Staphylococcal toxic shock syndrome 2000-2006: epidemiology, clinical features, and molecular characteristics

Circulating strains of Staphylococcus aureus (SA) have changed in the last 30 years including the emergence of community-associated methicillin-resistant SA (MRSA). A report suggested staphylococcal toxic shock syndrome (TSS) was increasing over 2000-2003. The last population-based assessment of TSS...

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Bibliographic Details
Published in:PloS one 2011-08, Vol.6 (8), p.e22997
Main Authors: DeVries, Aaron S, Lesher, Lindsey, Schlievert, Patrick M, Rogers, Tyson, Villaume, Lourdes G, Danila, Richard, Lynfield, Ruth
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Birth control
Child
Child, Preschool
Codes
Disease control
Disease prevention
Drug resistance
Epidemiology
Female
Health surveillance
Hospitalization
Hospitals
Humans
Incidence
Infant
Male
Medical records
Medicine
Menstruation
Methicillin
Metropolitan areas
Middle Aged
Minnesota - epidemiology
Neisseria meningitidis
Population
Product safety
Public health
Quality of life
Risk analysis
Risk factors
Septic shock
Shock, Septic - epidemiology
Shock, Septic - microbiology
Shock, Septic - pathology
Shock, Septic - physiopathology
Staphylococcal Infections - epidemiology
Staphylococcal Infections - microbiology
Staphylococcal Infections - pathology
Staphylococcal Infections - physiopathology
Staphylococcus aureus
Staphylococcus aureus - pathogenicity
Staphylococcus aureus infections
Staphylococcus infections
Streptococcus
Surveillance
Toxic shock syndrome
Trends
Womens health
Young Adult
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Summary:Circulating strains of Staphylococcus aureus (SA) have changed in the last 30 years including the emergence of community-associated methicillin-resistant SA (MRSA). A report suggested staphylococcal toxic shock syndrome (TSS) was increasing over 2000-2003. The last population-based assessment of TSS was 1986. Population-based active surveillance for TSS meeting the CDC definition using ICD-9 codes was conducted in the Minneapolis-St. Paul area (population 2,642,056) from 2000-2006. Medical records of potential cases were reviewed for case criteria, antimicrobial susceptibility, risk factors, and outcome. Superantigen PCR testing and PFGE were performed on available isolates from probable and confirmed cases. Of 7,491 hospitalizations that received one of the ICD-9 study codes, 61 TSS cases (33 menstrual, 28 non-menstrual) were identified. The average annual incidence per 100,000 of all, menstrual, and non-menstrual TSS was 0.52 (95% CI, 0.32-0.77), 0.69 (0.39-1.16), and 0.32 (0.12-0.67), respectively. Women 13-24 years had the highest incidence at 1.41 (0.63-2.61). No increase in incidence was observed from 2000-2006. MRSA was isolated in 1 menstrual and 3 non-menstrual cases (7% of TSS cases); 1 isolate was USA400. The superantigen gene tst-1 was identified in 20 (80%) of isolates and was more common in menstrual compared to non-menstrual isolates (89% vs. 50%, p = 0.07). Superantigen genes sea, seb and sec were found more frequently among non-menstrual compared to menstrual isolates [100% vs 25% (p = 0.4), 60% vs 0% (p
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0022997