Diagnosis of toxic shock syndrome by two different systems; clinical criteria and monitoring of TSST-1-reactive T cells

Microbiol Immunol. 2008 Nov;52(11):513-21. doi: 10.1111/j.1348-0421.2008.00071.x.


Two methods of TSS diagnosis were evaluated: comparison of symptoms with clinical criteria and monitoring for evidence of selective activation of Vbeta2(+) T cells by the causative toxin, TSS toxin-1 (TSST-1). Ten patients with acute and systemic febrile infections caused by Staphylococcus aureus were monitored for increase in TSST-1-reactive Vbeta2(+) T cells during their clinical courses. Nine of the ten patients were diagnosed with TSS based on evidence of selective activation of Vbeta2(+) T cells by TSST-1; however, clinical symptoms met the clinical criteria for TSS in only six of these nine patients. In the remaining patient, clinical symptoms met the clinical criteria, but selective activation of Vbeta2(+) T cells was not observed. Time taken to reach the diagnosis of TSS could be significantly shortened by utilizing the findings from tracing Vbeta2(+) T cells. In vitro studies showed that TSST-1- reactive T cells from TSS patients were anergic in the early phase of their illness. Examining selective activation of Vbeta2(+) T cells could be a useful tool to supplement clinical criteria for early diagnosis of TSS.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Bacterial Toxins / immunology
  • Enterotoxins / immunology
  • Female
  • Flow Cytometry
  • Humans
  • Lymphocyte Activation / immunology
  • Male
  • Methicillin-Resistant Staphylococcus aureus / immunology
  • Middle Aged
  • Shock, Septic / diagnosis*
  • Shock, Septic / immunology
  • Shock, Septic / microbiology
  • Staphylococcal Infections / diagnosis*
  • Staphylococcal Infections / immunology
  • Staphylococcal Infections / microbiology
  • Superantigens / immunology
  • T-Lymphocyte Subsets / immunology
  • T-Lymphocyte Subsets / metabolism*


  • Bacterial Toxins
  • Enterotoxins
  • Superantigens
  • enterotoxin F, Staphylococcal