Staphylococcal toxins in patients with psoriasis, atopic dermatitis, and erythroderma, and in healthy control subjects

Tomi, Nordwig S.; Kränke, Birger; Aberer, Elisabeth

doi:10.1016/j.jaad.2005.02.034

Cited by 145 publications

(139 citation statements)

References 26 publications

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“…They also found a significant relationship between toxin production of the strains isolated from skin lesions and disease grades (37). These results support the findings of previous studies (38,39). Tomi et al (39) showed that 36% of the S. aureus strains isolated from skin lesions of psoriasis patients secreted toxins.…”

Section: Discussionsupporting

confidence: 91%

“…In the same study, psoriasis patients who carried toxin-negative and toxin-positive S. aureus strains were compared, and disease grades of the patients with toxin-positive strains were found to be higher. These results show that there is a relationship between toxinpositive S. aureus colonization and psoriasis activation (39). On the other hand, Sayama et al (40) could only demonstrate the presence of enterotoxin (seb) and tst-1 in 5 of the 100 S. aureus strains isolated from diseased skin swabs of psoriasis patients, and they concluded that SAgs do not have a role in the development of psoriasis (40).…”

Section: Discussionmentioning

confidence: 91%

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PCR investigation of Panton-Valentine leukocidin, enterotoxin, exfoliative toxin,and agr genes in Staphylococcus aureus strains isolated from psoriasis patients*

Göçmen¹,

Sahiner²,

Koçak³

et al. 2015

Turk J Med Sci

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IntroductionPsoriasis is a chronic inflammatory disorder involving the skin. Genetic, environmental, and immunological factors play important roles in the development of the disease. Its incidence may change in different parts of the world depending on environmental, ethnic, and geographic differences. Both sexes are affected equally by the disease, and patients are usually diagnosed between 15 and 30 years of age. Although it can be seen in almost all races, it is rare in Asia and Africa. It has an overall prevalence of 2%-3% in the general population (1,2). Its prevalence in children is reported to range from 0% (Taiwan) to 2.1% (Italy), and in adults from 0.91% (United States) to 8.5% (Norway). In the United States, the annual incidence estimate in children is 40.8/100,000, while in adults the annual incidence varies from 78.9/100,000 (United States) to 230/100,000 (Italy) (1). The prevalence in the Turkish population is reported as 1.3% (2). Bacteria are known to play an important role in the development and chronicity of chronic inflammatory diseases such as atopic dermatitis and psoriasis. The relationship between bacterial colonization or infection of the skin and the development of inflammatory skin diseases is well described in studies reporting the relapse of guttate psoriasis following streptococcal pharyngitis and the development of atopic dermatitis following Staphylococcus aureus colonization of the skin (3,4).S. aureus colonizes the anterior nares of 20%-40% of the healthy adult population. It can also colonize the perineum, perianal region, axilla, gastrointestinal tract, and skin folds. Trauma, burns, diabetes, and immune suppression can lead to opportunistic infections with this colonizing pathogen (5).S. aureus can be the cause of a wide spectrum of infectious diseases due to its many virulence factors, which facilitate its spread in host tissues and its escape Background/aim: Staphylococcus aureus colonization is a determiner of disease activation in psoriasis patients. Here we evaluate the presence of genes encoding Panton-Valentine leukocidin (PVL), enterotoxins, TSST-1, exfoliative toxins, and the accessory gene regulatory locus by polymerase chain reaction (PCR) in S. aureus isolates obtained from healthy and diseased skin regions and anterior nares of psoriasis patients and healthy controls. Materials and methods:The presence of PVL and toxin genes was investigated, and agr typing was performed by PCR.Results: Eighteen of the isolated strains carried the sei, 1 carried the seb-sec, and 1 carried the seg enterotoxin gene. Eight of the strains carrying enterotoxin genes were isolated from nasal swabs, 6 from diseased skin swabs, and 4 from healthy skin swabs. None of the strains isolated from the control group carried the agr locus. On the other hand, 11 of the S. aureus strains isolated from the patients carried type 1, 7 carried type 1 + 3, 4 carried type 2, 4 carried type 3, and 1 carried type 1 + 2 agr loci. Conclusion:Enterotoxin production and the carried accessory gene regulatory loc...

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 91%

PCR investigation of Panton-Valentine leukocidin, enterotoxin, exfoliative toxin,and agr genes in Staphylococcus aureus strains isolated from psoriasis patients*

Göçmen¹,

Sahiner²,

Koçak³

et al. 2015

Turk J Med Sci

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“…The production of enterotoxins by strains that colonize atopic patients has been well studied, but most analyses examined only the excretion of enterotoxins A, B, and C and toxic shock syndrome toxin 1 (41,42). In most of those studies, seb was the most commonly found enterotoxin gene (42), and likewise, seb was one of the most frequently encountered enterotoxin genes seen in our strain collection; it was found in 9 of the 38 strains in this study.…”

Section: Discussionmentioning

confidence: 90%

Pulsed-Field Gel Electrophoresis of Staphylococcus aureus Isolates from Atopic Patients Revealing Presence of Similar Strains in Isolates from Children and Their Parents

et al. 2008

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Skin colonization with Staphylococcus aureus is often associated with atopic dermatitis, and staphylococcal enterotoxins have been implicated in the etiology of atopic disease. In this study, the colonization of patients with atopic dermatitis and their parents was investigated in order to evaluate the possibility of intrafamiliar transmission. S. aureus strains were isolated from 30 of 45 patients (66%). In 19 of 29 families (65%), at least one parent carried S. aureus, and the overall colonization rate of the parents was 48%. All strains were typed by pulsed-field gel electrophoresis (PFGE), and the presence of enterotoxin genes in the strains was assayed by multiplex PCR. A high percentage (84%) of the isolates present on the children and on at least one of their parents displayed identical PFGE and enterotoxin patterns as well as identical antibiotic resistance profiles, indicating intrafamiliar transmission. Forty-five percent of the strains did not carry any enterotoxin gene. The most frequently found enterotoxin genes were seg and sei, which were present in 36% of the strains, and seb, which was found in 24% of the strains. The other toxin genes occurred only in low frequencies. Most strains were resistant to penicillin (82%), and 15% showed resistance to more than one antibiotic. Intermediatelyvancomycin-resistant S. aureus or methicillin-resistant S. aureus strains were not detected. In conclusion, this study indicates that the colonization rate of parents of atopic children is rather high and may increase the risk of recolonization of the child.Staphylococcus aureus is a gram-positive pathogen that has been implicated in the pathogenesis of atopic dermatitis (AD). AD is one of the most frequent chronic inflammatory skin diseases and is found in 10% of all German children starting school (35). It is characterized by a dysregulation of the immune system that involves an increased Th2 response with an enhanced level of Th2 cytokines in the acute phase, a decreased level of other cytokines (e.g., tumor necrosis factor alpha), and decreased production of antistaphylococcal peptides of the innate immune system, i.e., ␤-defensin 3 and cathelicidins (12,30). This peptide deficiency, the impaired skin integrity, and the increased expression of fibrinogen (9) favor colonization with S. aureus in AD, which is found in a higher percentage on the skin of affected children than on the skin of a healthy control group (23). Many strains of S. aureus are able to secrete superantigens, i.e., enterotoxins and toxic shock syndrome toxin. The production of superantigens may lead to an aggravation of AD (3), and a reduction of colonization has been shown to be effective in reducing the severity of the disease (14). Furthermore, exposure to superantigens may lead to the sensitization of the patient and the production of specific immunoglobulin E antibodies against enterotoxin A and enterotoxin B. These antibody titers were found to be elevated in patients with severe skin lesions (17,25). Therefore, a reduction of S. aureus ...

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“…Tomi et al investigated 25 PS patients: the skin of 60% of patients was positive for S. aureus, and isolated S. aureus strains were toxigenic, carrying staphylococcal enterotoxins A to D (SEA to SED), in 36% of patients. Furthermore, the PASI score correlated significantly with the presence of enterotoxinproducing S. aureus strains (43).…”

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confidence: 92%

Staphylococcal Alpha-Toxin Is a Strong Inducer of Interleukin-17 in Humans

et al. 2011

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Patients with atopic dermatitis (AD) are frequently colonized with Staphylococcus aureus, with one-third of isolates producing alpha-toxin. Moreover, S. aureus colonization is positively correlated with the severity of eczema. Interleukin-17A (IL-17A) has gained attention in diseases associated with chronic skin infections. The aim of this study was to investigate the effects of sublytic alpha-toxin concentrations on IL-17A production. Sublytic alpha-toxin concentrations strongly induced IL-17A in peripheral blood mononuclear cells (PBMCs), isolated CD4 ؉ T cells, polarized Th17 cells, and Th17 clones from reactive atopy patch test lesions and blood from AD patients. Alphatoxin induced IL-17A directly in T cells. The effect of alpha-toxin was further amplified by upregulation of IL-1 in monocytes. In conclusion, higher levels of IL-17A secretion induced by alpha-toxin in the skin partially explain how colonization with S. aureus can contribute to chronic skin inflammation.Atopic dermatitis (AD) and psoriasis (PS) are the most common immune-mediated chronic inflammatory skin diseases, with an increasing prevalence, affecting approximately 1 to 4% of the population in industrial countries (8,36,39). One hallmark of AD is a striking susceptibility to colonization with Staphylococcus aureus: 80 to 100% of patients with AD are colonized with S. aureus (4, 27). In contrast, S. aureus can be isolated from the skin of only 5 to 30% of healthy individuals, mainly from intertriginous areas (27). Moreover, a positive correlation between disease severity and extent and S. aureus colonization of lesional and nonlesional skin has been noted (4), which may be due to IgE-mediated hypersensitivity (3, 23) or to production of exotoxins with superantigenic properties (28,40,46). For PS, one study detected S. aureus in nonlesional skin of 27% of patients and in 46% of skin lesions (26). Tomi et al. investigated 25 PS patients: the skin of 60% of patients was positive for S. aureus, and isolated S. aureus strains were toxigenic, carrying staphylococcal enterotoxins A to D (SEA to SED), in 36% of patients. Furthermore, the PASI score correlated significantly with the presence of enterotoxinproducing S. aureus strains (43).Recently, the superantigen SEB was shown to enhance house dust mite-induced patch test reactions in patients with AD (20). Besides unspecific stimulation of T-cell receptor (TCR) V␤ chains, superantigens can augment an antigen-specific T-helper 1 (Th1) response via the induction of interleukin-12 (IL-12) in antigen-presenting cells (APCs), which might contribute to AD becoming chronic (7,22). On the other hand, the severity of AD decreased in patients colonized with nontoxigenic S. aureus strains upon antimicrobial treatment as well, which suggests the involvement of pathogenic factors other than superantigens derived from S. aureus (5).A distinct percentage of S. aureus strains are able to produce alpha-toxin, a potent 33-kDa cytolysin which does not belong to the group of enterotoxins (superantigens) (9). In a for...

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Staphylococcal toxins in patients with psoriasis, atopic dermatitis, and erythroderma, and in healthy control subjects

Cited by 145 publications

References 26 publications

PCR investigation of Panton-Valentine leukocidin, enterotoxin, exfoliative toxin,and agr genes in Staphylococcus aureus strains isolated from psoriasis patients*

PCR investigation of Panton-Valentine leukocidin, enterotoxin, exfoliative toxin,and agr genes in Staphylococcus aureus strains isolated from psoriasis patients*

Pulsed-Field Gel Electrophoresis of Staphylococcus aureus Isolates from Atopic Patients Revealing Presence of Similar Strains in Isolates from Children and Their Parents

Staphylococcal Alpha-Toxin Is a Strong Inducer of Interleukin-17 in Humans

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