Nonmenstrual Toxic Shock Syndrome: The Growing Picture

Arthur L. Reingold, MD
JAMA. 1983;249(7):932. doi:10.1001/jama.1983.03330310062032.
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Toxic shock syndrome (TSS), formerly known as staphylococcal scarlet fever, has been recognized as a distinct clinical entity since 1927.1 While, in retrospect, one or more of the cases in the series of Todd et al2 may have been associated with menstruation, it is clear that most of the earliest reported cases of TSS were nonmenstrual. The number of such cases reported before 1980 was small, however, and it was not until TSS and its now well-verified association with menstruation and tampons were the subject of widespread publicity that physicians were stimulated to look for and report cases.

The case described by Jacobson and colleagues (p922) nicely illustrates a number of important aspects of a disease in which the clinical and epidemiologic dimensions continue to expand. As has been noted previously in postoperative and postpartum TSS cases,3-13 the incubation period can be remarkably short, frequently 12 to


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