Staphylococcal toxic shock syndrome (TSS) was originally described in menstruating women and linked to TSS toxin 1 (TSST-1)-producing Staphylococcus aureus. Using UK national surveillance data, we ascertained clinical, molecular and superantigenic characteristics of TSS cases. Average annual TSS incidence was 0.07/100,000 population. Patients with nonmenstrual TSS were younger than those with menstrual cases but had the same mortality rate. Children ≤16 years of age accounted for 39% of TSS cases, most caused by burns and skin and soft tissue infections. Nonmenstrual TSS is now more common than menstrual TSS in the UK, although both types are strongly associated with the tst+clonal complex (CC) 30 methicillin-sensitive S. aureus lineage, which accounted for 49.4% of all TSS and produced more TSST-1 and superantigen bioactivity than did tst+ CC30 methicillin-resistant S. aureus strains. Better understanding of this MSSA lineage and infections in children could focus interventions to prevent TSS in the future.
Bibliographical noteFunding Information:
This work was funded by the UK Clinical Research Collaboration (UKCRC, Research Training Fellowship G0800777/1 to H.S., and the Centre for Infection Prevention and Management)
The authors acknowledge the NIHR Biomedical Research Centre awarded to Imperial College Healthcare NHS Trust and the Imperial College Healthcare NHS Trust Tissue Bank. This work was funded by the UK Clinical Research Collaboration (UKCRC, Research Training Fellowship G0800777/1 to H.S., and the Centre for Infection Prevention and Management) and by the National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare-associated Infections and Antimicrobial Resistance at Imperial College London in partnership with Public Health England. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, the Department of Health or Public Health England.
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