Cases of Menstrual Toxic Shock Syndrome in the Czech Republic in 1997–2022 - Abstract
Staphylococcal toxic shock syndrome (TSS) is a serious condition that can be life threatening.
There are two forms of this disease: menstrual and non-menstrual. In the 25 years from 1997
to 2022, 105 cases of TSS related to menstruation were registered at the National Reference
Laboratory for Staphylococci of the National Institute of Public Health (NIPH) in Prague. All the
patients recovered, but one third of the them had a severe course of the illness including intensive
care unit admission reported in their discharge summaries. All the patients except for one had a
history of vaginal tampon use, in the remaining one it was a menstrual cup.
The article characterises toxigenic S. aureus strains that were confirmed as the causative
agents of these diseases. The most common were TSST-1 producers in combination with enterotoxin
– usually type A (65 strains, 61.9%). The TSST-1 toxin exclusively was produced by 33 strains,
seven strains (6.6%) were confirmed positive for only one type of enterotoxin. In one case in 2011,
S. aureus positive for enterotoxin H was isolated as the causative agent. Except for one case, these
always were MSSA strains.
Due to the large spectrum of possible symptoms of the TSS disease, establishing a clinical
diagnosis can be difficult. This may be facilitated by confirmation of staphylococcal toxin aetiology