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Dufresne K, DiMaggio DA, Maduta CS, Brinsmade SR, McCormick JK. Discovery of an antivirulence compound that targets the Staphylococcus aureus SaeRS two-component system to inhibit toxic shock syndrome toxin-1 production. J Biol Chem 2024; 300:107455. [PMID: 38852884 PMCID: PMC11328871 DOI: 10.1016/j.jbc.2024.107455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/30/2024] [Accepted: 06/01/2024] [Indexed: 06/11/2024] Open
Abstract
Menstrual toxic shock syndrome (mTSS) is a rare but severe disorder associated with the use of menstrual products such as high-absorbency tampons and is caused by Staphylococcus aureus strains that produce the toxic shock syndrome toxin-1 (TSST-1) superantigen. Herein, we screened a library of 3920 small bioactive molecules for the ability to inhibit transcription of the TSST-1 gene without inhibiting the growth of S. aureus. The dominant positive regulator of TSST-1 is the SaeRS two-component system (TCS), and we identified phenazopyridine hydrochloride (PP-HCl) that repressed the production of TSST-1 by inhibiting the kinase function of SaeS. PP-HCl competed with ATP for binding of the kinase SaeS leading to decreased phosphorylation of SaeR and reduced expression of TSST-1 as well as several other secreted virulence factors known to be regulated by SaeRS. PP-HCl targets the virulence of S. aureus, and it also decreases the impact of TSST-1 on human lymphocytes without affecting the healthy vaginal microbiota. Our findings demonstrate the promising potential of PP-HCl as a therapeutic strategy against mTSS.
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Affiliation(s)
- Karine Dufresne
- Department of Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada
| | - Dennis A DiMaggio
- Department of Biology, Georgetown University, Washington, District of Columbia, USA
| | - Carla S Maduta
- Department of Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada
| | - Shaun R Brinsmade
- Department of Biology, Georgetown University, Washington, District of Columbia, USA
| | - John K McCormick
- Department of Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada.
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Feeley M, Afon O, Gonzalez T, Gorrell C, Warner E, Matus C. Period Poverty: Surveying the Prevalence in Toledo-Area Schools. J Womens Health (Larchmt) 2024; 33:671-677. [PMID: 38350148 DOI: 10.1089/jwh.2023.0569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background: The lack of access to period products, which has been colloquially termed "period poverty," is a problem that millions of people face worldwide. Investigators have found that period poverty is a pervasive issue in the United States, despite its status as a high resource country. The purpose of this study was to determine the prevalence of period poverty in school-aged adolescents in Toledo, Ohio. Methods: This study used an observational cross-sectional design and was approved by the institutional review board. Participants completed a survey that assessed their access to period products, their level of understanding about their sexual/menstrual health, their feelings toward menstruation, and the perceived impact of periods on their lives. Results: Younger students were more likely to miss school due to lack of period products (p = 0.0084). To the question "Why don't you have pads or tampons?" 36.2% expressed financial concerns and 18.3% reported inadequate transportation. When asked whether students ever had to miss school due to their cycle, 9.4% identified a lack of products as their reason. Participants also reported high rates of absence from sports, work, spending time with family/friends, and theater/music practice due to their menstrual period. Discussion: As people across the globe experience period poverty, our study demonstrates evidence of this phenomenon among Toledo adolescents. Owing to the lack of access to menstrual hygiene products, students report repurposing miscellaneous items in place of pads or tampons, missing school or work, and associating negative connotations with their cycles.
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Affiliation(s)
- Madison Feeley
- The University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Ore Afon
- The University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Taylor Gonzalez
- The University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Courtney Gorrell
- The University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Emily Warner
- The University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
| | - Coral Matus
- Department of Family Medicine, The University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, USA
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Schoergenhofer C, Gelbenegger G, Hasanacevic D, Schöner L, Steiner MM, Firbas C, Buchtele N, Derhaschnig U, Tanzmann A, Model N, Larcher-Senn J, Drost M, Eibl MM, Roetzer A, Jilma B. A randomized, double-blind study on the safety and immunogenicity of rTSST-1 variant vaccine: phase 2 results. EClinicalMedicine 2024; 67:102404. [PMID: 38274114 PMCID: PMC10808908 DOI: 10.1016/j.eclinm.2023.102404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/14/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024] Open
Abstract
Background Toxic shock syndrome toxin-1 (TSST-1) is a superantigen produced by Staphylococcus aureus that causes the life-threatening toxic shock syndrome. The development of a safe and immunogenic vaccine against TSST-1 remains an unmet medical need. We investigated the safety, tolerability and immunogenicity of a recombinant TSST-1 variant vaccine (rTSST-1v) after 1-3 injections in healthy volunteers. Methods In this randomised, double-blind, adjuvant-controlled, parallel-group, phase 2 trial, healthy adults aged 18-64 were randomly allocated to undergo 1-3 injections of either 10 or 100 μg rTSST-1v or Al(OH)3. The primary endpoint was safety and tolerability of rTSST-1v in the intention-to-treat population. The per-protocol population was used for the immunogenicity analysis. The trial is registered with EudraCT#: 2015-003714-24; ClinicalTrials.gov#: NCT02814708. Findings Between April and November 2017,140 subjects were enrolled and 126 completed the trial. rTSST-1v showed a good safety and tolerability profile. A total of 855 systemic adverse events occurred, 280 of which were suspected related adverse events, without dose dependency. Two participants were discontinued early because of allergic reactions. Seroconversion occurred in >81% of subjects within 3 months of the first immunisation which was sustained until 18 months after the third immunisation in over 70% of subjects in the pooled low-dose group and in over 85% in the pooled high-dose group. Interpretation rTSST-1v in cumulative doses of up to 300 μg was safe, well-tolerated and highly immunogenic. Two immunisations with 100 μg rTSST-1v provided the most persistent immune response and may be evaluated in future trials. Funding Biomedizinische Forschung & Bio-Produkte AG funded this study.
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Affiliation(s)
| | - Georg Gelbenegger
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | | | - Léa Schöner
- Biomedizinische Forschung & Bio-Produkte AG, Vienna, Austria
| | - Margarete M. Steiner
- Division of General Anesthesia and Intensive Care Medicine, Department of Anesthesia, Critical Care and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Christa Firbas
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Nina Buchtele
- Division of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria
| | - Ulla Derhaschnig
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
| | - Andreas Tanzmann
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Nina Model
- Biomedizinische Forschung & Bio-Produkte AG, Vienna, Austria
| | | | - Manuel Drost
- Assign Data Management and Biostatistics GmbH, Innsbruck, Austria
| | - Martha M. Eibl
- Biomedizinische Forschung & Bio-Produkte AG, Vienna, Austria
| | - Andreas Roetzer
- Biomedizinische Forschung & Bio-Produkte AG, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
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Kumari S, Muneshwar KN. A Review on Initiatives for Promoting Better Menstrual Hygiene Practices and Management in India. Cureus 2023; 15:e47156. [PMID: 38021741 PMCID: PMC10651805 DOI: 10.7759/cureus.47156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Management of hygiene during menstruation is severely affected by the continued existence of several societal, cultural, and religious restrictions on menstruation and menstruation practices. Since they are frequently unprepared and unaware of their periods, especially in rural regions of the country, girls face a variety of hurdles and problems at home, in school, and at work. We observed from examining the studies that managing menstrual hygiene is affected by a lack of personal sanitation and inadequate, erroneous, or partial understanding of menstruation. Women either possess zero or minimal knowledge about genital infections, which are caused by poor personal hygiene during menstruation. Women in rural areas frequently lack access to sanitary items and have inadequate understanding of their sorts and applications, or cannot afford the high cost of such products. Females in rural areas must use washable cotton pads because of this, which they must use repeatedly. The requirements and desires of teenage girls and women continue to be disregarded, despite substantial developments in the water and sanitation industries. Menstrual products are disposed of in domestic garbage and public facilities when women are outside, while they are flushed down toilets at home without considering the risk of choking. Because of this, there should be a need to inform and educate individuals about the health risks and environmental problems connected to them. Reduced trash may be achieved by using modern techniques like incineration. Therefore, the importance of using natural or reusable sanitary products should be emphasized.
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Affiliation(s)
- Shambhavi Kumari
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Komal N Muneshwar
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Yang Y, Ma X, Myrick JG. Social media exposure, interpersonal network, and tampon use intention: A multigroup comparison based on network structure. J Health Psychol 2023; 28:343-355. [PMID: 36047030 PMCID: PMC10026152 DOI: 10.1177/13591053221120332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The scarcity of tampons in China has attracted scholarly attention. Extending the theory of planned behavior with social network structure, this cross-sectional online survey (N = 763) found that exposure to tampon-related information on social media was positively related to Chinese women's tampon use intentions. This association was mediated through attitudes, descriptive norms, and self-efficacy toward using tampons. Furthermore, the effects of social media exposure differed among people with different network structures. Our findings shed light on the promotion of nonconventional feminine hygiene products, which, in turn, may enhance Chinese women's well-being and gender equity across the globe.
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Affiliation(s)
- Yin Yang
- Donald P. Bellisario College of Communications, The Pennsylvania State University, University Park, PA, USA
| | - Xin Ma
- Department of Communication, University of Maryland, College Park, MD, USA
| | - Jessica Gall Myrick
- Donald P. Bellisario College of Communications, The Pennsylvania State University, University Park, PA, USA
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6
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Freire K, O'Shea S, Pope R, Orr R. Servicewomen's experiences of managing pelvic health in occupational settings. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231183839. [PMID: 37377334 DOI: 10.1177/17455057231183839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND Despite increasing numbers of women serving in defence forces worldwide, little is currently known about how servicewomen manage their pelvic health in the traditionally male environment of the military. OBJECTIVES The aim of this study was to explore the impacts of pelvic health issues on Australian Defence Force servicewomen and their experiences of managing their pelvic health in occupational settings. DESIGN A qualitative hermeneutic design. METHODS Telephone interviews were conducted on six currently serving female members of the Australian Defence Force located Australia-wide. A semi-structured interview guide, based on the study objectives, was used to guide the audio-recorded interviews. Data were analysed thematically. RESULTS Nine themes were identified. The first six themes explored the experiences of servicewomen in maintaining their pelvic health, including suppressing the urge to go, adjusting hydration depending on toilet access, managing menstruation, regaining 'full' fitness postpartum, awareness and prevention of pelvic health conditions, and inhibiting conversations about women's health. The last three themes explored how servicewomen coped with pelvic health conditions, including self-managing symptoms, diagnosing and treating pelvic conditions, and support for servicewomen's pelvic health. CONCLUSION This study suggests workplace culture, low levels of insight into pelvic health norms, and limited healthcare strategies within the Australian Defence Force to support female pelvic health have contributed to servicewomen self-managing pelvic health issues using approaches that may have had significant impacts on their health and well-being.
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Affiliation(s)
- Kate Freire
- Three Rivers Department of Rural Health, Charles Sturt University, Wagga Wagga, NSW, Australia
| | | | - Rod Pope
- Charles Sturt University, Albury, NSW, Australia
- Bond University, Gold Coast, QLD, Australia
| | - Rob Orr
- Bond University, Gold Coast, QLD, Australia
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Targeted Proteomics Analysis of Staphylococcal Superantigenic Toxins in Menstrual Fluid from Women with Menstrual Toxic Shock Syndrome (mTSS). Toxins (Basel) 2022; 14:toxins14120886. [PMID: 36548783 PMCID: PMC9788610 DOI: 10.3390/toxins14120886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/23/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Menstrual toxic shock syndrome (mTSS) is a rare life-threatening febrile illness that occurs in women using intravaginal menstrual protection. It is caused by toxic shock syndrome toxin 1 (TSST-1) produced by Staphylococcus aureus, triggering a sudden onset of rash and hypotension, subsequently leading to multiple organ failure. Detecting TSST-1 and S. aureus virulence factors in menstrual fluid could accelerate the diagnosis and improve therapeutic management of mTSS. However, menstrual fluid is a highly complex matrix, making detection of bacterial toxins challenging. Here, we present a mass-spectrometry-based proteomics workflow for the targeted, quantitative analysis of four S. aureus superantigenic toxins in menstrual fluids (TSST-1, SEA, SEC, and SED). This method was applied to characterize toxin levels in menstrual fluids collected from patients with mTSS and healthy women. Toxins were detectable in samples from patients with mTSS and one healthy donor at concentrations ranging from 0 to 0.46 µg/mL for TSST-1, and 0 to 1.07 µg/mL for SEC. SEA and SED were never detected in clinical specimens, even though many S. aureus strains were positive for the corresponding genes. The method presented here could be used to explore toxin production in vivo in users of intravaginal devices to improve the diagnosis, understanding, and prevention of mTSS.
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8
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Ortiz Rojas H, García-Perdomo H. Association between tampons and toxic shock syndrome in menstruating women: A systematic review and meta-analysis. SEXOLOGIES 2022. [DOI: 10.1016/j.sexol.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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9
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Noli Truant S, Redolfi DM, Sarratea MB, Malchiodi EL, Fernández MM. Superantigens, a Paradox of the Immune Response. Toxins (Basel) 2022; 14:toxins14110800. [PMID: 36422975 PMCID: PMC9692936 DOI: 10.3390/toxins14110800] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022] Open
Abstract
Staphylococcal enterotoxins are a wide family of bacterial exotoxins with the capacity to activate as much as 20% of the host T cells, which is why they were called superantigens. Superantigens (SAgs) can cause multiple diseases in humans and cattle, ranging from mild to life-threatening infections. Almost all S. aureus isolates encode at least one of these toxins, though there is no complete knowledge about how their production is triggered. One of the main problems with the available evidence for these toxins is that most studies have been conducted with a few superantigens; however, the resulting characteristics are attributed to the whole group. Although these toxins share homology and a two-domain structure organization, the similarity ratio varies from 20 to 89% among different SAgs, implying wide heterogeneity. Furthermore, every attempt to structurally classify these proteins has failed to answer differential biological functionalities. Taking these concerns into account, it might not be appropriate to extrapolate all the information that is currently available to every staphylococcal SAg. Here, we aimed to gather the available information about all staphylococcal SAgs, considering their functions and pathogenicity, their ability to interact with the immune system as well as their capacity to be used as immunotherapeutic agents, resembling the two faces of Dr. Jekyll and Mr. Hyde.
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10
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Marcelis Q, Gatzios A, Deconinck E, Rogiers V, Desmedt B, Vanhaecke T. Quantitative risk assessment of allergens leaching from menstrual hygiene products. Regul Toxicol Pharmacol 2022; 135:105260. [PMID: 36067853 DOI: 10.1016/j.yrtph.2022.105260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/11/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022]
Abstract
Allergic contact dermatitis (ACD) often associated with the topical use of perfumed products, remains one of the most common chronic skin disorders in Western countries. Since labelling of scented menstrual hygiene products (MHPs) is not mandatory, women might be unknowingly exposed to allergens. Given that vaginal mucosae lack the vital barrier function of the skin, skin allergens can easily penetrate and become systemically available and hence women may experience adverse effects in the anogenital region. The aim of this study was therefore to investigate whether women using scented MHPs are at risk of sensitization and hence developing ACD. Hereto, a Quantitative Risk Assessment (QRA) is performed on four well-known skin sensitizing chemicals (α-isomethyl ionone, benzyl salicylate, hexyl cinnamaldehyde and heliotropine) that were previously found leaching from five different scented MHPs including tampons and sanitary pads. The amounts of heliotropine, leached by one of the investigated tampons, exceeded acceptable exposure levels determined with the QRA and could induce sensitization. In addition, although no sensitization is expected for the other three compounds, an allergenic reaction might be provoked in women who are already sensitized. Labelling of allergens on scented MHPs would therefore help consumers to prevent adverse effects linked to ACD.
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Affiliation(s)
- Quinten Marcelis
- Department In Vitro Toxicology and Dermato-cosmetology (IVTD), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Jette, Belgium.
| | - Alexandra Gatzios
- Department In Vitro Toxicology and Dermato-cosmetology (IVTD), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Jette, Belgium.
| | - Eric Deconinck
- Medicines and Medicinal Health Products, Sciensano, Julliette Weytsmanstraat 14, 1050, Elsene, Belgium.
| | - Vera Rogiers
- Department In Vitro Toxicology and Dermato-cosmetology (IVTD), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Jette, Belgium
| | - Bart Desmedt
- Medicines and Medicinal Health Products, Sciensano, Julliette Weytsmanstraat 14, 1050, Elsene, Belgium.
| | - Tamara Vanhaecke
- Department In Vitro Toxicology and Dermato-cosmetology (IVTD), Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Jette, Belgium.
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El Soufi H, El Soufi Y, Al-Nuaimi S, Bagheri F. Toxic shock syndrome associated with menstrual cup use. IDCases 2021; 25:e01171. [PMID: 34141582 PMCID: PMC8188353 DOI: 10.1016/j.idcr.2021.e01171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/23/2021] [Accepted: 05/27/2021] [Indexed: 11/17/2022] Open
Abstract
Staphylococcal toxic shock syndrome is a rare but life-threatening condition. It occurs when Staphylococcus aureus bacteria colonizing the vagina of a healthy woman, produce toxic shock syndrome toxin 1 activating the immune system and leading to multiorgan failure. Menstrual cups also known as vaginal cups are usually used as alternatives to other intravaginal products for menstrual blood collection. In rare cases, they can also lead to toxic shock syndrome. We report a case of toxic shock syndrome associated with vaginal cup use in a healthy menstruating woman. The diagnosis was made based on the United States Centers for Disease Control and Prevention criteria of the syndrome and confirmed with a vaginal cultural growth of Staphylococcus aureus.
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Affiliation(s)
- Hind El Soufi
- Department of Internal Medicine, Jamaica Hospital Medical Center, Queens, NY, United States
| | - Yahya El Soufi
- Lebanese University, Faculty of Medical Sciences, Beirut, Lebanon
| | - Sarah Al-Nuaimi
- Department of Internal Medicine, Jamaica Hospital Medical Center, Queens, NY, United States
| | - Farshad Bagheri
- Director of Infectious Diseases Department, Jamaica Hospital Medical Center, Queens, NY, United States
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12
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High Fever, Nausea, and General Malaise. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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Contou D, Colin G, Travert B, Jochmans S, Conrad M, Lascarrou JB, Painvin B, Ferré A, Schnell D, La Combe B, Coudroy R, Ehrmann S, Rambaud J, Wiedemann A, Asfar P, Kalfon P, Guérot E, Préau S, Argaud L, Daviet F, Dellamonica J, Dupont A, Fartoukh M, Kamel T, Béduneau G, Canouï-Poitrine F, Boutin E, Lina G, Dessap AM, Tristant A, de Prost N. Menstrual toxic shock syndrome: a French nationwide multicenter retrospective study. Clin Infect Dis 2021; 74:246-253. [PMID: 33906228 DOI: 10.1093/cid/ciab378] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Studies describing the clinical features and short-term prognosis of patients admitted to the intensive care unit (ICU) for menstrual toxic shock syndrome (m-TSS) are lacking. METHODS This was a multicenter retrospective cohort study of patients with a clinical diagnosis of m-TSS admitted between January 1, 2005 and December 31, 2020 in 43 French pediatric (n=7) or adult (n=36) ICUs. The aim of the study was to describe the clinical features and short-term prognosis, as well as assess the 2011 Centers for Disease and Control (CDC) diagnostic criteria, of critically ill patients with m-TSS. RESULTS In total, 102 patients with m-TSS (median age: 18 [16-24] years) were admitted to one of the participating ICUs. All blood cultures (n=102) were sterile. Methicillin-sensitive Staphylococcus aureus grew from 92 of 96 vaginal samples. Screening for super-antigenic toxin gene sequences was performed for 76 of the 92 (83%) vaginal samples positive for Staphylococcus aureus and TSST-1 isolated from 66 (87%) strains. At ICU admission, no patient met the 2011 CDC criteria for confirmed m-TSS and only 53 (52%) fulfilled the criteria for probable m-TSS. Eighty-one patients (79%) were treated with anti-toxin antibiotic therapy and eight (8%) received intravenous immunoglobulins. Eighty-six (84%) patients required vasopressors and 21 (21%) tracheal intubation. No patient required limb amputation or died in the ICU. CONCLUSIONS In this large multicenter series of patients included in ICUs for m-TSS, none died or required limb amputation. The CDC criteria should not be used for the clinical diagnosis of m-TSS at ICU admission.
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Affiliation(s)
- Damien Contou
- Service de Réanimation Polyvalente, Centre Hospitalier Victor Dupouy, 69, rue du Lieutenant-Colonel Prud'hon, 95100 Argenteuil, France
| | - Gwenhaël Colin
- Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de Vendée, Les Oudairies, Boulevard Stéphane Moreau, 85925 La Roche-sur-Yon, France
| | - Brendan Travert
- Service de Réanimation Pédiatrique, Centre Hospitalier Universitaire de Nantes, 9 Quai Moncousu, 44036 Nantes, France
| | - Sébastien Jochmans
- Service de Médecine Intensive Réanimation, Groupe Hospitalier Sud Ile-de-France, Hôpital de Melun-Sénart, 270 avenue Marc Jacquet, 77000 Melun, France
| | - Marie Conrad
- Service de Réanimation, Centre Hospitalier Universitaire de Nancy, 25 Rue Lionnois, 54000 Nancy, France
| | - Jean-Baptiste Lascarrou
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Nantes, 9 Quai Moncousu, 44036 Nantes, France
| | - Benoit Painvin
- Service des Maladies Infectieuses et Réanimation Médicale, Centre Hospitalier Universitaire de Rennes, 2 Rue Henri le Guilloux, 35033 Rennes, France
| | - Alexis Ferré
- Service de Réanimation Médico-Chirurgicale, Centre Hospitalier André Mignot de Versailles, 177 Rue de Versailles, 78150 Le Chesnay-Rocquencourt, France
| | - David Schnell
- Service de Médecine Réanimation Polyvalente, Centre Hospitalier d'Angoulême, Rond point de Girac, 16959 Angoulême, France
| | - Beatrice La Combe
- Service de Réanimation Médico-Chirurgicale, Hôpital du Scorff - Groupe Hospitalier Bretagne Sud Lorient, 5 Avenue Choiseul, 56322 Lorient, France
| | - Rémi Coudroy
- Service de Médecine Intensive et Réanimation, Centre Hospitalier Universitaire de Poitiers, 2 rue de la Milétrie, 86021 Poitiers, France, INSERM CIC1402, ALIVE group, Université de Poitiers, France
| | - Stephan Ehrmann
- Service de Médecine Intensive et Réanimation, CHRU de Tours, CIC 1415, CRICS-TriggerSEP, Centre d'étude des pathologies respiratoires, INSERM U1100, Université de Tours, Tours, France
| | - Jérôme Rambaud
- Service de Réanimation Pédiatrique, Hôpital Trousseau, AP-HP, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Arnaud Wiedemann
- INSERM u1256 N-GERE et Réanimation Pédiatrique Spécialisée - C.H.R.U. Nancy - 5 rue du Morvan 54500 Vandœuvre-lès-Nancy, France
| | - Pierre Asfar
- SDépartement de Médecine Intensive-Réanimation, Centre Hospitalier Universitaire d'Angers, 4 Rue Larrey, 49100 Angers, France
| | - Pierre Kalfon
- Service de Réanimation, Centre Hospitalier de Chartres, 4 Rue Claude Bernard, 28630 Le Coudray, France
| | - Emmanuel Guérot
- Service de Médecine Intensive Réanimation, Hôpital européen Georges Pompidou AP-HP, 20 Rue Leblanc, 75015 Paris, France
| | - Sébastien Préau
- Service de Réanimation, Centre Hospitalier Universitaire de Lille, 2 Avenue Oscar Lambret, 59000 Lille, France
| | - Laurent Argaud
- Service de Médecine Intensive-Réanimation, hôpital Édouard-Herriot, 5, place d'Arsonval, F-69437 Lyon, France
| | - Florence Daviet
- Service de Médecine Intensive Réanimation, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille, Aix-Marseille Université, Chemin des Bourrely, 13015 Marseille, France
| | - Jean Dellamonica
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nice, 151 route de Saint-Antoine CS23079, UR2CA Université Cote d'Azur, 06000 Nice, France
| | - Audrey Dupont
- Service de Réanimation Pédiatrique, Centre Hospitalier Universitaire de Nice, 30 Voie Romaine, 06000 Nice, France
| | - Muriel Fartoukh
- Sorbonne Université, AP-HP, Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Tenon AP-HP, 4 rue de la Chine, 75020 Paris, France
| | - Toufik Kamel
- Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans Hôpital de La Source, 14 Avenue de l'Hôpital, 45100 Orléans, France
| | - Gaëtan Béduneau
- Universite de Normandie, UNIROUEN, EA3830, Service de Réanimation Médicale, Centre Hospitalier Universitaire de Rouen, 37 Boulevard Gambetta, 76000 Rouen, France
| | - Florence Canouï-Poitrine
- Service de Santé Publique, Hôpital Henri-Mondor, AP-HP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Emmanuelle Boutin
- Service de Santé Publique, Hôpital Henri-Mondor, AP-HP, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Gérard Lina
- Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Armand Mekontso Dessap
- Service de Médecine Intensive Réanimation, Groupe de Recherche CARMAS, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Anne Tristant
- Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Nicolas de Prost
- Service de Médecine Intensive Réanimation, Groupe de Recherche CARMAS, Centre Hospitalier Universitaire Henri Mondor, Assistance Publique-Hôpitaux de Paris, 51, avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
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14
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Vaginal Tampon Colonization by Staphylococcus aureus in Healthy Women. Appl Environ Microbiol 2020; 86:AEM.01249-20. [PMID: 32680868 DOI: 10.1128/aem.01249-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/08/2020] [Indexed: 11/20/2022] Open
Abstract
Tampons recovered from a cohort of 737 healthy women (median age, 32 years) were analyzed for the presence of Staphylococcus aureus A total of 198 tampons (27%) were colonized by S. aureus, 28 (4%) by a strain producing toxic shock syndrome toxin 1 (TSST-1). S. aureus was detected more frequently in tampons that did not require an applicator for their insertion (74/233 [32%] versus 90/381 [24%]; odds ratio [OR] = 1.51 [95% confidence interval, 1.04 to 2.17]) and in women who used an intrauterine device for contraception (53/155 [34%] versus 145/572 [27%]; OR = 1.53 [95% confidence interval, 1.05 to 2.24]). The S. aureus strains isolated from tampons belonged to 22 different clonal complexes (CCs). The most prevalent CC was CC398 agr1 (n = 57 [27%]), a clone that does not produce superantigenic toxins, followed by CC30 agr3 (n = 27, 13%), producing TSST-1 (24/27 [89%]), the principal clone of S. aureus involved in menstrual toxic shock syndrome (MTSS).IMPORTANCE Menstrual toxic shock syndrome (MTSS) is an uncommon severe acute disease that occurs in healthy menstruating women colonized by TSST-1-producing S. aureus who use intravaginal protection, such as tampons and menstrual cups. The catamenial product collected by the protection serves as a growth medium for S. aureus and allows TSST-1 production. Previous studies evaluated the prevalence of genital colonization by S. aureus by vaginal swabbing, but they did not examine tampon colonization. This study demonstrated a high prevalence of tampon colonization by S. aureus and the presence of the CC30 TSST-1 S. aureus clone responsible for MTSS in tampons from healthy women. The results support the vaginal carriage of this lineage in healthy women. In addition, the higher prevalence of S. aureus within tampons that do not require an applicator indicates a crucial role for handwashing before tampon handling to decrease the risk of tampon contamination.
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15
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Schlievert PM. Menstrual TSS remains a dangerous threat. EClinicalMedicine 2020; 21:100316. [PMID: 32382715 PMCID: PMC7201014 DOI: 10.1016/j.eclinm.2020.100316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Patrick M Schlievert
- University of Iowa, Carver College of Medicine, 51 Newton Road, Iowa City, Iowa 52242, USA
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