A New Exanthematous Disease in Newborn Infants Caused by Exotoxins Producing Methicillin-resistant Staphylococcus aureus

Abstract

Neonatal exanthematous diseases induced by toxic shock syndrome toxin-1 (TSST-1)-producing methicillin-resistant Staphyloccocus aureus (MRSA) is one of emerging infectious diseases in Japan. We experienced 36 patients with this disease in National Kagawa Children's Hospital and in 13 patients of them, investigated the role of both the toxin and cytokines in pathogenesis of it. The results are summarized as follows: 1. The TSST-1 level was high in the umbilical inflammatory exudate of cases induced by umbilical infection and in the gastric fluid of cases induced by respiratory infection. The blood TSST-1 level was below the detection limit in most of the exathematous++ cases examined, but it was detected in one of the nine cases induced by respiratory infection and a case secondary to severe MRSA infection (phlegmonous abscess in buttock). 2. Local cytokine levels were examined in the abscess pus obtained from a case of severe MRSA infection and in the gastric fluid from cases induced by respiratory infection. The local levels of TNF [alpha], IL-1 [beta], IL-6 and IL-8 were markedly high, but the local levels of IL-2 and IFN-[gamma] were similar to their blood levels. 3. The severity of hypercytokinemia (IL-1 [beta], IL-2, IL-6, IFN-[gamma]) was proportionate to the severity of exanthematous disease. Accompanied by increased levels of inhibitory factors sTNF-R, IL-1 ra, sIL-2R and IL-10, this hypercytokinemia normalized soon within four or five days. 4. As compared to cases induced by umbilical infection, cases induced by respiratory infection often had higher blood cytokine levels and some of them had cardiorespiratory disorders. Based on the results of this study, we consider that this disease is generally induced by toxemia with a small number of toxins without tissue destructive lesions by MRSA infection and that this is closely related to the course of the disease that shows a tendency to a spontaneous recovery.

Reemergence of Established Pathogens in the 21st Century

“…It is caused by MRSA producing TSST-1‚ and the affected neonates suffer‚ along with the MRSA infection or colonization‚ thrombocytopenia and an exanthem that does not fulfill criteria for toxic shock syndrome (it does not desquamate and it is not accompanied by shock)‚ and resolves spontaneously (Okada et al‚ 2000;Takahashi et al‚ 1998‚ 2000. It is caused by MRSA producing TSST-1‚ and the affected neonates suffer‚ along with the MRSA infection or colonization‚ thrombocytopenia and an exanthem that does not fulfill criteria for toxic shock syndrome (it does not desquamate and it is not accompanied by shock)‚ and resolves spontaneously (Okada et al‚ 2000;Takahashi et al‚ 1998‚ 2000.…”

Prevalence of Toxic Shock Syndrome Toxin 1 (TSST-1)-Producing Strains of Staphylococcus aureus and Antibody to TSST-1 among Healthy Japanese Women

“…There have been numerous reports, however, of neonatal TSS-like exanthematous disease (NTED), which is typically characterized by fever, erythema, and thrombocytopenia (49). Most reported cases of NTED have been caused by TSST-1-producing, methicillinresistant strains of Staphylococcus aureus (MRSA) (22,29,32,33), and susceptibility to this toxin was indicated by low levels of antibody directed against TSST-1 (32).…”

Roles of SEA-expressing Staphylococcus aureus, isolated from an atopic dermatitis patient, on expressions of human β-defensin-2 and inflammatory cytokines in HaCaT cells

“…Both IL-1ß and TNF-· play roles as potent primary stimuli for IL-6 and -8 production (17). The local cytokine levels of TNF-·, IL-1ß, -6 and -8 were markedly high in severe exanthematous diseases in newborn infants caused by exotoxins producing methicillin-resistant S. aureus (18). Interestingly, in this study, our data show that the expression of IL-8, but not IL-1ß, TNF-·, and IL-6, was upregulated by the treatment of autoclaved-S. aureus.…”