To the Editor.—
Weissberg and Dodson1 summarize interesting clinical observations on the possible relationship between recurrent vaginal and cervical ulcers and toxic shock syndrome (TSS) in a recent article in JAMA. The authors summarize previous reports back to 1977, ie, the year before the first clinical report on staphylococcal TSS.2 In 1978, Kuusela reported that Staphylococcus aureus strains show binding of a specific serum and connective tissue protein— fibronectin (cold insoluble globulin)— to their surface. We now report on the possible role of fibronectin exposed in vaginal ulcers in association with tampon use, permitting S aureus to colonize these ulcers.The initial step of many mucosal infections involves binding of pathogens to specific mucosal cell surface receptors. Uropathogenic Escherichia coli colonize the upper urinary tract by specific hairlike proteins (pili or fimbriae) that recognize specific glycosphingolipid cell surface receptors while Neisseria gonorrhoeae were reported to recognize other glycolipid
Wadström T, Rubin K, Ljungh A, Höök M, Switalski LM. Fibronectin and Toxic Shock Syndrome. JAMA. 1984;252(3):343. doi:10.1001/jama.1984.03350030017008
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