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Vaginal Tampon Model for Toxic Shock Syndrome

1989; Oxford University Press; Volume: 11; Issue: Supplement_1 Linguagem: Inglês

10.1093/clinids/11.supplement_1.s238

1537-6591

Marian E. Melish, Susanna Murata, Cynthia Fukunaga, Kanitha Frogner, C. McKissick,

Tendon Structure and Treatment

The effects of tampon composition, inoculum size, and simulated menses on production of toxic shock syndrome toxin 1 (TSST-I) and toxic shock syndrome (TSS) were evaluated in a rabbit model that simulates tampon use in humans. Three small generic compressedfiber tampons were successively inserted vaginally (remained in place 4.5 hours × 2; overnight × 1). Tampon no. 1 was inoculated with live TSST-l-positive staphylococci plus 5mL of saline or simulated menses (defibrinated rabbit blood plus 2.5 g of bovine serum albumin/dL) immediately after insertion; saline or simulated menses alone were used with tampons no. 2 and 3. The vagina was washed after removal of tampon no. 3. TSS-like illness was produced consistently in animals with carboxymethyl cellulose/polyester foam tampons, which supported higher organism counts and greater TSST-I production in association with subsequent tampons. Cotton and rayon tampons were not associated with as much clinical illness, organism growth, or TSST-I production. Simulated menses supported toxin production and clinical illness when the inoculum was one-tenth that required for controls. Sham tampon insertion was associated with TSS-like illness in two of 10 rabbits; thus, other factors may promote TSS in the absence of vaginal tampons. This model reliably reproduces menstrual TSS, since one-time vaginal inoculation with TSST-l-positive staphylococci in the presence of blood and certain tampons leads to TSS, and may be useful in evaluating catamenial products and in understanding other factors important in TSST-I production in vivo and the development of TSS.