Toxic shock syndrome: a perspective through the looking glass.

Toxic shock syndrome associated with Staphylococcus aureus was first described in 1978, although cases of patients with similar findings were reported as far back as 1927. Various strict clinical definitions for toxic shock syndrome have been proposed that still should include exclusionary data (titers, cultures) when possible. Epidemiologic studies of toxic shock syndrome confirm that it occurs in males and nonmenstruating females, but more commonly in menstruating females, especially those using tampons. Microbiologic studies have identified phenotypic characteristics of S. aureus strains associated with toxic shock syndrome but none have been shown to be causally related. The attentiveness of the lay press to toxic shock syndrome research should not divert investigators from an orderly scientific process and appropriate critical review.