Toxic Shock Syndrome in Iowa: Comparison of Definite, Probable, and Uncertain Cases

Abstract

From 1980 to 1986, 125 cases of toxic shock syndrome (TSS)-like illness were reported to the Iowa Department of Public Health. One hundred seventeen cases (94%) were in females, and 104 cases (83%o) were menstrually related. The case-fatality rate was 2.4%. Sixty-three (53%) of the cases of TSS-like illness were reported by personnel affiliated with a statewide hospital infection control network. The crude reporting efficiency of the network from 1980 to 1986 was estimated at 69%. Sixty-one (49%) of the TSSlike cases met all criteria for the diagnosis of TSS (definite cases). Thirty-seven cases (30%) met all criteria but one (probable cases), and 27 cases (21%) failed to meet two or more criteria (uncertain cases). A retrospective study was undertaken to determine the degree of relationship among the TSS case definitions. A comparison of definite, probable, and uncertain cases demonstrated no significant differences in mean age, sex ratio, proportion related to menses, proportion using tampons, proportion hospi alized, and mortality. Vaginal or cervical cultures were positive for Staphylococcus aureus in 92%, 76%/, and 53% of menstrually related definite, probable, and uncertain cases, respectively. The frequencies of S. aureus isolation for definite and probable cases were not significantly different. The isolation frequencies for definite vs. uncertain cases were significantly different, however (P = .001). In 22 (43%/) of the menstrually related definite cases, the woman used Playtex brand tampons, in contrast to only two (7o%) in probable cases (P =.001) and four (19%) in uncertain cases (P =.055). Based on the epidemiologic similarity between definite and probable TSS cases, combination of the two groups for purposes of reporting is not unr asonable. The increased relative frequency of Playx brand tampon use by patients with definite TSS is int iguing but unexplained and worthy of further study.