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Toxic shock syndrome.

K. J. is a 27-year-old woman whose hands now curve like claws. Most of her waist-length hair has fallen out, and gangrene has cut off the sensation in her fingertips and two toes. She has lost her job because she cannot use her hands. Sensational reports such as this one have been appearing recently on television and in newspapers nationwide. They describe the effects of a newly recognized illness known as toxic shock syndrome, or TSS, that has been associated with the use of tampons. The syndrome was first reported in 1978 by a Denver pediatrician, Dr. James Todd, who recognized it in seven children (three boys, four girls) and related it to Staphylococcus aureus(l). Between January and September 1980, the Center for Disease Control in Atlanta confirmed 299 cases across the nation, of which 29 were fatal. A recent Wisconsin study estimated that only three of every 100,000 menstruating women will suffer TSS; but, of these, 10 to 15 percent will die(2). Thus, TSS is a rare but potentially lethal disease. Further, the widespread concern generated by dramatic reports in the media require that nurses be aware of what is known about the syndrome-first, to allay the anxiety of the majority of women who do not, in fact, have TSS and, second, to effectively recognize and intervene in the syndrome and its potential complications in those who do. Toxic shock syndrome seems to primarily affect previously healthy young women during their menstrual periods-although a small number of cases have been reported in women not menstruating at the time of onset and in men. The toxin in toxic shock syndrome is believed