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

Two methods of TSS diagnosis were evaluated: comparison of symptoms with clinical criteria and monitoring for evidence of selective activation of Vβ2+ 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 Vβ2+ T cells during their clinical courses. Nine of the ten patients were diagnosed with TSS based on evidence of selective activation of Vβ2+ 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 Vβ2+ T cells was not observed. Time taken to reach the diagnosis of TSS could be significantly shortened by utilizing the findings from tracing Vβ2+ 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 Vβ2+ T cells could be a useful tool to supplement clinical criteria for early diagnosis of TSS.