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In fact, before the first such case was reported, Langmuir et al- theorized that the historic plague of Athens which began in 430 BC was due to toxin-producing S aureus during an influenza epidemic. These authors have suggested the term “Thucydides syndrome” for this disease process in honor of the Athenian general, Thucydides, who documented the effects of the illness extensively. It is of interest that the change or reappearance of bacterial strains and their association with toxic syndromes is not unique to S aureus; rather, this phenomenon has been described most recently with group A streptococcal infections as well.

The association of postinfluenza TSS with only influenza B outbreaks may be coincidence. However, this complication of influenza B has now been reported from four geographically separate locations during two different flu seasons and has not been recognized in association with influenza A or other viral illness. Despite the observation that influenza B outbreaks result in milder disease than those caused by influenza A, it appears that the complication of TSS is being seen exclusively with influenza B to date. review

Although TSS is an uncommon complication of influenza, a watchful attitude during the influenza season is warranted, perhaps especially when influenza B is prevalent. TSS should be considered in the differential diagnosis of individuals who become critically ill following an initial influenzalike illness, since specific therapy for proven, or unproven but presumed S aureus, may yield a favorable outcome in this highly lethal syndrome.
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