Prodromes of Menstrual Staphylococcal Toxic Shock

Study Overview
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Brief Summary
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Menstrual staphylococcal toxic shock is a rare but severe disease, requiring intensive care in over 80% of cases. Menstrual staphylococcal toxic shock develops during the peri-menstrual period, in healthy young women colonized by a vaginal strain of Staphylococcus aureus secreting the Toxic shock syndrome toxin 1 (TSST-1) and not immune to it, in a favorable environment, i.e. wearing intravaginal menstrual protection (tampon, menstrual cup). The rarity of the syndrome, its polymorphous clinical presentation and the absence of a totally specific biological examination make menstrual staphylococcal toxic shock a difficult pathology to diagnose. The reference clinical criteria correspond to the advanced picture of multivisceral failure, making it possible to classify cases a posteriori, but contribute to diagnostic delay and lack sensitivity. Patient accounts suggest the presence of symptoms in the days preceding the development of toxic shock, and also during previous menstrual cycles. The identification of prodromal symptoms could enable earlier management of menstrual staphylococcal toxic shock by removal of intra-vaginal sanitary protection, the main risk factor, before the disease becomes permanently established and requires intensive care.

Official Title
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Identification of Prodromal Clinical Signs of Menstrual Staphylococcal Toxic Shock

Conditions
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Toxic Shock Syndrome Staphylococcal

Intervention / Treatment
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* Other: Identification of symptoms of menstrual staphylococcal toxic shock in last three menstrual period
* Other: Identification of symptoms of menstrual in control patient in the last three menstrual period


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria : +Case inclusion criteria: Women between 13 and 30 years old inclusive Clinical diagnosis of staphylococcal toxic shock syndrome: confirmed or probable according to Center Disease Control (CDC) criteria: The 5 CDC clinical criteria for menstrual Staphylococcal Toxic Shock are: a fever above 39°C, arterial hypotension, generalized scarlatiniform erythroderma intense peeling of the palms or soles of the feet 7 to 14 days later, and systemic manifestations (at least three): Digestive: vomiting, diarrhea Muscular: myalgia, increase in serum creatine phosphokinase Hyperemia of the vaginal, oropharyngeal and conjunctival mucous membranes Renal: hyperuricemia, hypercreatininemia, leukocyturia without urinary infection, Hepatic: increase in transaminases Hematological: thrombocytopenia (< 100,000 platelets/mm3) Neurological: apart from episodes of fever or hypotension such as disorientation or altered consciousness. In the presence of 4 criteria, the case is considered probable and 5 criteria as confirmed case. Detection of S. aureus strain carrying Toxic shock syndrome toxin-1 (TSST1) on vaginal samples. Onset of symptoms ≤ 72 hours before the start of menstruation and ≥ 72 hours after the end of menstruation. Use during the last 3 cycles of vaginal protection: tampon or menstrual cup. +Control inclusion criteria: Women between 13 and 30 years old inclusive Presence of menstruation Use of intimate periodic protection, tampon or menstrual cup, during the last 3 periods No history of toxic menstrual shock Exclusion Criteria: Non-menstruating women Women protected by law Women (or relatives) who oppose the study

Ages Eligible for Study
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Minimum Age: 13 Years
Maximum Age: 30 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Women who have developed menstrual staphylococcal toxic shock<br>Clinical diagnosis of staphylococcal toxic shock syndrome: confirmed or probable according to CDC criteria : The 5 CDC clinical criteria for Staphylococcal Toxic Shock are: a fever above 39°C, arterial hypotension, generalized scarlatiniform erythroderma intense desquamation of the palms or soles of the feet 7 to 14 days later, and systemic manifestations (at least three): Digestive: vomiting, diarrhea Muscular: myalgias, increased serum creatine phospho-kinase Vaginal, oropharyngeal and conjunctival mucosal hyperemia Renal: hyperuricemia, hypercreatininemia, leukocyturia without urinary infection, Hepatic: increased transaminases Hematological: thrombocytopenia (< 100,000 platelets/mm3) Neurological: excluding episodes of fever or hypotension such as disorientation or altered consciousness. If 4 criteria are met, the case is considered probable, and if 5 criteria are met, confirmed. | Other: Identification of symptoms of menstrual staphylococcal toxic shock in last three menstrual period<br>* questionnaire including : fever felt or measured; chills; malaise or feeling of malaise (dizziness when standing up); unusual fatigue; headache; confusion, disorientation; nausea; vomiting; diarrhea; abdominal pain; muscle pain, aches; sore throat or pain when swallowing; red tongue or mouth ulceration; skin rashes (redness, patches...); other<br>|
| Control healthy women<br>Women over 13 years of age, menstruating and using internal sanitary protection with No history of menstrual toxic shock for controls | Other: Identification of symptoms of menstrual in control patient in the last three menstrual period<br>* questionnaire including : fever felt or measured; chills; malaise or feeling of malaise (dizziness when standing up); unusual fatigue; headache; confusion, disorientation; nausea; vomiting; diarrhea; abdominal pain; muscle pain, aches; sore throat or pain when swallowing; red tongue or mouth ulceration; skin rashes (redness, patches...); other...<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Women with No history of menstrual toxic shock for controls | A single collection of information through a questionnaire delivered to the last menstrual period | in the week following the last menstrual period | 
| Patient with Menstrual Staphylococcal Toxic Shock (STC) | A single collection of information through a questionnaire delivered as close as possible to the occurrence of the STC | in the week following onset Staphylococcal Toxic Shock | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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prodromes, Menstrual toxic shock, Staphylococcus aureus