orabase and Shock--Septic

Tampon use has been identified as a major risk factor for toxic shock syndrome, although the etiologic role of tampons is not clearly understood. Two epidemiologic studies conducted to date have reported an association between tampon absorbency and risk of toxic shock syndrome. This finding is not corroborated by laboratory studies, however, which have suggested that absorbency may be a marker for other characteristics that create an environment conductive to the elaboration of toxic shock syndrome toxin 1. We used data from the previously reported Tri-state study to estimate simultaneously the effects of tampon oxygen content, absorbency and chemical composition. Although the data are sparse, oxygen content was more strongly associated with risk of toxic shock syndrome than either absorbency or chemical composition. The results suggest that it may be possible to develop a highly absorbent tampon that is not associated with a high risk of toxic shock syndrome.

Topics: Acrylates; Bacterial Toxins; Carboxymethylcellulose Sodium; Case-Control Studies; Cellulose; Confounding Factors, Epidemiologic; Evaluation Studies as Topic; Female; Gossypium; Humans; Oxygen; Polyesters; Risk Factors; Shock, Septic; Tampons, Surgical

Eleven bacterial and two yeast strains, four of which were previously identified as having activity on a lightly cross-linked carboxymethyl cellulose (CLD-2) found in one type of superabsorbent tampon, were grown on a variety of substrates, most containing cellulosics. None produced detectable amounts of cellulases, but all elaborated beta-glucosidase. None of these 13 strains nor 3 commercially obtained beta-glucosidase preparations could hydrolyze CLD-2, although a commercial cellulase and two other bacterial preparations known to produce cellulases could. Based on these results, it appears that previous work suggesting that the degradation of CLD-2 by vaginal microbes and beta-glucosidase is implicated in the production by Staphylococcus aureus of toxin causing toxic shock syndrome must be reevaluated.

Topics: Bacteria; beta-Glucosidase; Carboxymethylcellulose Sodium; Cellulase; Cellulose; Female; Glucosidases; Humans; Methylcellulose; Mitosporic Fungi; Shock, Septic; Vagina

beta-glucosidase, cellulase, alpha-mannosidase, beta-galactosidase, and N-acetyl-beta-glucosaminidase were tested for their ability to hydrolyse the carboxymethylcellulose contained in 'Rely' tampons (R-CMC). The end-products of the hydrolysis were determined by chromatography. Only beta-glucosidase and cellulase hydrolysed R-CMC and the major product detectable after enzymic degradation was glucose, as confirmed chromatographically and by the glucose oxidase test. The enzymic-degradation products of R-CMC were able to support the growth of a toxic-shock-syndrome strain of Staphylococcus aureus. This finding suggests that as it is degraded by enzymes in the vaginal cavity R-CMC may become an exogenous source of nutrients for pathogenic organisms.

Topics: Carboxymethylcellulose Sodium; Cellulase; Female; Glycoside Hydrolases; Humans; Hydrolysis; Menstruation; Shock, Septic; Staphylococcus aureus; Syndrome; Tampons, Surgical; Vagina

Topics: Carboxymethylcellulose Sodium; Female; Glucose; Humans; Methylcellulose; Shock, Septic; Staphylococcus aureus; Tampons, Surgical

Topics: Carboxymethylcellulose Sodium; Female; Glucosidases; Humans; Hydrolysis; Methylcellulose; Shock, Septic; Tampons, Surgical

Topics: Bacteria; Carboxymethylcellulose Sodium; Cellulase; Female; Humans; Methylcellulose; Risk; Shock, Septic; Tampons, Surgical

Analysis of statistical methods used in matched case-control studies of toxic shock syndrome shows that matching has implications for validity and precision of the studies and for the choice of analysis techniques. The studies considered accounted for the matching in the analysis, either by the Mantel-Haenszel or Miettinen-Pike-Morrow approach to 1-to-M matched designs, or by the use of conditional maximum likelihood fitting of logistic regression models. Methods of dealing with confounding and effect modification in the (matched) logistic regression model are presented in the context of studies of toxic shock syndrome. The varied statistical techniques used in these studies were generally appropriate to the matched design except that nonmatching variables were not thoroughly considered as effect modifiers or confounders.

Topics: Carboxymethylcellulose Sodium; Humans; Regression Analysis; Research Design; Risk; Shock, Septic; Statistics as Topic; Syndrome; Tampons, Surgical

Topics: Adult; Carboxymethylcellulose Sodium; Cellulase; Enterobacteriaceae; Female; Humans; Shock, Septic; Syndrome; Tampons, Surgical