Toxic Shock Syndrome, Staphylococcus aureus, and Influenza

To the Editor.— The recent reports of toxic shock syndrome (TSS) during influenza outbreaks1,2may not imply a unique association with the influenza virus, but are more probably due to secondary focal staphylococcal infections including sinusitis—a frequent complication of influenza. The patient reported by Sperber and Francis1had clear-cut pneumonia, as did two of the nine patients reported by MacDonald et al2; the remainder could have had occult sinus infection. In either situation, it would not be unusual to cultureStaphylococcus aureusfrom respiratory secretions. Such focal infections appear to be linked both epidemiologically and microbiologically to the pathogenesis of TSS.3During the last two influenza outbreaks in Denver, we have noted a large number of patients with secondary sinusitis. Growth of a toxin producingS aureusin a sinus (or in a lung) may provide conditions for toxin production that may not ordinarily be present