The Characteristics of Staphylococcal Scalded Skin Syndrome in Atopic Dermatitis / 고신대학교의과대학학술지

OBJECTIVES: Staphylococcal scalded skin syndrome (4S), a blistering dermatosis caused by exfoliative toxins from Staphylococcus aureus, occurs frequently in patients with atopic dermatitis (AD). However, association between 4S and AD has not rarely been reported. We investigated the characteristics of 4S according to AD status.METHODS: The study included 146 children with 4S who visited Busan St. Mary's Hospital from 2007–2018. Clinical features were analyzed from medical records and pictures, and 4S was classified as localized or generalized. We also retrospectively investigated the preceding conditions and test results related to AD.RESULTS: Among 146 patients with 4S, median age was 2.0 years, and 35 (24.0%) had AD. Since 2007, the incidence of both 4S and AD have increased, without obvious seasonal patterns. Generalized and localized disease occurred in 90 and 56 patients, respectively. Twenty-four of 35 patients with AD (68.6%) and 32 of 111 (28.8%) without AD had localized disease. Significant differences were observed between the groups (P = 0.000). Among those with AD, the most common preceding condition was skin infection or unknown (45.2%); however, respiratory disease was the most common (47.9%) among patients without AD. Eosinophil levels were higher in the AD group (P = 0.002), and there were no statistically significant differences in total immunoglobulin E (IgE), Dermatophagoides farinae (Df IgE), egg-white IgE, and culture results between the groups.CONCLUSIONS: Localized 4S frequently occurred without preceding conditions in children with AD and usually arose from skin infection compared to generalized 4S.

Antibiotics resistance profile of staphylococci isolated from urogenital infections and toxins production of staphylococcus aureus strains

Aim: The aim of this study was to investigate the antibiotic resistance of staphylococci and seek toxin production by Staphylococcus aureus strains isolated from urogenital infections. Material and Methods: The staphylococci strains were isolated from urogenital samples collected from hospitalized patients or not. The antibiotic susceptibility was performed by the diffusion method and the search of production of toxin by S. aureus was done by radial immunoprecipitation technique. Results: Out of the 1904 samples analyzed, 80 staphylococci strains were isolated. The major (70%) part of the positive samples were coagulase-negative staphylococci composed of S. saprophyticus (50.0%), S. epidermidis (16.25%), S. xylosus (2.5%), and S. haemolyticus (1.25%). S. aureus was the unique coagulase positive strains. It was observed a multi-resistance of the isolated strains to beta-lactams, aminoglycosides, tetracycline, and co-trimazole. All the S. haemolyticus and S. xylosus strains were resistant to methicillin. Nitrofurantoin was the most active molecule in all kind of strains. There was no methicillin-resistant S. aureus producing Panton-Valentine Leukocidin (PVL) detected but all the S. aureus producing PVL were community methicillin-sensitive S. aureus. Most of the tested strains produced ETB (83.33%) and ETA (45.33%). Conclusion: The presence of multidrug resistance staphylococci strains producing toxins indicate an existence of potential reservoir of virulent antibiotics resistance stains in the community

Molecular Characterization of Community-Associated Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus Isolates from Children with Skin Infections in Busan, Korea

The prevalence and molecular characteristics of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) and methicillin-susceptible S. aureus (CA-MSSA) from children with skin infection were investigated by staphylocoagulase (SC) typing, multilocus sequence typing (MLST), SCCmec typing and virulent toxins, including Panton-Valentine leucocidin (PVL), and exfoliative toxins (ET). Among 69 cases of CA-S. aureus for a 3 month period from March to June, 2014 at hospital in Busan, 28 (40.6%) were MRSA and 41 (59.4%) were MSSA. Of the 28 CA-MRSA isolates, two major clones were identified as SC type Vb-ST72-SCCmec type IV (53.6%) and SC type l-ST89-SCCmec type II variant (42.8%), and the remaining one (3.6%) was SC type lll-ST8-SCCmec type IV. In CA-MSSA, the prevalent clone was SC type Vb-ST72 (29.3%), followed by SC type Vb-ST188 (21.9%), SC type Va-ST121 (19.5%) and SC type lV-ST30 (9.6%). None was positive for PVL gene, and all of the SC type l-ST89-SCCmec type II variant clones were ETB gene positive. The data suggest that there are significant clonal relatedness with specific SC types, and genetic diversities in both community strains isolated from children with skin infections.

Staphylococcal Scalded Skin Syndrome, A Descriptive Review of 17 Korean Patients / 대한피부과학회지

BACKGROUND: Staphylococcal scalded skin syndrome is a superficial blistering skin disease caused by exfoliative toxins of Staphylococcus aureus. Adult cases are rare but accompanied by high mortality rates and poor prognoses. A rapid diagnosis, including distinguishing this disease from toxic epidermal necrolysis, and immediate treatment are essential. An increasing number of methicillin-resistant Staphylococcus aureus cases has been reported recently, which further complicates the treatment options. OBJECTIVE: We performed this study to evaluate clinical features and courses, and to investigate microbiological and histological manifestations of staphylococcal scalded skin syndrome in Korean children and adults. METHODS: We retrospectively reviewed, among 14 children (including 2 neonates) and 3 adults, medical records, clinical photographs, microbiological results and histological findings, including frozen section on the blister roof and Tzanck smear in some patients. RESULTS: The adult patients had longer disease durations than children (mean 24.7 versus 9.9 days). One adult patient died of pneumonia and sepsis. The children recovered without complications. All of cultured Staphylococcus aureus in 11 of the 17 patients were methicillin-resistant. On the frozen sections, the roof of the blister consisted of the uppermost epidermis. Taking specimens from fresh blisters was important for clear diagnosis. CONCLUSION: Adult patients had longer disease durations and poorer prognoses than children. The frozen section on the roof of fresh blister and the Tzanck smear were convenient methods for early and dependable diagnosis. Given the prevalence of methicillin-resistant strains of Staphylococcus aureus, treating the condition with antibiotics covering this strain should be considered.

Detección de genes de toxinas pirogénicas y toxinas exfoliativas en aislamientos clínicos de Staphylococcus aureus en Colombia / Detection of genes of pyrogenic toxins and exfoliating toxins in clinical isolation for Staphylococcus aureaus in Colombia

Introducción: staphylococcus aureus está asociado con graves enfermedadessistémicas causadas por superantígenos (toxinas pirogénicas y exfoliativas).Métodos: 100 aislamientos clínicos de S. aureus se identificaron por métodoautomatizado y PCR, la prevalencia de genes de superantígenos por PCR múltiple y las correlaciones mediante la prueba exacta de Fischer.Resultados: en 38 aislamientos se observó que la prevalencia de los genes de enterotoxinas, toxina del síndrome de choque tóxico y toxinas exfoliativas fue 44%, 7% y 4%, respectivamente. La única correlación significativa (p = 0,045) fue entre la presencia de los genes de superantígenos y los aislamientos hospitalarios.Conclusiones: existe una alta prevalencia de genes de enterotoxinas y una baja de genes de toxinas exfoliativas y del síndrome de choque tóxico en aislamientos de S. aureus en esta población. Esta es la primera investigación que presenta datosde prevalencia de superantígenos en Colombia, y proporciona nueva información para América Latina.

Síndrome estafilocócico de la piel escaldada. Nuestra experiencia en 10 años / Staphylococcal scalded skin syndrome (SSSS). Our 10-year experience

El síndrome estafilocócico de la piel escaldada (SEPE) es una enfermedad cutánea aguda infrecuente, causada por toxinas exfoliativas del Staphylococcus aureus. El objetivo de este estudio es describir las características epidemiológicas, clínicas y terapéuticas de los pacientes con diagnóstico de SEPE en nuestro medio.Material y métodos.Se realizó un estudio retrospectivo, descriptivo y observacional, en el que se revisaron las historias clínicas de los pacientes con diagnóstico de SEPE vistos entre mayo de 2000 y mayo de 2010, atendidos en la Sección de Dermatología Pediátrica del Hospital Ramos Mejía, y entre mayo de 2005 y mayo de 2010 en el Servicio de Dermatología del Hospital Alemán.Resultados.Se incluyó un total de 62 pacientes, cuya edad media al momento del diagnóstico fue de 22 meses. No se observó predilección por sexo ni estación del año. El 13% de los pacientes recibió corticoides sistémicos previo al diagnóstico de SEPE. Todos los pacientes excepto uno, realizaron tratamiento antibiótico luego del diagnóstico de esta entidad. El 92% recibió cefalosporinas de primera generación. El 23% de los pacientes requirió internación y el 100% evolucionó satisfactoriamente.Conclusiones.El SEPE es una entidad poco frecuente. Si bien en nuestro medio no hallamos datos epidemiológicos sobre esta entidad, los datos demográficos encontrados en este estudio difieren de los publicados en la literatura mundial. Debe sospecharse en recién nacidos y niños pequeños con eritrodermia aguda y afectación peribucal o conjuntival.

Staphylococcal scalded skin syndrome (SSSS) is a rare cutaneous disease caused by exfoliativetoxins of Staphylococcus aureus. The aim of this study is to describe the epidemiology, clinicalmanifestations and treatment of patients with the diagnosis of SSSS in our community.Methods. We conducted a retrospective, descriptive and observational study, reviewing the clinicalrecords of patients with a diagnosis of SSSS, as seen between May 2000 and May 2010 atthe Pediatric Dermatology Section of the Hospital Ramos Mejía, and between May 2005 and May2010 at the Dermatology Unit of the Hospital Alemán.Results. A total of 62 patients were included, whose average age at the time of diagnosis was22 months. No predilection for sex or season of the year was observed. Thirteen percent of thepatients received systemic steroids prior to SSSS diagnosis. All but one of the patients received antibiotictreatment after the diagnosis of this entity. First generation cephaloporins were given to92% of patients; 23% of them required hospitalization and all of them had a satisfactory outcome.Discussion. SSSS is an infrequent entity. Even though there are no epidemiological studies inour country concerning SSSS, the data we gathered differs with world-wide published literature.SSSS must be suspected in new-borns and in young children with an acute onset of erythroderma,perioral affectation and conjunctivitis.

Determination of staphylococcal exotoxins, SCCmec types, and genetic relatedness of Staphylococcus intermedius group isolates from veterinary staff, companion animals, and hospital environments in Korea

The Staphylococcus (S.) intermedius group (SIG) has been a main research subject in recent years. S. pseudintermedius causes pyoderma and otitis in companion animals as well as foodborne diseases. To prevent SIG-associated infection and disease outbreaks, identification of both staphylococcal exotoxins and staphylococcal cassette chromosome mec (SCCmec) types among SIG isolates may be helpful. In this study, it was found that a single isolate (one out of 178 SIG isolates examined) harbored the canine enterotoxin SEC gene. However, the S. intermedius exfoliative toxin gene was found in 166 SIG isolates although the S. aureus-derived exfoliative toxin genes, such as eta, etb and etd, were not detected. SCCmec typing resulted in classifying one isolate as SCCmec type IV, 41 isolates as type V (including three S. intermedius isolates), and 10 isolates as non-classifiable. Genetic relatedness of all S. pseudintermedius isolates recovered from veterinary staff, companion animals, and hospital environments was determined by pulsed-field gel electrophoresis. Strains having the same band patterns were detected in S. pseudintermedius isolates collected at 13 and 18 months, suggesting possible colonization and/or expansion of a specific S. pseudintermedius strain in a veterinary hospital.

Staphylococcal Scalded Skin Syndrome in an Immunocompetent Adult / 대한피부과학회지

Staphylococcal scalded skin syndrome (SSSS) is an exfoliative infectious disorder caused by the exfoliative toxins of Staphylococcus aureus. The condition usually affects infants and children younger than 5 years of age. However, SSSS is rarely observed in adults. Adult SSSS is usually associated with renal failure, immunosuppression, malignancy, alcohol abuse, or HIV infection. In contrast to infant cases, adult SSSS is often accompanied with a high mortality rate, sepsis and poor prognosis. We report a rare case of SSSS in an immunocompetent 34-year-old man without renal failure.

Distribution of the putative virulence factor encoding gene sheta in Staphylococcus hyicus strains of various origins

In the present study, Staphylococcus (S.) hyicus strains isolated in Russia (n = 23) and Germany (n = 17) were investigated for the prevalence of the previously described genes sheta and shetb. Sheta was detected in 16 S. hyicus strains. Sheta-positive strains were mainly found among strains isolated from exudative epidermitis, and frequently together with the exfoliative toxin-encoding genes exhD and exhC. Partial sequencing of sheta in a single S. hyicus strain revealed an almost complete match with the sheta sequence obtained from GenBank. None of the S. hyicus strains displayed a positive reaction with the shetb-specific oligonucleotide primer used in the present study. According to the present results, the exotoxin encoding gene sheta seems to be distributed among S. hyicus strains in Russia and Germany. The toxigenic potential of this exotoxin, which does not have the classical structure of a staphylococcal exfoliative toxin, remains to be elucidated.

Reclassification of Staphylococcal Scalded Skin Syndrome by Clinical Analysis of 25 Cases / 대한피부과학회지

BACKGROUND: Staphylococcal scalded skin syndrome (SSSS) is defined as a spectrum of superficial blistering skin disease caused by the exfoliative toxins of Staphylococcus (S.) aureus. The spectrum of the disease includes generalized, localized (bullous impetigo), abortive and intermediate forms. OBJECTIVE: The purpose of this study is to reclassify clinical types of SSSS by reviewing the clinical and microbiologic features of SSSS and to redefine the clinical types exactly. METHODS: We retrospectively reviewed medical records, clinical photographs and the microbiologic results of 25 patients with SSSS and studied them according to the new classification. We defined the 3 clinical types as follows: i) The Generalized type is defined as a case where tender erythroderma and large thin bullae occur on the whole body excluding the mucous membrane, palms and soles. The nikolsky sign is positive. ii) The intermediate type is defined as a case where tender erythroderma and vesicles or pustules occur in the regionally limited area. The Nikolsky sign is positive. iii) The abortive type is defined as a case where tender erythema occurs only on the whole body or in regionally limited areas. The nikolsky sign is negative. All patients of SSSS have periorificial, radial crusting and fissuring. RESULTS: We could reclassify the clinical types of SSSS into 3 types (generalized, intermediate, abortive) according to this retrospective clinical study. Of the 25 patients, 3 patients were of the generalized type, 13 patients were of the intermediate type and 9 patients were of the abortive type. All the types have the acute eczematous lesion on the periorbital and perioral areas. The male to female sex ratio was 1: 1.3. The mean age of onset was 2.9 years. Cultures from the suspected site of the primary infection were positive in 14 out of 21 patients, and colonized sites were the throat (29%), conjunctiva (21%), nasal cavity (21%), ear (21%) and skin (8%) in 14 patients. Methicillin-sensitive S. aureus and methicillin-resistant S. aureus were 8 cases and 6 cases, respectively. In all clinical types, the most common complication was conjunctivitis (54.5%). Four cases were accompanied by atopic dermatitis. All the patients were cured with first generation cephalosporin without significant sequelae. CONCLUSION: We reclassified SSSS into generalized, intermediate and abortive types with reference to our 25 cases and previously existing papers, and offered a correct definition for the 3 types.

inhibitor of Staphylococcus aureus exfoliative toxin

We describe here an inhibitor of Staphylococcus aureus exfoliative toxin. The toxin was extracted from an S. aureus strain isolated from a case of staphylococcus scalded skin syndrome. The activity of the toxin was compared in tryptic soy broth and brain heart infusion broth. Both supported growth of S. aureus but the culture filtrate of brain heart infusion broth lacked exfoliative toxin activity. Furthermore it appeared to contain a substance that neutralized the action of exfoliative toxin. This suggests the possibility of a treatment for staphylococcal scalded skin syndrome and bullous impetigo