No Epidermis: Is it the drug, COVID-19 or Something Else?

Summary@#Staphylococcal toxic shock syndrome (TSS) is a clinical disease with acute onset of fever, rash, hypotension and multi-organ system involvement. Staphylococcal scalded skin syndrome (SSSS), mostly described in neonate and children, is a superficial blistering disease caused by the exfoliative toxin of specific strains of Staphylococcus aureus. TSS and SSSS rarely occur concurrently in adults. We here describe a 35-year-old woman who was initially referred to dermatology team as toxic epidermal necrolysis. She presented with a rapid epidermal detachment without mucosal involvement, fever and shock, associated with acute kidney injury and transaminitis, severe metabolic acidosis, complicated by COVID-19 infection, and finally succumbed within 36 hours of hospitalization. Early recognition and prompt treatment are the key factors in the management as TSS itself can lead to mortality. Staphylococcal TSS and SSSS are important differential diagnosis to consider in acute epidermal detachment, as not all cases are drug-induced.

Clinical analysis of streptococcal toxic shock syndrome caused by Group A Streptococcus infection in children / 中华实用儿科临床杂志

Objective:To analyze the clinical characteristics of Group A Streptococcal(GAS) toxic shock syndrome (STSS) in children. Methods:The clinical data of 10 STSS children hospitalized in Shenzhen Children′s Hospital from January 2015 to March 2022 were downloaded from the electronic medical record system.The clinical manifestations were analyzed and treatment experience was summarized respectively.Results:There were 5 males and 5 females, with an average age of (5.29±2.87) years.All the patients were healthy in the past.The diagnoses were confirmed by blood culture in 2 cases, pus culture in 5 cases, and blood metagenomics next generation sequencing in 3 cases.The rapid detection of GAS antigen was positive in 7 cases.All cases had fever, and 9 cases of them developed fever after viral infection, including pneumonia in 7 cases, skin and soft tissue infections in 6 cases, necrotizing fasciitis in 3 cases, and purulent meningitis in 1 case.All cases also presented with shock.Six cases had liver function injury, and 4 cases suffered from acute kindey injury.Four cases had infection-related encephalopathy, and 7 cases were afflicted with disseminated intravascular coagulation.Two cases had respiratory failure, and 2 cases had rhabdomyolysis.There were 3 cases with a decreased white blood cell (WBC) count and 7 cases with an increased WBC count on admission.Seven cases were found to have thrombocytopenia, but their platelet levels were all elevated after recovery.C-reactive protein and procalcitonin and the proportion of neutrophils were markedly increased in all cases.All cases suffered from hypoalbuminemia, hyponatremia and hypocalcemia.All the 10 positive strains were sensitive to Penicillin, Ceftriaxone/Cefotaxime and Vancomycin.Eight cases were treated with combined antibiotics after admission.Eight patients received intravenous immunoglobulin.All cases were cured and discharged.Conclusions:The STSS progresses rapidly in children, so pediatricians should pay great attention to the disease.Early identification, diagnosis of infection sources, infusion of antibiotics and surgical treatment are the keys to disease management.

Streptococcal toxic shock syndrome / 中华实用儿科临床杂志

Streptococcal toxic shock syndrome (STSS) is a Group A Streptococcus (GAS) induced invasive infectious disease, which is characterized by abrupt onset and rapid progression with a high mortality rate.With the wide application of antimicrobial agents, the incidence of GAS infections has been substantially reduced.Nevertheless, STSS usually causes shock and multiple organ failure at the early stage of its clinical process, and the clinical symptoms are non-specific.Therefore, early identification, timely anti-infection and symptomatic treatment are particularly critical.Clinicians should pay high attention to the disease.

Síndrome de choque tóxico por Streptococcus pyogenes en un hospital de la Ciudad de México / Toxic shock syndrome caused by Streptococcus in a hospital from the Mexico City / Síndrome de choque tóxico por Streptococcus pyogenes em um hospital da Cidade do México

Resumen: El síndrome de choque tóxico por Streptococcus se describió por primera vez en 1978 por Todd y su equipo. Éste incluye datos de hipotensión, disoxia celular, aislamiento de Streptococcus pyogenes, así como la inclusión de dos o más de los siguientes criterios: síndrome de dificultad respiratoria aguda, insuficiencia renal, anormalidad hepática, coagulopatía y erupción cutánea con descamación. Es una enfermedad relativamente rara entre niños y adultos; representa una alta mortalidad, la cual oscila de 23 al 70%. En más de la mitad de los casos, se desconoce la causa de entrada de este patógeno al torrente sanguíneo, aunque los pacientes con alcoholismo, en los extremos de la vida, con comorbilidades (como enfermedad renal crónica, insuficiencia hepática y leucemias) y que hayan sido sometidos a esplenectomía son más susceptibles al contagio y a infecciones severas. En los pacientes que desarrollan infecciones de tejidos blandos profundos, como fascitis necrosante o infección intrauterina, el dolor severo es el síntoma inicial más frecuente.

Abstract: Streptococcal toxic shock syndrome was first described by Todd and collaborators in 1978, this syndrome includes hypotension, traces of cellular dysoxia, isolation Streptococcus pyogenes; as well as two or more of the following criteria: acute respiratory distress syndrome, renal failure, liver abnormality, coagulopathy, skin rash with necrosis flaking of soft tissues. It is a relatively rare disease among children and adults, representing a high mortality ranging from 23 to 70%. In more than half of the cases the cause of entry of this pathogen into the bloodstream is unknown, although patients with alcoholism, on the edge of death, with splenectomy, with comorbidities (chronic kidney disease, liver failure, leukemia) are more susceptible to infection, to acquire severe infections and shock. Cutaneous infections usually are followed by minor skin irritations (insect bites), 20% of the cases experience a flu-like syndrome (fever, chills, myalgia and diarrhea). In patients who develop deep soft tissue infections such as necrotizing fasciitis or intrauterine infection, the severe pain is the most common initial symptom of streptococcal TSS.

Resumo: A síndrome do choque tóxico estreptocócico foi descrita pela primeira vez por Todd et al em 1978, incluindo dados sobre hipotensão, disxia celular, isolamento de Streptococcus pyogenes, bem como 2 ou mais dos seguintes critérios: síndrome do desconforto respiratório agudo, insuficiência renal, anormalidade hepática, coagulopatia, erupção cutânea com descamação. É uma doença relativamente rara em crianças e adultos, representa uma alta mortalidade que varia de 23 a 70%. Em mais da metade dos casos, a causa desse patógeno na corrente sanguínea é desconhecida, embora pacientes com alcoolismo, extremos da vida, com esplenectomia e comorbidades (como doença renal crônica, insuficiência hepática, leucemia) sejam mais suscetíveis à infecção e infecções graves. Em pacientes que desenvolvem infecções profundas dos tecidos moles, como fasceíte necrozante ou infecção intra-uterina, a dor intensa é o sintoma inicial mais frequente.

Streptococcal toxic shock syndrome caused by Streptococcus pyogenes: a retrospective study of 15 pediatric cases / 中华儿科杂志

Objective@#To improve the understanding of clinical characteristics of streptococcal toxic shock syndrome (STSS) caused by Streptococcus pyogenes (S. pyogenes) in children.@*Methods@#A retrospective study was conducted to analyze the clinical data of STSS caused by S. pyogenes (culture-confirmed) in 7 tertiary hospitals during 2010—2017 in China. Clinical and laboratory data were collected by reviewing the medical records.@*Results@#Fifteen cases of STSS, including 9 males, were confirmed and the ages of the patients ranged from 6 months to 15 years, with median age of 3 years. All cases had the positive blood culture for S. pyogenes and only 3 cases had short course of β-lactam treatment before blood culture. Medical evaluation was initiated within (5.1±4.6) days after symptom onset. All patients had fever, and 13 patients had multiple organ dysfunction and 10 patients had disseminated intravascular coagulationl (DIC). Twelve cases had severe pneumonia with or without skin and (or) soft tissue infections. Underlying conditions included giant hemangioma of the skin in 2 patients and varicella in 1 patient. All isolated strains in 14 cases were sensitive to penicillin G, ceftriaxone/cefotaxime, vancomycin, but 12 and 13 isolates were resistant to clindamycin and erythromycin, respectively. Eight patients died, and 5 of them died within 24 hours after admission. One patient was lost to follow-up after intended discharge against medical advice.@*Conclusion@#STSS caused by S. pyogenes in children is a severe syndrome with rapid clinical progression and high mortality rate, and thus the pediatricians should be aware of STSS and immediately initiate aggressive treatment for the suspected cases.

Streptococcal toxic shock syndrome in children: one case report and literature review / 中国感染与化疗杂志

Objective To investigate the clinical manifestations, treatment and prognosis of streptococcal toxic shock syndrome (STSS) in children. Methods One case of STSS was reported in a child who was admitted to Children's Hospital of Fudan University. Search terms such as "streptococcal toxic shock syndrome", "children" and "case report" were used to identify relevant reports from PubMed database, as well as Chinese databases including Chongqing VIP, Wanfang, and China National Knowledge Infrastructure for further review. Results The patient in this report was a 11-year-old female. The main clinical manifestations were fever, red, swelling, and pain in the right lower extremity, associated with impaired walking and hypotension. Imaging examination suggested diffuse abnormal signals in the soft tissue of right thigh. Group A Streptococcus (namely Streptococcus pyogenes) was isolated from the puncture fluid. The patient was improved after active shock-correcting and anti-infective treatment. A total of 6 STSS cases were identified from Chinese databases between January 1, 1996 and May 1, 2017. All the 7 cases (including this one, 4 males and 3 females, 15 months to 13 years of age) reported fever and skin rashes, and rapidly progressed to shock. Respiratory failure was reported in 4 cases and supported with a ventilator. Three patients died, including 2 within 24 hours after hospitaladmission. A total of 38 STSS cases (40 days to 18 years of age) were identified from PubMed database. The main clinical manifestations of these cases were respiratory tract or digestive tract symptoms, and skin and soft tissue infection. In addition, chickenpox was found in 3 cases, Kawasaki disease in 2 cases, neonatal bullous impetigo, pancreatitis, infectious mononucleosis, and lymphohistiocytosis in one case each. Of the 38 patients, 22 survived and 16 died. Conclusions STSS is a rare and severe form of invasive streptococcal infection in children. The early manifestations are not specific, which may be mistaken for upper respiratory tract infection, gastrointestinal dysfunction symptoms, skin and soft tissue infection, or muscle and joint disorder, or even similar to or associated with Kawasaki disease. But rapid progression to shock and multiple organ failure of STSS pose a serious threat to children. Pediatricians should keep alert on STSS. Early identification, timely diagnosis, and adequate treatment are key to improving patient outcome.

Case report and literature review of streptococcal toxic shock syndrome / 天津医药

Streptococcal toxic shock syndrome (STSS) has a low morbidity and high mortality in neonates. We recently diagnosed and treated a case of neonatal streptococcal toxic shock syndrome. This paper reviewed the diagnosis and treatment of the patient and reviewed the relevant literature of the epidemiology, diagnosis and treatment.

Estudio multicéntrico de infecciones invasivas por Streptococcus pyogenes en niños de Argentina / Multicenter study on invasive Streptococcus pyogenes infections in children in Argentina

Introducción. Las infecciones invasivas por Streptococcus pyogenes (IISP) presentan elevada morbimortalidad aún en la actualidad; no obstante, a nivel regional, existen escasas publicaciones en pediatría. Objetivo. Describir la prevalencia, los factores predisponentes y las características clínicas de niños internados por IISP, analizar los factores de riesgo asociados a bacteriemia y letalidad. Material y métodos. Estudio retrospectivo, descriptivo de IISP en niños ≤ 18 años, internados en Pediatría de 20 centros asistenciales del país, entre 2010 y 2012. Variables evaluadas: edad, sexo, focos clínicos iniciales y tardíos, patología crónica previa, factores predisponentes, tratamiento y evolución. Resultados. Se analizaron 143 pacientes. Incidencia de 4,97 casos/10 000 egresos. Mediana de edad 54 meses; tenían patología crónica previa 11,2%. Tuvieron factores predisponentes 67,1%. Las formas de presentación más frecuentes fueron la piel y las partes blandas en 77, sepsis en 30, osteoarticulares en 19, fascitis necrotizante en 13, síndrome de shock tóxico en 11. Se aisló Streptococcus pyogenes en 56,6% de los hemocultivos; la presencia de más de un foco clínico y la ausencia de cirugía se asociaron a bacteriemia (OR 4,8; p= 0,003 y OR 3,1; p= 0,0012, respectivamente). El promedio de internación fue 13,4 días. La tasa de letalidad fue 7,6% asociada a síndrome de shock tóxico (OR 10; p= 0,005), fascitis necrotizante (OR 104; p < 0,0001) e ingreso a la Unidad de Cuidados Intensivos Pediátricos (OR 26; p < 0,001). Conclusiones. La mayoría de las IISP se presentaron en pacientes sin patología crónica previa. Los focos de presentación, frecuentemente con bacteriemia, fueron la piel y las partes blandas. Hubo asociación estadísticamente significativa entre bacteriemia y ≥ 2 focos iniciales y ausencia de cirugía. La letalidad, asociada a SSTS y fascitis necrotizante, fue similar a otras publicaciones.

Introduction. Invasive Streptococcus pyogenes infections (ISpIs) cause a high morbidity and mortality, even at present; however, at a regional level there are few publications on this subject in the field of pediatrics. Objective. To describe the prevalence, predisposing factors and clinical characteristics of children hospitalized for ISpI, and analyze risk factors associated with bacteremia and lethality. Material and methods. Retrospective, descriptive study on ISpIs in children <18 years old hospitalized in the Pediatric Ward of 20 healthcare facilities across Argentina between 2010 and 2012. Assessed outcome measures: age, gender, early and late clinical sources of infection, prior chronic condition, predisposing factors, treatment and evolution. Results. One hundred and forty-three patients were analyzed. The incidence of ISpI was 4.97 cases/10 000 hospital discharges. Patients' median age was 54 months old, and 11.2% had a prior chronic condition. Also, 67.1% had predisposing factors. The most common clinical manifestations were in the skin and soft tissue in 77 patients, sepsis in 30, bone and joint involvement in 19, necrotizing fasciitis in 13, and toxic shock syndrome in 11. Streptococcus pyogenes was isolated in the blood cultures of 56.6%. More than one clinical source of infection and no surgery were associated with bacteremia (odds ratio [OR]: 4.8, p= 0.003 and OR: 3.1, p= 0.0012, respectively). The average length of stay in the hospital was 13.4 days. Fatality rate was 7.6% in association with toxic shock syndrome (OR: 10, p= 0.005), necrotizing fasciitis (OR: 104, p < 0.0001) and admission to the Pediatric Intensive Care Unit (OR: 26, p < 0.001). Conclusions. Most ISpIs were observed in patients without a prior chronic condition. The most common manifestation was, frequently with bacteremia, in the skin and soft tissue. A statistically significant association was observed between bacteremia and ≥2 early sources of infection and no surgery. Fatality rate, in association with streptococcal toxic shock syndrome and necrotizing fasciitis, was similar to that observed in other publications.

Prevalence of Exfoliative and Toxic Shock Syndrome Toxin Genes in Methicillin-resistant Staphylococcus aureus Strains Isolated from Clinical Specimens in Makkah, Saudi Arabia.

The emergence of methicillin-resistant Staphylococcus aureus (MRSA) strains possessing virulence genes encoding such toxins as exfoliative toxins (ETs), toxic shock syndrome toxin-1 (TSST-1), is worrying, especially in relation to the increasing frequency of nosocomial infections. The present study aimed to determine the prevalence of genes encoding ETs and TSST-1 in MRSA isolates by polymerase chain reaction (PCR). The results showed that out of 88 investigated MRSA isolates, tst and etb toxin gene were found in 3 (3.4%) and 2 (2.3%) respectively, while none eta toxin genes were detected. It was concluded that the incidence of ET and TSST-1encoding genes among MRSA isolates in Makkah is lower or near to the global prevalence.

A Case of Streptococcal Toxic Shock Syndrome Caused by Group A Streptococcus Pneumonia / 대한내과학회지

Streptococcal toxic shock syndrome (TSS) is characterized clinically by shock and multiple organ failure, combined with invasive group A streptococcus (GAS) infection. Invasive GAS infection declined with the introduction of modern antibiotics, but has recently arisen again globally with severe presentations like TSS. Cases of streptococcal TSS have been reported in Korea since the 1990s and its prevalence may increase. We report the first case of GAS pneumonia initially presenting as streptococcal TSS, as a warning that this potentially fatal illness requires an early diagnosis and prompt treatment when patients with pneumonia develop shock and multiple organ failure.

Prevalence of Antibody to Toxic Shock Syndrome Toxin-1 in Burn Patients

BACKGROUND: Burn wounds lack normal barriers that protect against pathogenic bacteria, and burn patients are easily colonized and infected by Staphylococcus aureus. Toxic shock syndrome (TSS) is a rare but fatal disease caused by S. aureus. A lack of detectable antibodies to TSS toxin-1 (TSST-1) in serum indicates susceptibility to TSS. METHODS: A total of 207 patients (169 men and 38 women; median age, 42.5 yr) admitted to a burn center in Korea were enrolled in this study. The serum antibody titer to TSST-1 was measured by sandwich ELISA. S. aureus isolates from the patients' nasal swab culture were tested for TSST-1 toxin production by PCR-based detection of the TSST-1 toxin gene. RESULTS: One hundred seventy-four (84.1%) patients showed positive results for antibody against TSST-1. All patients aged > or =61 yr (n=28) and <26 months (n=7) were positive for the anti-TSST-1 antibody. S. aureus was isolated from 70 patients (33.8%), and 58.6% of the isolates were methicillin resistant. Seventeen patients were colonized with TSST-1-producing S. aureus. The antibody positivity in these 17 carriers was 88.2%, and the positivity in the non-carriers was 83.7%. CONCLUSIONS: Most burn patients had antibody to TSST-1, and nasal colonization with TSST-1-producing S. aureus was associated with positive titers of anti-TSST-1 antibody. Additionally, patients with negative titers of anti-TSST-1 antibody might be susceptible to TSS.

Near-fatal fellatio: a case of necrotizing fasciitis after oral sex.

A 35-year-old man was admitted to hospital 2 weeks after rough oral sex with Streptococcus pyogenes bacteremia, toxic shock syndrome and extensive necrotizing fasciitis of the abdominal and pelvic walls requiring debridement. His partner was diagnosed with strep throat shortly after their sexual encounter

Ocorrência do gene da toxina da síndrome do choque tóxico em Staphylococcus spp. isolados de leite de vacas com mastite e de leite cru refrigerado / Occurrence of the toxic shock syndrome toxin gene in Staphylococcus spp.isolated from bovine mastitis milk and refrigerated raw milk

Avaliou-se a presença do gene (tst-1) para Toxina da Síndrome do Choque Tóxico-1 (TSST-1), utilizando-se a técnica de Reaçãoem Cadeia da Polimerase (PCR) em um total de 264 Staphylococcus spp. isolados de leite. Desses, 221 eram Staphylococcusaureus, 33 Staphylococcus coagulase negativo (SCN) e 10 Staphylococcus coagulase positivo (SCP). As amostras eram oriundasde vacas com mastite (n=96) e de leite cru refrigerado (n=168), coletadas de 46 e 22 propriedades, respectivamente. As amostrasforam coletadas de rebanhos localizados em diferentes regiões dos Estados de Minas Gerais e Rio de Janeiro. Observou-seproduto de amplificação (250 pares de base-pb) na reação de PCR para tst-1 em sete amostras (2,6%), sendo todas as estirpesidentificadas como Staphylococcus aureus isoladas de leite cru refrigerado. Embora a detecção do gene não indique a produçãoda toxina, o monitoramento de estirpes bacterianas potencialmente produtoras torna-se importante como forma de realizar umlevantamento epidemiológico e controle dos rebanhos leiteiros brasileiros, uma vez que esse gene está associado aos elementosgenéticos móveis, representando um risco à possível transferência horizontal de genes para outras bactérias. Além disso, a presençadesses genes tem sido associada à presença de genes para enterotoxinas estafilocócicas, o que pode implicar o aumento dapatogenicidade dos isolados bacterianos e um potencial risco à saúde pública.

Was evaluated the presence of the gene (tst -1) for toxic shock syndrome toxin - 1 (TSST -1), using the technique of PolymeraseChain Reaction (PCR) on a total of 264 Staphylococcus spp. isolated from milk. Of these, 221 were Staphylococcus aureus, 33Staphylococcus coagulase negative (SCN) and 10 Staphylococcus coagulase positive (SCP). The samples were from cows withmastitis (n=96) and refrigerated raw milk (n=168), collected from 46 and 22 dairy herds, respectively. Samples were collectedfrom herds located in different regions of Minas Gerais and Rio de Janeiro States. Was observed PCR amplification of the tst-1gene (250 base pairs-bp) in seven (2.6 %) samples, and all strains of Staphylococcus aureus isolated from refrigerated raw milk.Although its detection in isolated does not mean that it will be expressed, monitoring of bacterial strains producing potentiallybecomes important as performing an epidemiological survey and control of Brazilian dairy herds, since this gene is associatedwith mobile genetic elements, representing a risk to possible horizontal gene transfer to other bacteria. Furthermore, the presenceof these genes have been associated with the presence of genes for enterotoxins, which may result in increased pathogenicity ofthe isolates and a potential risk to public health.

Group B Streptococcal Toxic Shock-like Syndrome: A Case Report and Review of the Literature / 대한임상미생물학회지

Toxic shock syndrome is an acute and febrile illness that rapidly progress to shock and multi-organ failure, and it is caused by toxin-producing strains of Staphylococcus aureus or Streptococcus species. Streptococcal toxic shock syndrome (STSS) is usually caused by group A streptococci, but non-group A STSS is rare. In this study, we describe a case of STSS caused by Streptococcus agalactiae(group B streptococci) in a patient with alcoholic liver cirrhosis. At arrival in our hospital, the patient had a decreased mental status with hemorrhagic bullae on four extremities, and he progressed to a fatal outcome within 4 days in spite of antibiotic treatment.

Development of ELISA based detection system for lethal toxin of Clostridium sordellii.

Background & objectives: Clostridium sordellii and its toxins are associated with diseases in animals as well as human. C. sordellii produces two protein toxins (lethal toxin and haemorrhagic toxin). Lethal toxin has gained more importance due its high toxicity. The present study was carried out to develop a sandwich ELISA for detection of lethal toxin of C. sordellii. Methods: The catalytic domain (1.6kb) of lethal toxin of C. sordellii was PCR amplified, cloned into pQE30 UA vector and transformed into Escherichia coli SG 13009. Expression conditions were optimized and the recombinant protein was purified under native condition using Ni-NTA affinity chromatography, confirmed by SDS-PAGE and Western blot. Antibody was generated against the purified recombinant protein using Freund’s complete and incomplete adjuvants (FCA and FIA) in BALB/c mice and rabbit. A sandwich ELISA was optimized for the detection of lethal toxin. Results: The maximum recombinant protein expression was achieved at 0.5 mM IPTG (isopropylthiogalactoside) induction 4.0 h of post-induction. The polyclonal antibody raised in mice and rabbit showed a titre up to 1:512000. The produced antibody was highly sensitive with the detection limit of 0.3 ng/ml of lethal toxin at 1:4000 dilutions of mice (capturing) and rabbit (revealing) antibody. Interpretation & conclusions: An ELISA based detection system was developed for the detection of lethal toxin of C. sordellii. The developed detection system was found to be specific as there was no cross-reactivity with any other clostridial toxins. It will be useful for the detection of lethal toxin of C. sordellii in clinical and environmental samples.

A case of staphylococcus toxic shock syndrome presenting with multiple pneumatocoeles in the chest.

Staphylococcus toxic shock syndrome is a severe illness caused by infection with toxin producing Staphylococcus aureus and is associated with a poor outcome. We report a case of Staphylococcus TSS presenting with cough and expectoration along with multiple pneumatoceles visible on the chest radiograph that progressed to acute respiratory distress syndrome with eventual foci in brain. The patient was aggressively managed and recovered completely.

Ampicillin alone and in combination with riboflavin modulates Staphylococcus aureus infection induced septic arthritis in mice.

Effects of ampicillin (Amp) in combination with riboflavin on septic arthritis in mice infected with Staphylococcus aureus have been reported. Ampicillin was given at 100 mg/kg after 24 h of infection, followed by riboflavin (Ribo) at 20 mg/kg body wt, after 2 h of Amp treatment. Mice were sacrificed at 3, 9, 15 days post infection (dpi). Combined treatment of infected mice with ampicillin and riboflavin eradicated the bacteria from blood, spleen and synovial tissue and showed a significant gross reduction in arthritis, reduced serum levels of TNF- and IFN-. S. aureus infected mice exhibited higher synovial TNF- and IL-6, which was also reduced by ampicillin and riboflavin treatment. S. aureus infected mice showed a disturbed antioxidant status measured in terms of cellular anti-oxidants like reduced glutathione and anti-oxidant enzymes such as superoxide dismutase and catalase and were ameliorated when the animals were co-treated with ampicillin along with riboflavin. Results of the study showed that combined treatment with anti-oxidant and antibiotic may protect from staphylococcal arthritis and may ameliorate oxidative stress caused by S. aureus infection.

Infección por Staphyloccus aureus resistente a la meticillina adquirido en la comunidad (SAMR-AC) / Community-acquired methicillin-resistant Staphylococcus aureus infection (CA-MRSA)

Se presenta un paciente de 1 año de edad con antecedentes de salud, que desarrolló infección estafilocócica de piel y partes blandas, que lo llevó al desarrollo de shock tóxico, disfunción múltiple de órganos y muerte. Se aisló en cultivo de tejido pulmonar posmorten cepa de Staphylococcus aureus resistente a la meticillina, productor de la toxina Panton-Valantine leucocidina demostrado por caracterización molecular. Se estableció el diagnóstico anatomopatológico de sepsis generaliza y bronconeumonía necrosante bilateral.

A one-year old patient with history of health problems, who developed Staphylococcus aureus-caused infection in the skin and soft tissues that led him to toxic shock, multiple organ failure and death. Methilline-resistant Staphylococcus aureus strain was isolated in pulmonary tissue culture after death. This strain produced Panton-Valantine toxin called leukocidin as proved in molecular characterization. There was established the anatomic-pathological diagnosis of generalized sepsis and bilateral necrosing bronchopneumonia.

Two Cases of Streptococcal Toxic Shock Syndrome Caused by Streptococcus agalactiae and Streptococcus dysagalactiae

Streptococcal toxic shock syndrome (STSS) is an acute, progressive illness that manifests with fever, hypotension, and accelerated multi-organ failure. It is usually caused by Group A Streptococcus (Streptococcus pyogenes). STSS due to non-group A streptococci is rare, but its incidence has recently increased. We report here on two cases of STSS caused by Group B Streptococcus (Streptococcus agalactiae) and Group G Streptococcus (Streptococcus dysagalactiae).

Correlation Between the Prevalence of Superantigenic Toxin Genes and Coagulase Serotypes of Staphylococcus aureus Isolates

A heterogenic group of staphylococcal exotoxins, including staphylococcal superantigenic toxins, enterotoxin (SE), toxic shock syndrome toxin-1 (TSST-1), and coagulase are the most important virulence factors of Staphylococcus aureus. We analyzed the prevalence of genes encoding five enterotoxins and TSST-1 in S. aureus isolated from clinical ear discharges. The genes were identified by multiplex PCR and we compared the results to references of coagulase serotypes. In 102 isolates of S. aureus, 44 of them were methicillin-resistant S. aureus (MRSA) and the others were methicillin-susceptible S. aureus (MSSA). Among both types of S. aureus, 33 strains were positive for sea, 2 for seb, 23 for sec, 26 for see, and 26 for tst. Overall, 59 (57.8%) isolates were positive for one or more superantigenic toxin genes. From these, 71.2% (42/59) strains harbored more than one toxin gene in different combinations. The major combinations of genes were sea and see, and sec and tst. The degree of possession of superantigenic toxic genes was similar in both MRSA and MSSA isolates (56.8% vs 58.6%, respectively), yet significant differences in toxin gene profiles and coagulase serotypes between two isolates were detected. All of 13 positive strains for sec and tst were MRSA and belonged to coagulase serotype II. On the other hand, 80.0% of 20 positive strains for sea and see were MSSA with coagulase serotype IV and VII, whereas 20.0% of them were MRSA with coagulase serotype IV. This data indicates that the profile of superantigenic toxin genes correlates to coagulase serotype and methicillin resistance in S. aureus isolates.