{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T09:02:20Z","timestamp":1784192540661,"version":"3.55.0"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2002,4,1]],"date-time":"2002-04-01T00:00:00Z","timestamp":1017619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2002,4,28]]},"abstract":"<jats:title>SUMMARY<\/jats:title><jats:p>Staphylococcal toxic shock syndrome (TSS) is an acute life threatening disease. The diagnosis can be made clinically based on diagnostic criteria. The clinical manifestations are caused in large part by the release of high levels of T-cell-derived cytokines as a result of potent toxins, also called superantigens (SAg), produced by Staphylococcus aureus, but it is not clear which clinical symptoms\/signs are strictly T-cell dependent. Here, we report on three adults with multiple myeloma (MM) presenting with S. aureus sepsis\/shock, and two patients with typical TSS. The MM patients had compromised humoral immunity because of depression of normal immunoglobulin (Ig) levels at the expense of the M protein. In addition, their T cells were absent due to high dose chemotherapy initiated for bone marrow transplantation. The MM cases lacked mucosal hyperemia, erythroderma and desquamation, but were otherwise indistinguishable from the TSS cases. All patients grew S. aureus and in each case, SAg genes were detected by PCR. In several cases, the plasma contained biological SAg activity resulting in V\u03b2 specific proliferation of indicator T cells in vitro. The same specific activity was observed with the supernatant fluids of S. aureus broth cultures from the respective bacterial isolates. This confirms the presence of bio-active toxins in the plasma but did not lead to full blown TSS when T cells were lacking. Thus, S. aureus sepsis\/shock can be clinically distinguished from typical TSS, and we suggest that muco-cutaneous manifestations of TSS are the most telling signs of massive T-cell-dependent cytokine release.<\/jats:p>","DOI":"10.1046\/j.1365-2249.2002.01805.x","type":"journal-article","created":{"date-parts":[[2003,3,11]],"date-time":"2003-03-11T10:31:44Z","timestamp":1047378704000},"page":"131-139","source":"Crossref","is-referenced-by-count":10,"title":["Lack of muco-cutaneous signs of toxic shock syndrome when T cells are absent:<i>S. aureus<\/i>shock in immunodeficient adults with multiple myeloma"],"prefix":"10.1093","volume":"128","author":[{"given":"N S","family":"KAMEL","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Hematology-Oncology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M C","family":"BANKS","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Hematology-Oncology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"DOSIK","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Hematology-Oncology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D","family":"URSEA","sequence":"additional","affiliation":[{"name":"Department of Paediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A A","family":"YARILINA","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Hematology-Oncology"},{"name":"Immunology Program of the Graduate School of Medical Sciences, Weill Medical College, Cornell University, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D N","family":"POSNETT","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Hematology-Oncology"},{"name":"Immunology Program of the Graduate School of Medical Sciences, Weill Medical College, Cornell University, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2002,4,28]]},"reference":[{"key":"2022011221425473900_b1","first-page":"38","article-title":"Case definitions for public health surveillance. Toxic shock syndrome","volume":"39","author":"Anon","year":"1990","journal-title":"MMWR"},{"key":"2022011221425473900_b2","doi-asserted-by":"crossref","first-page":"807","DOI":"10.3201\/eid0506.990611","article-title":"Toxic shock syndrome in the United States: surveillance update, 1979\u20131996","volume":"5","author":"Hajjeh","year":"1999","journal-title":"Emerg Infect Dis"},{"key":"2022011221425473900_b3","doi-asserted-by":"crossref","first-page":"S28","DOI":"10.1093\/clinids\/11.Supplement_1.S28","article-title":"Active surveillance for Toxic Shock Syndrome in the United States, 1986","volume":"11(Suppl.)","author":"Gaventa","year":"1989","journal-title":"Rev Infect Dis"},{"key":"2022011221425473900_b4","first-page":"565","volume-title":"The staphylococci in human disease.","author":"Sheagren","year":"1997"},{"key":"2022011221425473900_b5","first-page":"287","volume-title":"The staphylococci in human disease.","author":"Kauffman","year":"1997"},{"key":"2022011221425473900_b6","first-page":"509","volume-title":"The staphylococci in human disease.","author":"Chesney","year":"1997"},{"key":"2022011221425473900_b7","first-page":"113","volume-title":"The staphylococci in human disease.","author":"Kloos","year":"1997"},{"key":"2022011221425473900_b8","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1093\/infdis\/151.5.883","article-title":"Development of serum antibody to toxic shock toxin among individuals with toxic shock syndrome in Wisconsin","volume":"151","author":"Stolz","year":"1985","journal-title":"J Infect Dis"},{"key":"2022011221425473900_b9","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1093\/infdis\/148.4.692","article-title":"Prevalence of serum antibody to staphylococcal enterotoxin F among Wisconsin residents: implications for toxic\u2013shock syndrome","volume":"148","author":"Vergeront","year":"1983","journal-title":"J Infect Dis"},{"key":"2022011221425473900_b10","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1093\/infdis\/165.4.638","article-title":"A recalcitrant, erythematous, desquamating disorder associated with toxin-producing staphylococci in patients with AIDS","volume":"165","author":"Cone","year":"1992","journal-title":"J Infect Dis"},{"key":"2022011221425473900_b11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1574-695X.2000.tb01404.x","article-title":"Evolving superantigens of Staphylococcus aureus","volume":"27","author":"Ulrich","year":"2001","journal-title":"FEMS Immunol Med Microbiol"},{"key":"2022011221425473900_b12","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1086\/318494","article-title":"Bacteremic non-menstrual Staphylococcal Toxic Shock Syndrome associated with enterotoxins A and C","volume":"32","author":"Czachor","year":"2001","journal-title":"Clin Infect Dis"},{"key":"2022011221425473900_b13","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1023\/A:1020547509410","article-title":"Superantigens in human disease","volume":"19","author":"Bernal","year":"1999","journal-title":"J Clin Immunol"},{"key":"2022011221425473900_b14","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1128\/iai.22.1.62-68.1978","article-title":"Biological effects of staphylococcal enterotoxin A on human peripheral lymphocytes","volume":"22","author":"Langford","year":"1978","journal-title":"Infect Immun"},{"key":"2022011221425473900_b15","doi-asserted-by":"crossref","first-page":"2446","DOI":"10.1128\/JCM.37.8.2446-2449.1999","article-title":"Involvment of enterotoxins G and I in staphylococcal toxic shock syndrome and staphylococcal scarlet fever","volume":"37","author":"Jarraud","year":"1999","journal-title":"J Clin Microbiol"},{"key":"2022011221425473900_b16","volume-title":"Staphylococcus aureus from female genital mucosa express unique superantigens (in press)","author":"Banks"},{"key":"2022011221425473900_b17","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1136\/jcp.48.3.260","article-title":"Immunological factors and risk of infection in plateau phase myeloma","volume":"48","author":"Hargreaves","year":"1995","journal-title":"J Clin Pathol"},{"key":"2022011221425473900_b18","first-page":"439","volume-title":"Myeloma, biology and management 2nd edn","author":"Phillips","year":"1998"},{"key":"2022011221425473900_b19","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1093\/intimm\/11.2.229","article-title":"Differentiation of human CD8 T cells: Implications for in vivo persistence of oligoclonal CD8+28\u2013 cytotoxic effector clones","volume":"11","author":"Posnett","year":"1999","journal-title":"Int Immunol"},{"key":"2022011221425473900_b20","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1126\/science.2524876","article-title":"V\u03b2-specific stimulation of human T cells by staphylococcal toxins","volume":"244","author":"Kappler","year":"1989","journal-title":"Science"},{"key":"2022011221425473900_b21","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1084\/jem.174.4.891","article-title":"Characterization of human T cells reactive with the mycoplasma arthritidis-derived superantigen (MAM): generation of a monoclonal antibody against V\u03b217, the T cell receptor product expressed by a large fraction of MAM-reactive human T cells","volume":"174","author":"Friedman","year":"1991","journal-title":"J Exp Med"},{"key":"2022011221425473900_b22","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1084\/jem.172.3.981","article-title":"Selective expansion of T cells expressing V\u03b22 in toxic shock syndrome","volume":"172","author":"Choi","year":"1990","journal-title":"J Exp Med"},{"key":"2022011221425473900_b23","doi-asserted-by":"crossref","first-page":"300","DOI":"10.7326\/0003-4819-105-2-300_2","article-title":"The acquired immunodeficiency syndrome and nonmenstrual toxic shock syndrome [letter]","volume":"105","author":"Sparano","year":"1986","journal-title":"Ann Intern Med"},{"key":"2022011221425473900_b24","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1378\/chest.104.3.950","article-title":"Toxic shock syndrome as the AIDS-defining diagnosis","volume":"104","author":"Finkelstein","year":"1993","journal-title":"Chest"},{"key":"2022011221425473900_b25","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1097\/00006205-199401000-00007","article-title":"The human immunodeficiency virus and nonmenstrual toxic shock syndrome: a female case presentation","volume":"19","author":"Woods","year":"1994","journal-title":"Nurse Pract"},{"key":"2022011221425473900_b26","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1093\/clinids\/22.5.875","article-title":"Staphylococcal toxic shock syndrome associated with human immunodeficiency virus infection: report of a case with bacteremia","volume":"22","author":"Gutierrez Rodero","year":"1996","journal-title":"Clin Infect Dis"},{"key":"2022011221425473900_b27","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1097\/00006454-199607000-00021","article-title":"Nonmenstrual toxic shock syndrome in a young child with human immunodeficiency virus infection","volume":"15","author":"Shah","year":"1996","journal-title":"Pediatr Infect Dis J"},{"key":"2022011221425473900_b28","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1046\/j.1365-4362.1997.d01-734.x","article-title":"Toxic shock syndrome in AIDS [letter]","volume":"36","author":"Klinker","year":"1997","journal-title":"Int J Dermatol"},{"key":"2022011221425473900_b29","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/S0022-3476(97)70136-7","article-title":"Toxic shock syndrome without rash in a young child: link with syndrome of hemorrhagic shock and encephalopathy","volume":"131","author":"Van Lierde","year":"1997","journal-title":"J Pediatr"},{"key":"2022011221425473900_b30","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1080\/00325481.1993.11945747","article-title":"Toxic Shock Syndrome. Are you recognizing its changing presentations?","volume":"94","author":"Strausbaugh","year":"1993","journal-title":"Postgrad Med"},{"key":"2022011221425473900_b31","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1093\/clinids\/16.1.100","article-title":"Clinical spectrum of nonmenstrual toxic shock syndrome (TSS): comparison with menstrual TSS by multivariate discriminant analyses [see comments]","volume":"16","author":"Kain","year":"1993","journal-title":"Clin Infect Dis"},{"key":"2022011221425473900_b32","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1084\/jem.175.2.613","article-title":"Engagement of major histocompatibility complex class II molecules by superantigen induces inflammatory cytokine gene expression in human rheumatoid fibroblast-like synoviocytes","volume":"175","author":"Mourad","year":"1992","journal-title":"J Exp Med"},{"key":"2022011221425473900_b33","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1006\/smim.1993.1007","article-title":"Staphylococcal superantigens as inducers of signal transduction in MHC class II-positive cells","volume":"5","author":"Mourad","year":"1993","journal-title":"Sem Immunol"},{"key":"2022011221425473900_b34","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1093\/clind\/16.2.288","article-title":"Menstrual toxic shock syndrome complicated by persistent bacteremia: case report and review","volume":"16","author":"Crowther","year":"1993","journal-title":"Clin Infect Dis"},{"key":"2022011221425473900_b35","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/S0891-5520(05)70081-7","article-title":"Structure and function of streptococcal and staphylococcal superantigens in septic shock","volume":"13","author":"Bannan","year":"1999","journal-title":"Infect Dis Clin North Am"},{"key":"2022011221425473900_b36","doi-asserted-by":"crossref","first-page":"880","DOI":"10.1016\/0091-6749(89)90383-7","article-title":"Role of substance P in immediate-type skin reactions induced by staphylococcal enterotoxin B in unsensitized monkeys","volume":"84","author":"Albert","year":"1989","journal-title":"J Allergy Clin Immunol"},{"key":"2022011221425473900_b37","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1111\/j.1749-6632.1987.tb35767.x","article-title":"Neuropeptides and the immune system: substance P receptors on the bronchus associated lymphoid tissue of rats","volume":"496","author":"Weidermann","year":"1987","journal-title":"Ann N Y Acad Sci"},{"key":"2022011221425473900_b38","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1006\/excr.1994.1057","article-title":"Cytokines modulate terminal differentiation and the expression of predesquamin in cultured keratinocytes","volume":"211","author":"Brysk","year":"1994","journal-title":"Exp Cell Res"},{"key":"2022011221425473900_b39","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/S0002-9343(96)00304-X","article-title":"Adjunctive treatment of streptococcal toxic shock syndrome using intravenous immunoglobulin: case report and review","volume":"102","author":"Perez","year":"1997","journal-title":"Am J Med"},{"key":"2022011221425473900_b40","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1086\/515199","article-title":"Intravenous immunoglobulin therapy for streptococcal toxic shock syndrome \u2013 a comparative observational study. The Canadian Streptococcal Study Group","volume":"28","author":"Kaul","year":"1999","journal-title":"Clin Infect Dis"},{"key":"2022011221425473900_b41","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1086\/514588","article-title":"Varying titers of neutralizing antibodies to streptococcal superantigens in different preparations of normal polyspecific immunoglobulin G: implications for therapeutic efficacy [see comments]","volume":"26","author":"Norrby-Teglund","year":"1998","journal-title":"Clin Infect Dis"},{"key":"2022011221425473900_b42","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1086\/314977","article-title":"Cross-reactive antibodies prevent the lethal effects of Staphylococcus aureus superantigens","volume":"180","author":"Bavari","year":"1999","journal-title":"J Infect Dis"},{"key":"2022011221425473900_b43","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1172\/JCI116240","article-title":"Intravenous immunoglobulin contains specific antibodies inhibitory to activation of T cells by staphylococcal toxin superantigens [see comment]","volume":"91","author":"Takei","year":"1993","journal-title":"J Clin Invest"}],"container-title":["Clinical and Experimental Immunology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1046%2Fj.1365-2249.2002.01805.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1046%2Fj.1365-2249.2002.01805.x","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/cei\/article-pdf\/128\/1\/131\/42139067\/j.1365-2249.2002.01805.x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/cei\/article-pdf\/128\/1\/131\/42139067\/j.1365-2249.2002.01805.x.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,3]],"date-time":"2024-01-03T21:08:00Z","timestamp":1704316080000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/cei\/article\/128\/1\/131\/6478610"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2002,4]]},"references-count":43,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2002,4,28]]},"published-print":{"date-parts":[[2002,4,28]]}},"URL":"https:\/\/doi.org\/10.1046\/j.1365-2249.2002.01805.x","relation":{},"ISSN":["0009-9104","1365-2249"],"issn-type":[{"value":"0009-9104","type":"print"},{"value":"1365-2249","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2002,4]]},"published":{"date-parts":[[2002,4]]}}}