Staphylococcal scalded-skin syndrome

Farrell, Anne M.

doi:10.1016/s0140-6736(99)90120-4

Cited by 38 publications

(19 citation statements)

References 12 publications

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“…ET-producing Staphylococcus aureus is involved in staphylococcal scalded-skin syndrome (SSSS) or Ritter disease and in bullous impetigo in neonates (1)(2)(3). Serologically, ETs causing diseases in human have been divided into three major serotypes: ETA, ETB, and ETD (4)(5)(6).…”

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confidence: 99%

Emergence of Staphylococcus aureus Carrying Multiple Drug Resistance Genes on a Plasmid Encoding Exfoliative Toxin B

Hisatsune

Hirakawa

Yamaguchi

et al. 2013

Antimicrob Agents Chemother

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We report the complete nucleotide sequence and analysis of pETB TY825 , a Staphylococcus aureus TY825 plasmid encoding exfoliative toxin B (ETB). S. aureus TY825 is a clinical isolate obtained from an impetigo patient in 2002. The size of pETB TY825 , 60.6 kbp, was unexpectedly larger than that of the archetype pETB TY4 (ϳ30 kbp). Genomic comparison of the plasmids shows that pETB TY825 has the archetype pETB TY4 as the backbone and has a single large extra DNA region of 22.4 kbp. The extra DNA region contains genes for resistance to aminoglycoside [aac(6=)/aph(2؆)], macrolide (msrA), and penicillin (blaZ). A plasmid deletion experiment indicated that these three resistance elements were functionally active. We retrospectively examined the resistance profile of the clinical ETB-producing S. aureus strains isolated in 1977 to 2007 using a MIC determination with gentamicin (GM), arbekacin (ABK), and erythromycin (EM) and by PCR analyses for aac(6=)/aph(2؆) and msrA using purified plasmid preparations. The ETB-producing S. aureus strains began to display high resistance to GM, which was parallel with the detection of aac(6=)/aph(2؆) and mecA, after 1990. Conversely, there was no significant change in the ABK MIC during the testing period, although it had a tendency to slightly increase. After 2001, isolates resistant to EM significantly increased; however, msrA was hardly detected in ETB-producing S. aureus strains, and only five isolates were positive for both aac(6=)/aph(2؆) and msrA. In this study, we report the emergence of a fusion plasmid carrying the toxin gene etb and drug resistance genes. Prevalence of the pETB TY825 carrier may further increase the clinical threat, since ETB-producing S. aureus is closely related to more severe impetigo or staphylococcal scalded-skin syndrome (SSSS), which requires a general antimicrobial treatment. Exfoliative toxin (ET) is an exotoxin produced by staphylococcal species, causing blisters on human and animal skin (1). ET-producing Staphylococcus aureus is involved in staphylococcal scalded-skin syndrome (SSSS) or Ritter disease and in bullous impetigo in neonates (1-3). Serologically, ETs causing diseases in human have been divided into three major serotypes: ETA, ETB, and ETD (4-6). All types cause intraepidermal cleavage in the granular layer, without epidermal necrolysis or inflammatory response in the skin (4, 5, 7). ETs are serine proteases that selectively cleave desmoglein 1, a desmosomal protein connecting epidermal cells present in the epidermis (8).Virulence factors of staphylococci such as ET are accessory proteins, which are not essential for cell growth or division. Genetic determinants for these factors are often associated with mobile genetic elements, such as phages, plasmids, and pathogenicity islands (9-11). The eta gene is located on the genome of a temperate phage ( ETA) (12), the etb gene is on a large plasmid (4, 13), and the etd gene is chromosomally located in a pathogenicity island (6).We previously reported the complete nucleotide sequence of th...

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confidence: 99%

Emergence of Staphylococcus aureus Carrying Multiple Drug Resistance Genes on a Plasmid Encoding Exfoliative Toxin B

Hisatsune

Hirakawa

Yamaguchi

et al. 2013

Antimicrob Agents Chemother

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“…Unlike the generalized SSSS, bullae did not develop. The scarletiniform rash was very difficult to differentiate from other causes of infectious erythroderma such as toxic shock syndrome (TSS) and streptococcal scarlet fever 3,9) . .…”

Section: Discussionmentioning

confidence: 99%

Regional outbreak of staphylococcal scalded skin syndrome in healthy children

et al. 2010

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= Abstract = Purpose : Staphylococcal scalded skin syndrome (SSSS) is a relatively uncommon superficial blistering skin disease that is due to Staphylococcus aureus. We had experienced a regional outbreak of SSSS over 3 years in healthy children. Methods : We retrospectively reviewed the medical records of those patients diagnosed as SSSS. Most of neonatal cases were nosocomial infections and excluded from the analysis. The clinical features, laboratory findings, the isolation and antibiotic resistance of S. aureus, the antibiotic management and other supportive treatments were analyzed. Results : Fifty-five patients with SSSS were admitted to our hospital from October 2001 to September 2004. The median age of patients was 3.0 years. Of the 55 patients, 9 were the generalized type, 13 were the intermediate type and 33 were the scarletiniform rash. All the patients were living in neighborhood of the Jinju area. S. aureus were isolated from 9 of the patients and all of the isolated S. aureus were methicillin resistant. All the patients except two were treated with intravenous flocloxacillin or nafcillin and/or cefotaxime. All the patients recovered during the follow-up period of 2 to 3 weeks. Conclusion : We experienced a regional outbreak of SSSS in previous healthy children. Further study for finding the carriers of S. aureus caused SSSS and preventing the spread of this disease is needed. Additionally, guidelines for treating SSSS due to methicillin resistant S. aureus should be established. (Korean J Pediatr 2010;53:48-55)

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“…Criteria required for diagnosis of SSSS are typical clinical patterns, isolation of an exotoxin-producing S. aureus strain and histopathological evidence of intraepidermal cleavage through stratum granulosum [9,21]. Many authors assume that the presence of characteristic skin lesions along with the isolation of phage group II S. aureus is sufficient for the diagnosis of SSSS [3,6,22], but there are also reports on exfoliative toxinproducing S. aureus strains other than phage group II [1,4,11,23]. Recent investigations of the pathogenetical mechanisms of SSSS led to the identification of the exfoliative toxins of S. aureus as glutamate-specific trypsin-like serine proteases.…”

Section: Discussionmentioning

confidence: 99%

Staphylococcal Scalded Skin Syndrome in an Adult Patient with T-Lymphoblastic Non-Hodgkin’s Lymphoma

Scheinpflug¹,

Schalk²,

Mohren³

2008

Oncol Res Treat

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Background: Staphylococcal scalded skin syndrome (SSSS) is an exfoliative dermatitis caused by Staphylococcus aureus infection. In contrast to infants, it is rarely observed in adults. SSSS in adults usually occurs in predisposed individuals such as those with renal failure or immunodeficiency, but has also been reported in otherwise healthy subjects. The reported mortality rate in adults is usually high because of serious underlying disease. Patient and Methods: We report a case of SSSS in a young female patient with T-lymphoblastic lymphoma, who survived this potentially lethal complication. Conclusions: To the best of our knowledge, this is the first case of SSSS in an adult patient with T-lymphoblastic non-Hodgkin’s lymphoma. Clinicians should be aware of SSSS as a rare but potentially fatal disorder, particularly in adult patients with malignancies undergoing aggressive chemotherapy.

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Staphylococcal scalded-skin syndrome

Cited by 38 publications

References 12 publications

Emergence of Staphylococcus aureus Carrying Multiple Drug Resistance Genes on a Plasmid Encoding Exfoliative Toxin B

Emergence of Staphylococcus aureus Carrying Multiple Drug Resistance Genes on a Plasmid Encoding Exfoliative Toxin B

Regional outbreak of staphylococcal scalded skin syndrome in healthy children

Staphylococcal Scalded Skin Syndrome in an Adult Patient with T-Lymphoblastic Non-Hodgkin’s Lymphoma

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