Toxic-shock syndrome: tampons, toxins, and time: the evolution of understanding an illness.

Toxic-shock syndrome (TSS) was first described in 1978, but cases of illness meeting the TSS case definition (presence of fever, hypotension, rash, and desquamation, as well as involvement of three organ systems and absence of evidence for other etiologies) have occurred for many years. Awareness of TSS grew rapidly among the general public and persons in the health-care professions during the last quarter of 1980 when tampon use was associated with the development of TSS. However, TSS is almost certainly caused by a toxin produced by Staphylococcus aureus. This article describes steps in the evolution of understanding TSS: recognition of the syndrome, discovery of risk factors, elucidation of the probable cause, and description of the clinical picture and the epidemiology. The article concludes with a list of unanswered questions.