The Robin Danielson Feminine Hygiene Product Safety Act is a proposed act of the United States Congress , directing the National Institutes of Health (NIH) to research the possible health risks of menstrual hygiene products made with dioxins , synthetic fibers, chemicals such as chlorine or fragrance irritants. It also called for the Food and Drug Administration (FDA) to monitor dioxin levels in similar hygiene products.
50-547: First introduced in 1997 (but renamed in 1999), the bill is named after Robin Danielson , who died in 1998 of toxic shock syndrome , a rare bacterial disease linked to high-absorbency tampon use. Congresswoman Carolyn Maloney has re-introduced the bill a number of times since then, but it has never passed or received significant support. This article relating to law in the United States or its constituent jurisdictions
100-579: A combination of cephalosporins , penicillins or vancomycin . The addition of clindamycin or gentamicin reduces toxin production and mortality. In some cases doctors will prescribe other treatments such as blood pressure medications (to stabilize blood pressure if it is too low), dialysis, oxygen mask (to stabilize oxygen levels), and sometimes a ventilator. These will sometimes be used to help treat side effects of contracting TSS. With proper treatment, people usually recover in two to three weeks. The condition can, however, be fatal within hours. TSS has
150-456: A complete destruction of red blood cells . The name group A (beta-hemolytic) Streptococcus is thus also used. The species name is derived from Greek words meaning 'a chain' ( streptos ) of berries ( coccus [Latinized from kokkos ]) and pus ( pyo )-forming ( genes ), since a number of infections caused by the bacterium produce pus. The main criterion for differentiation between Staphylococcus spp. and Streptococcus spp.
200-428: A human is rare. S. pyogenes typically colonizes the throat, genital mucosa, rectum , and skin. Of healthy adults, 1% to 5% have throat, vaginal, or rectal carriage, with children being more common carriers. Most frequently, transmission from one person to another occurs due to inhalation of respiratory droplets , produced by sneezing and coughing from an infected person. Skin contact, contact with objects harboring
250-408: A life-threatening surgical emergency. The bacterium is also an important cause of infection in newborns , who are susceptible to some forms of the infection that are rarely seen in adults, including meningitis . Like many pathogenic bacteria, S. pyogenes may colonize a healthy person's respiratory system without causing disease, existing as a commensal member of the respiratory microbiota. It
300-564: A mortality rate of 30–70%. Children who are affected by TSS tend to recover easier than adults do. During menstruation: For anyone: Staphylococcal toxic shock syndrome is rare and the number of reported cases has declined significantly since the 1980s. Patrick Schlievert, who published a study on it in 2004, determined incidence at three to four out of 100,000 tampon users per year; the information supplied by manufacturers of sanitary products such as Tampax and Stayfree puts it at one to 17 of every 100,000 menstruating females, per year. TSS
350-431: A significant rise in the mid-1980s and has since remained stable at 2 to 4 cases per 100,000 population. In the developing world , the number of cases is usually on the higher extreme. TSS was first described in 1927. It came to be associated with very absorbent tampons that were removed from sale soon after. Symptoms of toxic shock syndrome (TSS) vary depending on the underlying cause. TSS resulting from infection with
400-463: A small percentage of infections and include rheumatic fever and acute post-infectious glomerulonephritis . Both conditions appear several weeks following the initial streptococcal infection. Rheumatic fever is characterized by inflammation of the joints and/or heart following an episode of streptococcal pharyngitis . Acute glomerulonephritis, inflammation of the renal glomerulus , can follow streptococcal pharyngitis or skin infection. S. pyogenes
450-510: A streptococcal cause, while commonly recommended, is poorly supported by the evidence. Some recommend delaying surgical debridement . The overall risk of death is about 50% in streptococcal disease, and 5% in staphylococcal disease. Death may occur within 2 days. In the United States, the incidence of menstrual staphylococcal TSS declined sharply in the 1990s, while both menstrual and nonmenstrual cases have stabilized at about 0.3 to 0.5 cases per 100,000 population. Streptococcal TSS (STSS) saw
500-425: A sunburn-like rash), and can involve any region of the body including the lips, mouth, eyes, palms and soles of the feet. In patients who survive, the rash desquamates (peels off) after 10–21 days. The initial presentation of symptoms can be hard to differentiate from septic shock and other conditions such as Rocky Mountain spotted fever, rubeola, leptospirosis, drug toxicities, and viral exanthems. STSS caused by
550-454: Is TSS Toxin-1, or TSST -1. The TSST-1 is secreted as a single polypeptide chain. The gene encoding toxic shock syndrome toxin is carried by a mobile genetic element of S. aureus in the SaPI family of pathogenicity islands . The toxin causes the non-specific binding of MHC II , on professional antigen presenting cells, with T-cell receptors , on T cells. In typical T-cell recognition, an antigen
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#1732924286166600-496: Is a stub . You can help Misplaced Pages by expanding it . This health -related article is a stub . You can help Misplaced Pages by expanding it . Toxic shock syndrome Toxic shock syndrome ( TSS ) is a condition caused by bacterial toxins . Symptoms may include fever , rash , skin peeling , and low blood pressure . There may also be symptoms related to the specific underlying infection such as mastitis , osteomyelitis , necrotising fasciitis , or pneumonia . TSS
650-485: Is a polyvalent inactivated vaccine against several types of Streptococcus including S. pyogenes called " vacuna antipiogena polivalente BIOL" it is recommended an administration in a series of 5 weeks. Two weekly applications are made at intervals of 2 to 4 days. The vaccine is produced by the Instituto Biológico Argentino. There is another potential vaccine being developed; the vaccine candidate peptide
700-401: Is called StreptInCor. Many S. pyogenes proteins have unique properties, which have been harnessed in recent years to produce a highly specific "superglue" and a route to enhance the effectiveness of antibody therapy . The CRISPR system from this organism that is used to recognize and destroy DNA from invading viruses, thus stopping the infection, was appropriated in 2012 for use as
750-452: Is commonly found in some populations as part of the mixed microbiome of the upper respiratory tract. Individuals who have the bacterium in their bodies but no signs of disease are known as asymptomatic carriers . The bacteria may start to cause disease when the host's immune system weakens, such as during a viral respiratory infection, which may lead to S. pyogenes superinfection . S. pyogenes infections are commonly associated with
800-548: Is controlled via quorum sensing . One of the biofilm forming pathways in GAS is the Rgg2/3 pathway. It regulates SHP's (short hydrophobic peptides) that are quorum sensing pheromones a.k.a. autoinducers. The SHP's are translated to an immature form of the pheromone and must undergo processing, first by a metalloprotease enzyme inside the cell and then in the extracellular space, to reach their mature active form. The mode of transportation out of
850-498: Is relatively high compared to other bacterial infections acquired during pregnancy, and S. pyogenes is a leading cause of septic shock and death in pregnant and postpartum women. In 1928, Rebecca Lancefield published a method for serotyping S. pyogenes based on its cell-wall polysaccharide, a virulence factor displayed on its surface. Later, in 1946, Lancefield described the serologic classification of S. pyogenes isolates based on components of their surface pili (known as
900-452: Is sensitive to penicillin , and has not developed resistance to it, making penicillin a suitable antibiotic to treat infections caused by this bacterium. Failure of treatment with penicillin is generally attributed to other local commensal microorganisms producing β-lactamase , or failure to achieve adequate tissue levels in the pharynx. Certain strains have developed resistance to macrolides , tetracyclines , and clindamycin . There
950-417: Is taken up by an antigen-presenting cell, processed, expressed on the cell surface in complex with class II major histocompatibility complex (MHC) in a groove formed by the alpha and beta chains of class II MHC, and recognized by an antigen-specific T-cell receptor. This results in polyclonal T-cell activation. Superantigens do not require processing by antigen-presenting cells but instead, interact directly with
1000-462: Is that you can get TSS with synthetic tampons, but not with an all-cotton tampon." A rise in reported cases occurred in the early 2000s: eight deaths from the syndrome in California in 2002 after three successive years of four deaths per year, and Schlievert's study found cases in part of Minnesota more than tripled from 2000 to 2003. Schlievert considers earlier onset of menstruation to be a cause of
1050-484: Is the catalase test . Staphylococci are catalase positive whereas streptococci are catalase-negative. S. pyogenes can be cultured on fresh blood agar plates. The PYR test allows for the differentiation of Streptococcus pyogenes from other morphologically similar beta-hemolytic streptococci (including S. dysgalactiae subsp. esquismilis ) as S. pyogenes will produce a positive test result. An estimated 700 million GAS infections occur worldwide each year. While
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#17329242861661100-462: Is typically caused by bacteria of the Streptococcus pyogenes or Staphylococcus aureus type, though others may also be involved. Streptococcal toxic shock syndrome is sometimes referred to as toxic-shock-like syndrome (TSLS). The underlying mechanism involves the production of superantigens during an invasive streptococcus infection or a localized staphylococcus infection. Risk factors for
1150-706: The RopB pathway disrupts it. RopB is another Rgg-like protein (Rgg1) that directly activates SpeB (Streptococcal pyrogenic exotoxin B), a cysteine protease that acts as a virulence factor. In the absence of this pathway, biofilm formation is enhanced, possibly due to the lack of the protease degrading pheromones or other Rgg2/3 pathway counteracting effects. S. pyogenes is the cause of many human diseases, ranging from mild superficial skin infections to life-threatening systemic diseases. The most frequent manifestations of disease are commonly known as scarlet fever . Infections typically begin in
1200-483: The S. aureus toxin that causes TSS may account for the increased risk associated with Rely. Streptococcus pyogenes Streptococcus pyogenes is a species of Gram-positive , aerotolerant bacteria in the genus Streptococcus . These bacteria are extracellular , and made up of non-motile and non-sporing cocci (round cells) that tend to link in chains. They are clinically important for humans, as they are an infrequent, but usually pathogenic , part of
1250-507: The intensive care unit is often necessary for supportive care (for aggressive fluid management, ventilation, renal replacement therapy and inotropic support), particularly in the case of multiple organ failure . Treatment includes removal or draining of the source of infection—often a tampon—and draining of abscesses. Outcomes are poorer in patients who do not have the source of infection removed. Antibiotic treatment should cover both S. pyogenes and S. aureus . This may include
1300-508: The skin microbiota that can cause group A streptococcal infection . S. pyogenes is the predominant species harboring the Lancefield group A antigen , and is often called group A Streptococcus ( GAS ). However, both Streptococcus dysgalactiae and the Streptococcus anginosus group can possess group A antigen as well. Group A streptococci, when grown on blood agar , typically produce small (2–3 mm) zones of beta-hemolysis ,
1350-606: The M protein is also the weakest point in this pathogen's defense, as antibodies produced by the immune system against M protein target the bacteria for engulfment by phagocytes . M proteins are unique to each strain, and identification can be used clinically to confirm the strain causing an infection. The genomes of different strains were sequenced (genome size is 1.8–1.9 Mbp) encoding about 1700-1900 proteins (1700 in strain NZ131, 1865 in strain MGAS5005 ). Complete genome sequences of
1400-501: The T-antigen) which are used by bacteria to attach to host cells. As of 2016, a total of 120 M proteins are identified. These M proteins are encoded by 234 types emm gene with greater than 1,200 alleles. All strains of S. pyogenes are polylysogenized, in that they carry one or more bacteriophage on their genomes. Some of the 'phages may be defective, but in some cases active 'phage may compensate for defects in others. In general,
1450-450: The bacterium Streptococcus pyogenes , or TSLS, typically presents in people with pre-existing skin infections with the bacteria. These individuals often experience severe pain at the site of the skin infection, followed by rapid progression of symptoms as described above for TSS. In both TSS (caused by S. aureus ) and TSLS (caused by S. pyogenes ), disease progression stems from a superantigen toxin. The toxin in S. aureus infections
1500-416: The bacterium Staphylococcus aureus typically manifests in otherwise healthy individuals via signs and symptoms including high fever , accompanied by low blood pressure , malaise and confusion, which can rapidly progress to stupor , coma , and multiple organ failure. The characteristic rash, often seen early in the course of illness, resembles a sunburn (conversely, streptococcal TSS will rarely involve
1550-555: The bacterium, and consumption of contaminated food are possible but uncommon modes of transmission. Streptococcal pharyngitis occurs most frequently in late winter to early spring in most countries as indoor spaces are used more often and thus more crowded. Disease cases are the lowest during autumn. Maternal S. pyogenes infection usually happens in late pregnancy, at more than 30 weeks of gestation to four weeks postpartum . Maternal infections account for 2 to 4% of all clinically diagnosed S. pyogenes infections. The risk of sepsis
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1600-406: The capsule and several factors embedded in the cell wall, including M protein , lipoteichoic acid , and protein F (SfbI) facilitate attachment to various host cells. M protein also inhibits opsonization by the alternative complement pathway by binding to host complement regulators. The M protein found on some serotypes is also able to prevent opsonization by binding to fibrinogen . However,
1650-471: The cell and the extracellular processing factor(s) are still unknown. The mature SHP pheromone can then be taken into nearby cells and the cell it originated from via a transmembrane protein, oligopeptide permease. In the cytosol the pheromones have two functions in the Rgg2/3 pathway. Firstly, they inhibit the activity of Rgg3 which is a transcriptional regulator repressing SHP production. Secondly, they bind another transcriptional regulator, Rgg2, that increases
1700-423: The early 1980s. Tierno blames the introduction of higher-absorbency tampons in 1978. A study by Tierno also determined that all-cotton tampons were less likely to produce the conditions in which TSS can grow; this was done using a direct comparison of 20 brands of tampons including conventional cotton/rayon tampons and 100% organic cotton tampons from Natracare. In fact, Dr Tierno goes as far to state, "The bottom line
1750-448: The genome of S. pyogenes strains isolated during disease are >90% identical, they differ by the 'phage they carry. S. pyogenes has several virulence factors that enable it to attach to host tissues, evade the immune response, and spread by penetrating host tissue layers. A carbohydrate-based bacterial capsule composed of hyaluronic acid surrounds the bacterium, protecting it from phagocytosis by neutrophils . In addition,
1800-817: The girls who were menstruating when the illness developed were using tampons. Many cases of TSS occurred after tampons were left in after they should have been removed. Following controversial test marketing in Rochester, New York , and Fort Wayne, Indiana , in August 1978, Procter and Gamble introduced superabsorbent Rely tampons to the United States market in response to demands for tampons that could contain an entire menstrual flow without leaking or replacement. Rely used carboxymethylcellulose (CMC) and compressed beads of polyester for absorption. This tampon design could absorb nearly 20 times its own weight in fluid. Further,
1850-544: The invariant region of the class II MHC molecule. In patients with TSS, up to 20% of the body's T-cells can be activated at one time. This polyclonal T-cell population causes a cytokine storm , followed by a multisystem disease. A few possible causes of toxic shock syndrome are: For staphylococcal toxic shock syndrome, the diagnosis is based upon CDC criteria defined in 2011, as follows: Cases are classified as confirmed or probable as follows: The severity of this disease frequently warrants hospitalization. Admission to
1900-553: The overall mortality rate for these infections is less than 0.1%, over 650,000 of the cases are severe and invasive, and these cases have a mortality rate of 25%. Early recognition and treatment are critical; diagnostic failure can result in sepsis and death. S. pyogenes is clinically and historically significant as the cause of scarlet fever , which results from exposure to the species' exotoxin . Unlike most bacterial pathogens, S. pyogenes only infects humans. Thus, zoonotic transmission from an animal (or animal products) to
1950-508: The production of SHP's, having an antagonistic effect to Rgg3. SHP's activating their own transcriptional activator creates a positive feedback loop, which is common for the production for quorum sensing peptides. It enables the rapid production of the pheromones in large quantities. The production of SHP's increases biofilm biogenesis. It has been suggested that GAS switches between biofilm formation and degradation by utilizing pathways with opposing effects. Whilst Rgg2/3 pathway increases biofilm,
2000-485: The release of one or more bacterial toxins . The release of endotoxins from throat infections has been linked to the development of scarlet fever. Other toxins produced by S. pyogenes may lead to streptococcal toxic shock syndrome , a life-threatening emergency. S. pyogenes can also cause disease in the form of post-infectious "non-pyogenic" (not associated with local bacterial multiplication and pus formation) syndromes. These autoimmune -mediated complications follow
2050-420: The rise; others, such as Philip M. Tierno and Bruce A. Hanna, blame new high-absorbency tampons introduced in 1999 and manufacturers discontinuing warnings not to leave tampons in overnight. In Japan, Cases of streptococcal toxic shock syndrome (STSS) reached 1,019 from January to June 2024, as compared to the 941 cases reported in 2023. TSS is more common during the winter and spring and occurs most often in
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2100-464: The staphylococcal type include the use of very absorbent tampons , skin lesions in young children characterized by fever, low blood pressure, rash, vomiting and/or diarrhea, and multiorgan failure. Diagnosis is typically based on symptoms. Treatment includes intravenous fluids , antibiotics , incision and drainage of any abscesses , and possibly intravenous immunoglobulin . The need for rapid removal of infected tissue via surgery in those with
2150-510: The summer of 1980. In September 1980, CDC reported users of Rely were at increased risk for developing TSS. On 22 September 1980, Procter and Gamble recalled Rely following release of the CDC report. As part of the voluntary recall, Procter and Gamble entered into a consent agreement with the FDA "providing for a program for notification to consumers and retrieval of the product from the market". However, it
2200-531: The tampon would "blossom" into a cup shape in the vagina to hold menstrual fluids without leakage. In January 1980, epidemiologists in Wisconsin and Minnesota reported the appearance of TSS, mostly in those menstruating, to the CDC . S. aureus was successfully cultured from most of the subjects. The Toxic Shock Syndrome Task Force was created and investigated the epidemic as the number of reported cases rose throughout
2250-434: The throat or skin. The most striking sign is a strawberry-like rash. Examples of mild S. pyogenes infections include pharyngitis (strep throat) and localized skin infection ( impetigo ). Erysipelas and cellulitis are characterized by multiplication and lateral spread of S. pyogenes in deep layers of the skin. S. pyogenes invasion and multiplication in the fascia beneath the skin can lead to necrotizing fasciitis ,
2300-473: The type strain of S. pyogenes ( NCTC 8198 = CCUG 4207 ) are available in DNA Data Bank of Japan , European Nucleotide Archive , and GenBank under the accession numbers LN831034 and CP028841 . Biofilms are a way for S. pyogenes, as well as other bacterial cells, to communicate with each other. In the biofilm gene expression for multiple purposes (such as defending against the host immune system)
2350-486: The young and old. Toxic shock syndrome is commonly known to be an issue for those who menstruate, although fifty percent of Toxic Shock Syndrome cases are unrelated to menstruation. TSS in these cases can be caused by skin wounds, surgical sites, nasal packing, and burns. The term "toxic shock syndrome" was first used in 1978 by a Denver pediatrician, James K. Todd , to describe the staphylococcal illness in three boys and four girls aged 8–17 years. Even though S. aureus
2400-489: Was clear to other investigators that Rely was not the only culprit. Other regions of the United States saw increases in menstrual TSS before Rely was introduced. It was shown later that higher absorbency of tampons was associated with an increased risk for TSS, regardless of the chemical composition or the brand of the tampon. The sole exception was Rely, for which the risk for TSS was still higher when corrected for its absorbency. The ability of carboxymethylcellulose to filter
2450-490: Was considered a sporadic disease that occurred in immunocompromised people. It was not a more well-known disease until the 1980s, when high-absorbency tampons were in use. Due to the idea of the tampons having a high absorbency this led users to believe that they could leave a tampon in for several hours. Doing this allowed the bacteria to grow and led to infection. This resulted in a spike of cases of TSS. Philip M. Tierno Jr. helped determine that tampons were behind TSS cases in
2500-429: Was isolated from mucosal sites in the patients, bacteria could not be isolated from the blood, cerebrospinal fluid, or urine, raising suspicion that a toxin was involved. The authors of the study noted reports of similar staphylococcal illnesses had appeared occasionally as far back as 1927, but the authors at the time failed to consider the possibility of a connection between toxic shock syndrome and tampon use, as three of
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