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March 12, 1982

Toxic Shock Syndrome— Additional Perspectives

JAMA. 1982;247(10):1464. doi:10.1001/jama.1982.03320350068036

When Todd and colleagues1 published a report of seven children suffering from acute erythroderma and shock, many physicians were skeptical that toxic shock syndrome (TSS) was a new disease. This fundamental question is not resolved. Is TSS the result of elaboration of new toxin(s); a combination of increased amounts of toxins present for many years; or toxins, new or old, dependent for clinical expression on peculiar environmental influences (ie, highly absorbent tampons and suture materials)? Answers to these questions have clinical and medicolegal implications.

In this issue of The Journal (p 1448), Bartlett and colleagues describe another group that is susceptible to TSS: postoperative patients. Striking features of the reported illnesses were generalized toxic reactions with multisystem involvement and absence of overt wound infection. The surgery involved minor procedures ordinarily associated with a strikingly low incidence of infection. One of 13 patients died, and in two cases there was