Toxic shock syndrome: an update

Article Abstract:

Toxic shock syndrome (TSS) is a potentially life-threatening disorder due to infection by strains of Staphylococcus aureus that produce toxins. TSS was widely discussed in 1980, when it was noted in young, previously healthy menstruating women. It was ultimately linked to the use of tampons, the composition of which has since been altered. This article reviews the clinical features, epidemiology, risk factors, microbiology, and host factors associated with TSS. The disease can be both mild or severe; many mild cases of TSS are probably treated on an outpatient basis. The case-fatality rate for TSS is approximately 2 percent. Treatment is primarily supportive to drain infected sites, normalize blood volume and blood pressure, and treat serious complications. The number of non-menstrual cases of TSS has not declined since 1980, in contrast to the number of menstrual cases. Women aged 15 to 19 are at greater risk of this disorder than older menstruating women. White women are at greater risk than nonwhite women. Even after the composition of tampons was changed, the risk of menstrual TSS remained higher among tampon users in 1986 and 1987. More absorbent tampons were associated with greater risk. Nonmenstrual cases of TSS caused by S. aureus infection of the vagina are related to the use of barrier contraceptives (diaphragm and contraceptive sponge). Most S. aureus strains that cause menstrual TSS produce TSS toxin-1 (TSST-1), while others produce other staphylococcal enterotoxins. These toxins appear able to massively stimulate the immune system, causing high levels of production of interleukins and tumor necrosis factor (which cause many of the symptoms of TSS). However, TSS does not develop in most cases, even when TSST-1-producing bacteria are present: other factors, such as the level of antibodies against TSST-1, help determine whether TSS will be the outcome. Women who want to significantly lower their risk of TSS should switch from tampons to napkins; if this is undesirable, tampons of the lowest possible absorbency should be chosen. (Consumer Summary produced by Reliance Medical Information, Inc.)

Risk factors, Physiological aspects, Toxic shock syndrome, Tampons

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Human immunodeficiency virus infection in children with tuberculosis in Santo Domingo, Dominican Republic: prevalence, clinical findings, and response to antituberculosis treatment

Article Abstract:

HIV-infected children who have tuberculosis may be less likely to respond to the traditional tuberculosis drugs than HIV-negative children with tuberculosis. This was demonstrated in 204 children with tuberculosis, 26 of whom were HIV-infected. All the children were initially treated with standard tuberculosis treatment. Twenty-nine percent of the HIV-infected children did not respond to this treatment, compared to 3% of the HIV-negative children. Four HIV-infected children who did not respond to the treatment were re-treated for longer periods and responded.

Complications and side effects, Drug therapy, HIV infection in children, Pediatric HIV infections, Tuberculosis, Antitubercular agents

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Mycobacterium avium complex in water, food, and soil samples collected from the environment of HIV-infected individuals

Article Abstract:

Soil may be a source of organisms that can cause Mycobacterium avium complex (MAC) infection in HIV patients in San Francisco, but food and water may not be significant sources. Food, water, and soil samples were collected from the homes of 290 HIV-positive participants at risk for MAC in San Francisco. MAC organisms were cultured from 55% of potted plants, 2% of water samples and .5% of food samples. However, no direct connection could be established between the environmental presence of MAC and MAC infection in HIV patients.

Environmental aspects, HIV patients, Mycobacterium avium complex

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