Staphylococcal scalded skin syndrome in an adult associated with methicillin-resistant Staphylococcus aureus.

We report the first adult case of staphylococcal scalded skin syndrome (SSSS) due to methicillin-resistant Staphylococcus aureus (MRSA). This case is particularly unusual as the MRSA produced toxic shock syndrome toxin 1 and enterotoxin, but not exfoliatoxin. SSSS was originally described in neonates and is thought to result from exfoliatins which produce subcorneal splitting of the epidermis and are only produced by certain strains of S. aureus. This case reflects the range of toxins that can be associated with SSSS and the clinical manifestations of MRSA infection in adult patients.

[Infections caused by staphylococci. The human as a source of infection for S. aureus and coagulase negative staphylococci]. / Infektionen durch Staphylokokken. Der Mensch als Infektionsquelle für S. aureus und koagulasenegative Staphylokokken.

Both Staphylococcus aureus and coagulase-negative staphylococci are among the most important pathogens of nosocomial infections. While Staphylococcus aureus can cause a variety of pyogenic infections and toxin-mediated diseases coagulase-negative staphylococci of the Staphylococcus epidermis group play an important role in infections developing in immunocompromised patients and those with temporarily or permanently implanted foreign bodies made of polymer. The major sources of staphylococcal infections are the skin and mucosa in humans. While in the case of Staphylococcus aureus the infection route may be either endogenous or exogenous, in the case of coagulase-negative staphylococci, the endogenous route predominates. This ecological-epidemiological situation forms the basis for strategies aimed at preventing nosocomial staphylococcal infections.

Pathogenicity of Staphylococcus lugdunensis, Staphylococcus schleiferi, and three other coagulase-negative staphylococci in a mouse model and possible virulence factors.

Staphylococcus lugdunesis and Staphylococcus schleiferi, two newly described species, have been isolated from numerous types of human infections. We compared the pathogenicity of 30 strains of S. lugdunensis, S. schleiferi, Staphylococcus epidermidis, Staphylococcus warneri, and Staphylococcus hominis, using a mouse model in which a foreign body preadhered with the test strain was implanted subcutaneously, followed by injection of the test strain. All five species of staphylococci produced abscesses. Staphylococcus epidermidis, S. schleiferi, and S. lugdunensis yielded species means of 76-91% abscess formation; 80-100% of the infected foreign bodies and tissues were culture positive. These three species were more virulent than S. warneri or S. hominis, which produced abscesses in 54 and 65% of mice, respectively; only 10-48% of the infected samples were culture positive. Transmission electron microscopy of pure cultures of selected strains showed that all species possessed glycocalyx. All species produced a variety of possible virulence factors, such as alpha and delta hemolysins, as well as the aggressins lipase and esterase. The production of exoenzymes did not always correlate with virulence as demonstrated by abscess formation in mice.