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June 12, 1987

The Thucydides Syndrome

JAMA. 1987;257(22):3071. doi:10.1001/jama.1987.03390220069022

To the Editor.—  Two articles and an editorial in the Feb 27 issue of The Journal1-3 establish the existence of toxic shock syndrome as a complication of influenza. They also, at least partially, verify the hypothesis that epidemic influenza accompanied by superinfection with noninvasive, toxigenic strains of staphylococci was the explanation for the plague of Athens of 430 to 427 BC. We have proposed the term Thucydides syndrome for this disease.4Certain clinical differences exist between the modern cases thus far described and those that occurred in ancient Attica. We believe that these differences can be readily explained in a manner wholly consonant with the known clinical manifestations produced by various staphylococcal exotoxins.The recent cases follow closely the rather rigid diagnostic criteria first described by Todd et al5 and codified by the Centers for Disease Control. These include the rapid onset of hypotension, scarlatiniform rash followed