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Toxic Shock Syndrome Toxin

Bruce A. Hanna, PhD; Philip M. Tierno Jr, PhD
JAMA. 1985;254(15):2062. doi:10.1001/jama.1985.03360150038011.
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To the Editor.—  While there is little doubt that toxic shock syndrome toxin-1 (TSST-1) is an important agent in the expression of toxic shock syndrome (TSS), the evidence presented by Garbe et al1 for the role of additional toxin(s) is surely compelling. We also have noted that isolates of Staphylococcus aureus from nonmenstrual cases of TSS fall into two categories: (1) those from richly vascularized, hence oxygenated, superficial wounds and (2) those from deep sites of infection where low oxidation reduction potentials prevail. In our experience, TSST-1-producing strains seem to be associated with the former but not the latter. Since TSST-1 is expressed only aerobically, this observation is not unexpected. Several candidates for the title "TSST-2" have been suggested previously and must now await further study.More importantly, however, the findings of Garbe et al1 raise a very perturbing issue. While the proportion of nonmenstrual cases of TSS


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