h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

I wanted to know about this for a long time. I had heard of TSS, but did not quite understand what was happening. So, congratulations for writing this so well and clearly.
May I call your attention to three little mistakes I noticed while reading the article? Under Symptoms of TSS:
paragr. 1: The average time for TSS symptoms TO appear...
paragr. 2: ... but the onset is very fast and SYMPTOMS are often...
paragr. 3: ... and usually include some or ALL OF the following....
I did not read to correct, but just noticed these, don't know if there are more. Sorry!

There are two (linked) major errors in this articles. Toxic shock syndrome is as you correctly state due to a super-toxin. The bacteria do not enter the bloodstream, otherwise it would be SEPTICAEMIA - which is a different problem. Blood cultures are negative in TSS. Therefore it follows that treatment is NOT antibiotics but removal of the source of the bacteria (the tampon), although antibiotics are often given to eliminate the bacterium.

You also omitted to mention the particular feature of the super-absorbent tampons most associated with TSS - they contained magnesium.

FAL. I've only just noticed theses comments. (There is an asapect of hootoo which I don't understand, which is how to be automatically subscribed to conversations emanating from Entries which one has written)
It's best to post such errors to Editorial Feedback. I'll do that this evening. for that.

'The bacteria do not enter the bloodstream'

Well, according to this article:
http://www.postgradmed.com/issues/2001/10_01/issa.htm

bacteremia occurs in 60% of TSS patients - so I think I'll leave that in.

'You also omitted to mention the particular feature of the super-absorbent tampons most associated with TSS - they contained magnesium'.

It was found that TSS-T1 was produced when the magnesium ion concentration was particularly low. Therefore, it was speculated that the tampons were ABSORBING Mg ions from the environment, thus producing coditions conducive to bacxterial growth. So I don't intend to alter what I wrote here either.

On the second point you are of course correct.In my defense I incorrectly remembered something I was taught 15 years ago

On the first point however, although it might be nice to think you know better than a doctor who treats these conditions and has passed the diploma of the Royal College of Physicians, it ain't going to happen

Have you actually read that reference you give?

You are talking about TSS related to menstruation. That is almost exclusively Staphylococcal which I assumed you knew. Streptococcal TSS has very different causes. Of course TSS caused by surgery has been in the news recently.

The reference you give says "Bacteremia occurs in about 60% of patients who have streptococcal TSS, compared with less than 3% of those with staphylococcal infection". Since we ARE talking about staphylococcal TSS,you have totally misquoted.

Indeed the case definition includes as follows "Normal results on the following tests (if performed)
Blood, throat, or cerebrospinal fluid cultures (blood culture may be positive for S aureus) - so as you can see positive blood cultures actually tend to suggest another diagnosis.

Do you understand the difference between septicaemia and bacteraemia? TSS is NOT septicaemia - the whole reason why toxins were suspected as the cause was because of the negative blood cultures.

but we're used to a somewhat less aggressive tone in these parts.