The Rise of Staphylococcal Super Antigens in Psoriatic Patients, a Case-Control Study

Abstract

Background:Staphylococcus aureus, the major virulence factor of hospital and community acquired infections, secretes numerous exotoxins (super antigens), which may affect immunological and inflammatory status in psoriatic skin lesion.Objectives:This study is designed to compare the S. aureus super antigens level in sera of psoriatic patients with normal cases (nevus).Patients and Methods:A case control study was performed in dermatology ward of Rasoul Hospital in Tehran, IR Iran (2008 - 2010). Staphylococcal super antigens (Entrotoxin A, B, D and TSST1) were measured in serum of 41 psoriatic patients and 28 normal persons (Nevus) by ELISA. Chi square values (CI 95%, P value < 0.05) were calculated for all categorical variables.Results:In this study 63.4% (26) of cases were male, 36.6% (15) were female. Age ranged from 4 months to 64 years old, with a mean age of 33.7 ± 15.4 years. Type of skin disease in cases: 20% (8) were inflicted by the Gutate form of the disease; 59% (23) with chronic plaque psoriasis (CPP), 7.7% (3) with erythrodermic and 12.8% (5) had other types of the disease (plaque, pustular, inverse). TSST (toxic shock syndrome toxin) was detected in 47% (20/41) of cases and in 6% (1/28) of the controls with a significant difference. (P value = 0.000) Entrotoxins (A, B, D) were detected in the sera of 48.8% (21/41) of cases; and only 6 %( 1/21) of controls, showed significant differences (P value = 0.000) positive TSST was more common in spring, and correlates with CPP type of psoriasis, but not related to patient`s gender and age.Conclusions:In this study, S. aureus were 25 times more in psoriatic patients. Super antigens should be first detected in the serum samples; if negative, the skin lesions should be examined by PCR especially in chronic types of disease. Adding the antibiotics against S. aureus to other conventional treatments might be helpful. It has a more important and significant role in children with acuteinfection.

Effect of Substance P in Staphylococcus aureus and Staphylococcus epidermidis Virulence: Implication for Skin Homeostasis

“…Indeed, whereas SP had no effect on the release of exoproteins by S. epidermidis , SP stimulated the production of the Staphylococcal enterotoxin C2 by S. aureus MFP03. It is particularly interesting to note that Staphylococcal enterotoxins are members of a family of bacterial toxins that are increased in S. aureus strains associated with atopic dermatitis (Nada et al, 2012 ), psoriasis (Atefi et al, 2014 ), and even diabetic foot ulcers (Vu et al, 2014 ). In parallel, in S. aureus SP induced a decrease in the production of a lipase, whereas the lipase precursor accumulated suggesting that under the influence of SP, the precursor was not processed.…”

Skin colonization of Staphylococcus aureus harboring superantigen toxin genes and its correlation with serum IL-22 level in psoriasis patients

“…They detected toxins in 96.8% of S. aureus isolates in lesional skin and 42.3% of S. aureus isolates in nonlesional skin. Also, Atefi et al, 2014 29 measured S. aureus toxins in the sera of a group of psoriasis patients. TSST was detected in 47% (20/41) of cases, significantly higher than in controls 6% (1/28), (P<0.0001).…”

MRSA and Skin Infections in Psoriatic Patients: Therapeutic Options and New Perspectives

“…This hypothesis is supported in the study by Balci et al [ 18 ], showing that there is an increased prevalence of toxigenic strains in the skin lesions of psoriatic patients compared to healthy subjects. Atefi et al [ 30 ] also confirmed, in a case-control study, that psoriatic patients have a higher frequency of staphylococcal superantigens measured in serum. In particular, there was a statistically significant difference between psoriatic patients and controls, considering Toxic Shock Syndrome Toxin (TSST), 47% vs. 6%, respectively, and Enterotoxins (A, B, D), 48.8% vs. 6%, respectively.…”