1173 POTENTIAL INFLUENCE OF FOCAL INFECTION CONDITIONS ON THE PATHOGENESIS OF TOXIC SHOCK SYNDROME

Abstract

Epidemiologically, patients with toxic shock syndrome (TSS) often have focal infections (abscess, menstrual), the conditions of which may play a role in inducing particular S. aureus strains to cause disease. Individuals colonized (e.g. nasopharynx) with these same strains may develop immunity without developing disease. Three children with TSS and definite non-menstrual focal infections (abscess, empyema, septic arthritis) were studied. Samples from their foci demonstrated: pH 6.75-6.82, pCO₂ 46-51 torr, pO₂ 63-123 torr, Toxic Shock Toxin-I (TSST-I) 4-53 ng/ml, protease activity .10-.24 units, and grew S. aureus. The isolated S. aureus strains each had a typical TSS phenotype (protease+, TSST-I+) which was optimally expressed in vitro (extracellular protein excretion, TSST-I production, protease activity) when grown under conditions similar to those documented in vivo (4-8% CO₂, pH 7.0, 21% O₂). Increased glucose levels and decreased pCO₂ resulted in decreased production of TSS markers without any change in quantitative organism growth. Anaerobic conditions, often assumed to be present in abscesses but not found in our patients, are also known to decrease TSST-I production in vitro. The unique in vivo focal conditions found in our TSS patients have in vitro correlates which may play an important role in the expression of organism phenotype and pathogenesis of TSS.

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