Pathogenesis of lethal shock after intravenous staphylococcal enterotoxin B in monkeys.

The pathogenesis of shock in the rhesus monkey given intravenous staphylococcal enterotoxin B (SEB) is not understood. Several cardiovascular changes produced by a highly purified preparation of SEB were studied after administration of doses ranging from 50 to 1,000 mug/kg. Irreversible arterial hypotension was found consistently at the higher doses. Arterial blood pressure and cardiac output declined substantially as shock developed. Total peripheral vascular resistance did not rise at any time, but showed a significant fall during the late stages of shock. Portal and central venous pressures remained essentially unchanged. Venous O(2) content and pO(2) declined gradually throughout the period of toxemia, but arterial O(2) content remained constant until just prior to death, when a slight fall was noted in some monkeys. These changes were consistent with a pooling of blood in the peripheral vascular beds and seemed to resemble cardiovascular responses reported to occur in monkeys during shock due to bacterial endotoxin. Epinephrine, administered in the late stages of shock, caused arterial pressure to increase almost immediately and cardiac output to return to normal about 1 min later. Although life could occasionally be prolonged for several hours by continuous or intermittent epinephrine infusions, this therapy never succeeded in reversing the lethal effects of high doses of SEB.

Influence of thorotrast blockade and acute renal artery ligation on disappearance of staphylococcal enterotoxin B from blood.

The protein toxin staphylococcal enterotoxin B (SEB) produces a clinical syndrome somewhat similar to that of gram-negative endotoxins. Our studies indicate a further similarity to endotoxin in that SEB is rapidly cleared from the plasma of monkeys. However, data reported herein show that an effective Thorotrast blockade of the reticuloendothelial system (RES) does not produce a significant change in the rapid disappearance kinetics of SEB. This observation contrasts with what is known regarding endotoxin clearance. Furthermore, other data reported herein indicate that acute bilateral renal artery ligation produces a profound delay in SEB clearance from plasma. A possible mechanism for renal degradation of SEB is theorized. The RES may play a less important role in the clearance of SEB. This finding contrasts with the demonstrated importance of the RES in clearance and detoxification of gram-negative endotoxin.

Effect of staphylococcal enterotoxin B on the electroencephalogram of monkeys.

A highly purified preparation of staphylococcal enterotoxin B was administered intravenously, 1 mg/kg, to rhesus monkeys. Electroencephalograms (EEG) were recorded from electrodes attached to the skin or implanted on the dura. The dose of toxin employed consistently produced a sequence of vascular collapse followed by death; in control studies, animals were bled periodically to produce a similar pattern of shock. Regardless of the time to death following administration of the enterotoxin, there were essentially no changes from base line EEG patterns until shortly before death. With the development of preterminal severe shock, there was a marked decrease in EEG wave frequency and an initial increase in amplitude. The latter diminished progressively to produce an isoelectric tracing immediately prior to death. This could be reversed for a brief period by epinephrine. An identical sequence of EEG changes was observed during the terminal period of hemorrhagic shock. It is postulated that cerebral anoxia, caused by inadequate blood flow, is the primary cause of the altered EEG patterns that accompany enterotoxin toxicity. In this respect, staphylococcal enterotoxin B produces changes apparently similar to bacterial endotoxin but distinctly different from the EEG effects reported after botulinum toxin, anthrax toxin, or rattlesnake and cobra venom.