Early and Definitive Diagnosis of Toxic Shock Syndrome by Detection of Marked Expansion of T-Cell-Receptor Vβ2-Positive T Cells

Abstract

We describe two cases of early toxic shock syndrome, caused by the superantigen produced from methicillin-resistant Staphylococcus aureus and diagnosed on the basis of an expansion of T-cell-receptor Vβ2-positive T cells. One case-patient showed atypical symptoms. Our results indicate that diagnostic systems incorporating laboratory techniques are essential for rapid, definitive diagnosis of toxic shock syndrome.

Staphylococcal Enterotoxin B Toxic Shock Syndrome Induced by Community-acquired Methicillin-resistant <i>Staphylococcus aureus</i> (CA-MRSA)

“…The massive proliferation of T cells bearing specific Vβ elements in their antigen receptors leads to the overproduction and/or release of cytokines, thus causing clinical TSS symptoms such as fever, hypotension and shock. Although the clinical definition of TSS is well established, there are few reports describing immunological confirmation of the direct contribution of TSST-1 or other staphylococcal superantigens to TSS (3). To our knowledge, the present report is the first confirming the activation of SEB-reactive Vβ3 + and Vβ12 + T cells in a patient fulfilling the diagnostic criteria of TSS.…”

Staphylococcus aureusSuperantigens Elicit Redundant and Extensive Human Vβ Patterns

“…As SAgs are active at very low concentrations (less than 1 pg/ml) (44), which are barely detectable in vivo, SAg-related diseases might theoretically be identified by determining TCR V␤ specificities in vitro. For example, an expansion of V␤2 T cells on the one hand and of V␤3, -14, and -17 T cells on the other hand, which correspond to TSST-1 and SEB superantigenic activities, respectively, has been detected in patients with TSS (6,10,25,29). Such an approach would be particularly useful for investigating suspected SAg-related diseases, including some inflammatory disorders, Kawasaki disease, and atopy (11).…”

Two Cases of Fatal Shock after Transfusion of Platelets Contaminated by Staphylococcus aureus: Role of Superantigenic Toxins

“…According to the Centers for Disease Control and Prevention definition of TSS, neither case can be considered as "probable" or "confirmed" TSS, because of the absence of rash and desquamation (table 1). However, cases of TSS without cutaneomucous involvement have already been reported and were confirmed by the proliferation of specific Vb-restricted T cells in response to the superantigen [9]. Moreover, desquamation usually occurs 1-2 weeks after onset of TSS, and the patients we describe died 4 and 7 days after the onset of infection [6].…”