Toxic shock syndrome in Britain--epidemiology and microbiology.

By 30 June 1984, only 99 confirmed and probable cases of toxic shock syndrome (TSS) had been reported in the British Isles. Sixty-three were related to menstruation in women aged 14 to 54 years who used tampons of various brands and absorbencies; 33 (52%) of these cases were in girls under 20. Five women died (8%) and 19 (30%) reported at least one other possible episode. Thirty-six cases associated with a variety of clinical conditions occurred in men aged 17 to 74 years (9), women aged 20 to 54 years (15) and 12 children aged 10 months to 10 years; six patients (17%) died. Strains of Staphylococcus aureus which produced toxic shock syndrome toxin 1 (TSST-1) were isolated from 53 of 58 (91%) menstrual, but only from 18 of 33 (54%) non-menstrual patients. The frequency of toxin production was highest (93%) for 56 vaginal isolates and lowest (33%) for 9 isolates from blood culture. Ninety-six percent (68 of 71) of strains that were TSST-1-positive were sensitive to lytic-group I phages at one of the three concentrations tested; 82% were lysed by phage 29. Nineteen percent of 339 strains from a variety of sources other than TSS, produced TSST-1, and 35% of the strains lysed by group I phages were positive. Antibody to TSST-1 was detected by enzyme-linked immunosorbent assay at a serum dilution of 1:100, in 232 of 320 (82%) healthy individuals aged 14 to 56 years, but in acute-phase sera from only four of 37 (18%) TSS patients. A rise in antibody levels during convalescence was noted in two menstrual and 5 non-menstrual patients. These results show that the epidemiology of TSS is similar in Britain and the United States and provide further evidence of the importance of TSST-1-producing strains in the aetiology of the disease.