researchers around the world to deal with toxic shock but all for naught. These researchers looked for ways to `mop up' the harmful proteins but failed. The extremely high level of cytokine molecules produced in the body following introduction of a toxin overwhelmed all attempted antidotes."

The research team in Jerusalem, however, decided to focus on blocking the "toxicity cascade" before activation of the T cells took place, and their P-12 peptide (named for the 12 amino acids that make it up) succeeded in doing so.

COPYRIGHT 2000 British Medical Association
COPYRIGHT 2000 Gale Group

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