IN 1978, the illness known as toxic shock syndrome (TSS) was first described by Todd and co-workers.1 During 1979 and 1980 the number of patients recognized as having this disease increased dramatically, and recent publications have described in detail the epidemiology and nature of the illness.2,3 Although there is a striking association between vaginal colonization with Staphylococcus aureus, menstrual bleeding, and the use of vaginal tampons, the pathogenesis of TSS is not completely understood. The presence of an occlusive tampon together with breaks or abrasions of the vaginal mucosa may allow multiplication of S aureus and perhaps enhance the absorption of a toxin elaborated by this organism.3
The combination of menstruation and tampon use is thought to contribute to production of the disease in the great majority of instances. Recently, Reingold and associates4 described a number of patients with TSS that was not associated with menses
Thomas SW, Baird IM, Frazier RD. Toxic Shock Syndrome Following Submucous Resection and Rhinoplasty. JAMA. 1982;247(17):2402–2403. doi:10.1001/jama.1982.03320420052033
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