However, both intrinsic and acquired mechanisms of resistance to aminoglycosides have occurred.
Although the climate was tropical, the vial was stored at room temperature, and during the course of the next I0 days it was reentered several times. On January 27th, 21 children were vaccinated and some received second injections.
That evening 18 of these 21 children became ill and 12 died within 2 days. The Royal Commission 3 that investigated this tragedy described an illness of rapid onset 5 - 8 hr after inoculation with a constellation of symptoms that included high fever, poor pulse, urine retention, loss of consciousness, blotchy skin rash, bright red tongue, vomiting, diarrhea, and in one child a desquamation of the hands and feet occurring 17 days after onset.
Of the nine children who survived, all later developed localized abscesses at the inoculation site from which a Staphylococcus aureus was recovered.
When obtained, however, blood cultures were negative. This Bundaberg strain was described as slightly hemolytic and intermediate in color between the typical "aureus" and " a l b u s. The toxin induced skin reactions in some individuals, but was completely nontoxic when administered in large doses to guinea pigs, rabbits, and monkeys.
Fifty years later, Todd et al. These authors coined the term "toxic shock syndrome" TSS and defined the clinical criteria to distinguish TSS from other diseases of similar presentation.
From five of the patients, an exotoxin-producing S. A relationship between this case and concomitant menses was not described, but illness was later found to be tampon associated. Shortly thereafter, in and earlya precipitous increase in the number of TSS cases was reported in young women during menstruation.
These findings have since been confirmed, and tampon use has been firmly established as a significant risk factor for the development of TSS. As in the earlier reports, S. Is serologic grouphlg usefid and reliable? These traits did not adequately explain the striking and severe symptoms of TSS.
Initially called staphylococcal enterotoxin F SEF and pyrogenic exotoxin C PECthey have been shown to be identical because they are coded by the same staphylococcal chromosomal gene 2. Early attempts to develop an animal model were unsuccessful, but purified TSST-I has been reported to produce the signs and symptoms of TSS in the baboon model.
TSST-I has also been reported to enhance the effect of endotoxin, suppress IgM synthesis, and induce human interleukin-1 production. Undoubtedly, this toxin is a primary agent for initiating TSS.
In TSS raised the question of what was causing increased disease incidence. Obviously something had changed; was it the women, the organism, or the tampons? Seroprevalence studies have shown since, that TSST-I antibody is equally distributed between men and women, increases with age, and has not changed in incidence from I to Microbiologic studies have shown that S.
In one vaginal flora study TSST-l-producing strains were recovered from 2. We reviewed 78 TSS cases in which cultures were performed. An endotoxin or endotoxin-like-producing organism was recovered in association with S.1.
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