A double outbreak of exfoliative toxin–producing strains ofStaphylococcus aureusin a maternity unit

Abstract

SummaryThis report describes a double outbreak of staphylococcal scalded skin syndrome (SSSS) in which two distinct tetracycline-resistant strains ofStaphylococcus aureusproducing different exfoliative toxins were involved. In the first phase the daytime staff of the delivery unit and eczematous skin conditions in midwives were implicated as the probable source. In the second phase a source within a post-natal ward was suggested with local cross-infection. In the final phase both sources were epidemiologically linked to cases of SSSS. Because early discharge was the policy of the unit many cases presented in the community rather than in the hospital.Confirmation of epidemiological findings was provided by additional laboratory studies. Two distinct strains ofS. aureuscould be defined, differing in phage-typing patterns, the exfoliative toxin produced, plasmid profile, cadmium resistance and bacteriocin production. Strict care in hand washing with a chlorhexidine-containing detergent was an important control measure.

Staphylococcal scalded skin syndrome related to an exfoliative toxin A- and B-producing strain in preterm infants

“…It affects primarily infants and children younger than 10 years of age [8]. Our patients exhibited the characteristic clinical picture [2,4,5,6,7].…”

“…All patients described in the literature including our own patients did not experience long-term residual changes to their skin. Although relapses/reinfections of the disease are reported in term newborns in maternity units [5], no relapse or reinfection in a premature infant has hitherto been described. In our patient, the degree of exfoliation was milder during the relapse/reinfection than during the primary disease.…”

“…Of these, 88% produce ETA, 4% ETB, and 8% produce both ETs [17]. The toxins are released into the bloodstream from organisms in the colonised or infected sites (our first patient had a conjunctivitis) and act at a remote target in the epidermis of the skin where they cause splitting specifically between the stratum spinosum and stratum granulosum [4,5]. The underlying mechanism is specific cleavage of Dsg1 by direct proteolysis of the extracellular domain by ETA as well as ETB.…”

Regional outbreak of staphylococcal scalded skin syndrome in healthy children

“…In neonates and children, transmission of the exfoliative toxin-producing S. aureus appears to occur through asymptomatic carriers 8) . Community-acquired MRSA infections have been increasingly reported among athletes and in the army.…”

“…Many outbreaks of SSSS have been reported 7,8,10,11) . Small outbreaks in children or a few familial outbreak cases 13) also have been reported.…”