A new disease that most frequently strikes young women and can produce death within a few days is being called to the attention of doctors across the United States.
The federal Center for Disease Control said this week that 55 cases of the illness -- called toxic-shock syndrome -- have been identified in the United States since last October. Fifty-two victims were women, and seven of them died.
Often, the victims do not seek medical attention rapidly enough because the disease initally displays symptoms similar to those of a minor virus infection.
"It's scary," said Dr. Kathryn Shands, the center epidemiologist in charge of tracking down new cases. "Most people don't seek care until they get fainting [spells] or dizziness or collapse from shock."
The disease produces a distinctive set of symptoms. Most victims have been women who started a menstrual period no more than five days before becoming ill. They develop a fever, vomiting and diarrhea, sometimes with a headache, sore throat and aching muscles.
Within the next two days, the victims go into shock -- that is, their blood pressure falls to dangerously low levels often producing kidney failure and disorientation. At the same time, they develop a patchy, red rash that can cause peeling of the skin.
The cases identified so far come from 13 states, Shands said. Thirty-one occured in Wisconsin -- not because there is an epidemic there, but because the state health department becaume aware of several isolated cases last December, and sent a letter to all Wisconsin physicians in February describing the disease.
There have been no cases reported in the Washington area.
Thirteen patients have had the disease more than once, including one woman who had it five times, Shands said. If the disease recurs, Shands said, it is likely to return during the next menstrual period, although it may skip one or more months.
Shands said she had seen one patient in Georgia who was recovering from the disease. The victim was a teen-age girl who had been treated in an intensive care unit.
"My major impression was that this was an incredible disease to strike a completely healthy adolescent girl," she said.
Diane Arendt, a 25-year-old accountant in Madison, Wis., became sick one Saturday night after playing racquetball and going to a movie. When she developed a headache and began vomiting, she thought it was because of popcorn she had eaten.
The fever, vomiting and diarrhea continued Sunday, and Arendt's roommate took care of her 7-year-old daughter. Neither woman was really worried.
But Monday morning, just as her roommate was leaving for work, Arendt said she fell into bed. "I started shaking my hands and talking about something out of the clear blue," she said.
Her roommate rushed her to the hospital, where doctors found her kidneys had stopped working. "I really couldn't breathe when I got there, and my blood pressure was 40 over 40," Arendt said. She was in the intensive care unit for six days.
She said her doctor told her roommate, "Had you not brought her in (that morning), she wouldn't be alive now."
Experts at the Atlanta-based center are analyzing specimens from the blood, urine, skin and mouths of patients looking for the cause of toxic-shock syndrome. So far, they suspect that the shock and other symptoms may be produced by a toxin -- a poison -- from a bacterium.
Of 45 patients who had bacterial cultures performed, 33 had staphylococcus aureus bacteria growing in the throat, vagina or rectum. Shands said this is far higher than would be expected. Less than (15 percent of the general population are carriers of this bacterium.
Shands said no one knows why almost all the victims are women. Some patients had had vaginal infections before becoming ill, which may have provided the right conditions for the disease to take hold.
Shands said that two other diseases, diptheria and gonococcemic both occur more commonly around the time of menstruation.
Toxic-shock syndrome was first described in 1978 by a Denver pediatrician, Dr. J. K. Todd, who reported seven cases in children, including three boys. d
Almost all the cases since then have been in teen-aged girls or adult women up to the age of 52. A few men have been stricken. Shands said the male patients may have gotten the disease through skin infections caused by staphylococci.
Dr. Joan Chesney, an assistant professor of pediatrics at the University of Wisconsin Medical School, alerted the Wisconsin state health department to toxic-shock syndrome late last year, after three cases cropped up in Madison hospitals within two days.
"My husband was involved in the care of the first patient," she said. "We were discussing her at night at home."
The next day at Madison General Hospital, Chesney said some residents rushed to her office to ask her to see a 15-year-old girl in shock and with an apparent kidney infection. An hour later, she went to a conference and heard about a third patient with the same set of symptoms.
"It was like a deja vu," she said.
Studies of medical records uncovered one case in Wisconsin that occurred in 1975, but all the others happened during 1979, according to state epidemiologist Jeff Davis.
Only one of the 31 Wisconsin patients died. Davis said he thinks the heightened awareness of doctors in the state led them to find and report milder cases of the disease. A few patients never developed shock serious enough to bring them to the hospital.
Shands hopes that doctors elsewhere will now begin to recognize and report other cases.