Toxic shock syndrome pathophysiology
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Pathophysiology
In both TSS (caused by S. aureus) and TSLS (caused by S. pyogenes), disease progression stems from a superantigen toxin that allows the non-specific binding of MHC II with T cell receptors, resulting in polyclonal T-cell activation.
Usually exotoxin producing strains of Staphylococcus aureus, a bacterium. S. aureus commonly colonizes skin and mucous membranes in humans. TSS has been associated with use of tampons and intravaginal contraceptive devices in women and occurs as a complication of skin abscesses or surgery. http://www.cdc.gov/ncidod/dbmd/diseaseinfo/toxicshock_t.htm
This infection can occur via the skin (e.g. cuts, surgery, burns), vagina (via tampon), or pharynx. However, most of the large number of individuals who are exposed to or colonized with toxin-producing strains of S. aureus or S. pyogenes do not develop toxic shock syndrome. One reason is that a large fraction of the population has protective antibodies against the toxins that cause TSS.[1] It is not clear why the antibodies are present in people who have never had the disease.
Although scientists have recognized an association between TSS and tampon use, no firm causal link has been established. Research conducted by the CDC suggested that use of some high absorbency tampons increased the risk of TSS in menstruating women. A few specific tampon designs and high absorbency tampon materials were also found to have some association with increased risk of TSS. These products and materials are no longer used in tampons sold in the U.S. (The materials include polyester, carboxymethylcellulose and polyacrylate).[2] Tampons made with rayon do not appear to have a higher risk of TSS than cotton tampons of similar absorbency.[3]
Toxin production by S. aureus requires a protein-rich environment, which is provided by the flow of menstrual blood, a neutral vaginal pH, which occurs during menstruation, and elevated oxygen levels, which is provided by the tampon that is inserted into the normally anaerobic vaginal environment.[4] Although ulcerations have been reported in women using super absorbent tampons, the link to menstrual TSS, if any, is unclear. The toxin implicated in menstrual TSS is capable of entering the bloodstream by crossing the vaginal wall in the absence of ulcerations.[5] Women may avoid problems by choosing a tampon with the minimum absorbency needed to control menstrual flow and using tampons only during active menstruation. Alternately, a woman may choose to use a different kind of menstrual product that may eliminate or reduce the risk of TSS, such as sanitary napkins or a menstrual cup.
References
- ↑ McCormick J, Yarwood J, Schlievert P. "Toxic shock syndrome and bacterial superantigens: an update". Annu Rev Microbiol. 55: 77–104. PMID 11544350.
- ↑ Citrinbaum, Joanna (Oct. 14, 2003). "The question's absorbing: 'Are tampons little white lies?'". The Digital Collegian. Retrieved 2006-03-20. Check date values in:
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(help) - ↑ Parsonnet J, Modern P, Giacobbe K (1996). "Effect of tampon composition on production of toxic shock syndrome toxin-1 by Staphylococcus aureus in vitro". J Infect Dis. 173 (1): 98–103. PMID 8537689.
- ↑ McCormick J, Yarwood J, Schlievert P. "Toxic shock syndrome and bacterial superantigens: an update". Annu Rev Microbiol. 55: 77–104. PMID 11544350.
- ↑ Schlievert P, Jablonski L, Roggiani M, Sadler I, Callantine S, Mitchell D, Ohlendorf D, Bohach G (2000). "Pyrogenic toxin superantigen site specificity in toxic shock syndrome and food poisoning in animals". Infect Immun. 68 (6): 3630–4. PMID 10816521.