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The Journal of Bone and Joint Surgery 78:903-6 (1996)
© 1996 The Journal of Bone and Joint Surgery, Inc.

Toxic Shock Syndrome Complicating Orthopaedic Manipulation of Bone. A Report of Two Cases*

BETSY C. HEROLD, M.D.{dagger}, CHRIS SULLIVAN, M.D.{dagger}, JOHN J. GRAYHACK, M.D.{ddagger}, MICHAEL DORNING, M.D.{dagger} and ROBERT S. DAUM, M.D.{dagger}, CHICAGO, ILLINOIS

Investigation performed at Wyler Children's Hospital, The University of Chicago, and Children's Memorial Hospital, Northwestern University, Chicago


   Introduction
 
In 1978, Todd and Fishaut described toxic shock syndrome, a multisystem disorder usually associated with toxic shock syndrome toxin-1, a toxin elaborated by Staphylococcus aureus. Most cases occur during menstruation and are associated with vaginal colonization by strains of this bacterium that elaborate the toxin. Other risk factors include the use of tampons, a young age, and a low serum concentration of anti-toxic shock syndrome toxin-1 antibody8. Toxic shock syndrome can also occur in patients who are not menstruating; the risk factors are less certain but include nasal operations and the presence of a non-operative or operative wound. Toxic shock syndrome that is not related to menstruation is less often associated with the isolation of Staphylococcus aureus that produces toxic shock syndrome toxin-1; only 40 to 60 per cent of isolates from such patients produce the toxin, compared with 90 to 100 per cent of isolates from patients . . . [Full Text of this Article]


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