Staphylococcal and streptococcal pyrogenic toxins involved in toxic shock syndrome and related illnesses

Crit Rev Microbiol. 1990;17(4):251-72. doi: 10.3109/10408419009105728.


Toxic-shock syndrome (TSS) is an acute onset, multiorgan illness which resembles severe scarlet fever. The illness is caused by Staphylococcus aureus strains that express TSS toxin-1 (TSST-1), enterotoxin B, or enterotoxin C. TSST-1 is associated with menstrual TSS and approximately one-half of nonmenstrual cases; the other two toxins cause nonmenstrual cases, 47% and 3%, respectively. The three toxins are expressed in culture media under similar environmental conditions. These conditions may explain the association of certain tampons with menstrual TSS. Biochemically, the toxins are all relatively low molecular weight and fairly heat and protease stable. Enterotoxins B and C, share nearly 50% sequence homology with streptococcal scarlet fever toxin A; they share no homology with TSST-1 despite sharing numerous biological properties. Numerous animal models for development of TSS have suggested mechanisms of toxin action, though the exact molecular action is not known. The toxins are all potent pyrogens, induce T lymphocyte proliferation, requiring interleukin 1 release from macrophages, suppress immunoglobulin production, enhance endotoxin shock, and enhance hypersensitivity skin reactions. The genetic control of the toxins has been studied and suggests the exotoxins are variable traits. Some additional properties of TSS S. aureus which facilitate disease causation have been clarified.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Amino Acid Sequence
  • Animals
  • Bacterial Toxins / adverse effects*
  • Bacterial Toxins / classification
  • Bacterial Toxins / genetics
  • Bacterial Toxins / isolation & purification
  • Base Sequence
  • Enterotoxins / pharmacology
  • Genes, Bacterial
  • Humans
  • Immune Tolerance / drug effects
  • Immunity, Cellular / drug effects
  • Lymphocyte Activation / drug effects
  • Menstrual Hygiene Products
  • Molecular Sequence Data
  • Rabbits
  • Regulatory Sequences, Nucleic Acid
  • Sequence Homology, Nucleic Acid
  • Shock, Septic / etiology*
  • Shock, Septic / microbiology
  • Staphylococcal Infections*
  • Staphylococcus aureus* / genetics
  • Staphylococcus aureus* / metabolism
  • Staphylococcus aureus* / pathogenicity
  • Streptococcal Infections*
  • Streptococcus pyogenes* / genetics
  • Streptococcus pyogenes* / metabolism
  • Streptococcus pyogenes* / pathogenicity
  • Superantigens*


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