A reversed passive latex agglutination method, in which latex particles were sensitized with specific anti-toxic shock syndrome toxin-i (TSST-1) immunoglobulin, was found to be a simple and sensitive method for the detection of TSST-1 production by Staphylococcus aureus strains. The minimum amount of TSST-1 detectable was approximately 1.0 nglml. Of 41 S. aureus isolates from toxic shock syndrome patients and controls, 23 were positive for TSST-1 production, whereas only 20 strains were positive for TSST-1 production by an Ouchterlony immunodiffusion method. The reversed passive latex agglutination method was used to examine S. aureus strains isolated in Japan from staphylococcal infections, feces from healthy individuals, food from poisoning outbreaks, and market food.
Synthesis of enterotoxins C, and C2 and thermonuclease throughout the growth cycle was investigated with Staphylococcus aureus type strains FRI137 and FRI361 and S. aureus isolates M5 (C,) and L2 (C2) of animal origin. Both enterotoxins were produced during the exponential growth phase or at the beginning of the stationary phase. The minimal incubation time (7 to 12 h) and the lowest population (107 to 2 x 109 CFU/ml) associated with detectable enterotoxin (1 to 6.5 ng/ml) were related to the total amount of toxin produced after 24 h. Thermonuclease was detected in all samples whenever enterotoxins were detected. Furthermore, strain FRI137 produced thermonuclease earlier and at lower cell populations than it did enterotoxin C,. Patterns of enterotoxin and thermonuclease synthesis did not correlate. The concentration of toxins increased throughout the growth cycle, while the concentration of thermonuclease remained constant during the last hours of the growth cycle.
Ail types of four brands of tampons were tested in triplicate by a tampQn sac method for their effect on production of toxic shock syndrome toxin 1 (TSST-1). In this method the available air is limited to that which is in the tampon sac. Tampons were weighed and inserted into dialysis sacs inoculated with a TSST-1-producing Staphylococcus apreus strain; the sacs were submerged into brain heart infusion agar, which was allowed to harden around the sacs, and were incubated for 18 h at 37°C. The tampons were removed, weighed, and extracted; the CFU of staphylococci and the amount of toxin present in the extracts were determined. Glass wool was used in place of the tamipons as one control, and inoculated empty sacs were used as a second control. The total CFU were consistently >2 x 1011 for the tampons and glass wool and-1011 for the empty sac control. Total toxin production for all tampons tested and the glass wool was 2 to 10 times higher than the toxin produced with the empty sac control. These results indicate that tampons provide increased surface area for the staphylococci to grow and adequate oxygen for toxin production. No significant inhibition of growth of the staphylococci or TSST-1 production by any of the tampons tested was noted.
Toxic shock syndrome is a staphylococcal disease caused by toxins produced by the staphylococci, toxic shock syndrome toxin-1 and enterotoxin B. The disease results from staphylococci growing in the vagina with the use of tampons during menstruation, primarily in young women. However, any staphylococcal infection can result in toxic shock syndrome if the staphylococci produce the appropriate toxins and the individual has no antibodies to the toxins. The symptoms can be quite severe, with high fever, low blood pressure, diffuse macular erythroderma, orthostatic dizziness, vomiting and or diarrhea at the onset, severe myalgia, peeling of the skin of the palms of the hands and the soles of the feet after seven to ten days, and death in some cases. The disease is not contagious as it is necessary for the toxin producing organisms to infect a cut or incision or be inserted into the vagina with a tampon. A high percentage of individuals have protective antibody titers to the toxins, with the percentage of individuals with titers increasing with age. Anyone colonized with a toxin-producing staphylococci will have a protective antibody titer. The source of the disease causing staphylococci is difficult to determine although it can be transferred from other family members or from a surgeon during operations. The disease is more or less accidental. The toxins are classed as superantigens because they react with many more T-cells than do conventional antigens. They stimulate the production of cytokines which may be directly involved in toxic shock syndrome
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