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Vitale C, Spinozzi V, Colangeli L, Sbraccia P, Guglielmi V. Staphylococcal scalded skin syndrome in adults with obesity and type 2 diabetes: A case series. Clin Case Rep 2022; 10:e6471. [DOI: 10.1002/ccr3.6471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/15/2022] [Accepted: 09/30/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
- Carolina Vitale
- Department of Systems Medicine University of Rome Tor Vergata Rome Italy
- Obesity Medical Center University Hospital Policlinico Tor Vergata Rome Italy
| | - Valentina Spinozzi
- Department of Systems Medicine University of Rome Tor Vergata Rome Italy
- Obesity Medical Center University Hospital Policlinico Tor Vergata Rome Italy
| | - Luca Colangeli
- Department of Systems Medicine University of Rome Tor Vergata Rome Italy
- Obesity Medical Center University Hospital Policlinico Tor Vergata Rome Italy
| | - Paolo Sbraccia
- Department of Systems Medicine University of Rome Tor Vergata Rome Italy
- Obesity Medical Center University Hospital Policlinico Tor Vergata Rome Italy
| | - Valeria Guglielmi
- Department of Systems Medicine University of Rome Tor Vergata Rome Italy
- Obesity Medical Center University Hospital Policlinico Tor Vergata Rome Italy
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Khallikane S, Moutaoukil M, Delsa H. [Staphylococcal scalded skin syndrom: a case report]. Pan Afr Med J 2021; 39:177. [PMID: 34584603 PMCID: PMC8449571 DOI: 10.11604/pamj.2021.39.177.22171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 05/08/2020] [Indexed: 11/16/2022] Open
Abstract
L´épidermose staphylococcique aiguë généralisée est une dermatose bulleuse médiée par des endotoxines staphylococciques exfoliatrices. L´affection touche le plus souvent les jeunes enfants. Nous rapportons le cas d´un nourrisson de 6 mois, ayant présenté une angine dans les jours précédant l´érythrodermie bulleuse, et dont la biopsie cutanée a montré l’aspect caractéristique de l´épidermolyse staphylococcique. L´évolution était rapidement défavorable et le nourrisson est décédé dans un tableau de choc septique réfractaire. Le terme de syndrome de la peau ébouillantée (SSSS), a été séparé de la nécrolyse épidermique d´origine toxique ou allergique par Lyell en l´aspect anatomique opposé de ces deux entités: dans le syndrome de la peau ébouillantée, le décollement cutané se fait par clivage de la partie superficielle de l´épiderme au niveau de la couche granuleuse, alors que dans le syndrome de Lyell toxique, le clivage siège plus profondément au niveau du corps muqueux.
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Affiliation(s)
- Said Khallikane
- Service de Réanimation Polyvalente, Troisième Hôpital Militaire, Laayoune, Royaume du Maroc
| | - Mohamed Moutaoukil
- Service de Réanimation Polyvalente, Quatrième Hôpital Militaire, Dakhla, Royaume du Maroc
| | - Hanane Delsa
- Service de Gastro-Entérologie, Université Mohammed VI des Sciences de la Santé (UM6SS), Hôpital Cheikh Khalifa Bin Zayd Al Nahyan, Casablanca, Royaume du Maroc
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Staphylococcus aureus Toxins and Their Molecular Activity in Infectious Diseases. Toxins (Basel) 2018; 10:toxins10060252. [PMID: 29921792 PMCID: PMC6024779 DOI: 10.3390/toxins10060252] [Citation(s) in RCA: 227] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/14/2018] [Accepted: 06/15/2018] [Indexed: 12/04/2022] Open
Abstract
Staphylococcus aureus is a microorganism resident in the skin and nasal membranes with a dreadful pathogenic potential to cause a variety of community and hospital-acquired infections. The frequency of these infections is increasing and their treatment is becoming more difficult. The ability of S. aureus to form biofilms and the emergence of multidrug-resistant strains are the main reasons determining the challenge in dealing with these infections. S. aureus' infectious capacity and its success as a pathogen is related to the expression of virulence factors, among which the production of a wide variety of toxins is highlighted. For this reason, a better understanding of S. aureus toxins is needed to enable the development of new strategies to reduce their production and consequently improve therapeutic approaches. This review focuses on understanding the toxin-based pathogenesis of S. aureus and their role on infectious diseases.
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Bukowski M, Wladyka B, Dubin G. Exfoliative toxins of Staphylococcus aureus. Toxins (Basel) 2010; 2:1148-65. [PMID: 22069631 PMCID: PMC3153237 DOI: 10.3390/toxins2051148] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Revised: 05/12/2010] [Accepted: 05/19/2010] [Indexed: 11/16/2022] Open
Abstract
Staphylococcus aureus is an important pathogen of humans and livestock. It causes a diverse array of diseases, ranging from relatively harmless localized skin infections to life-threatening systemic conditions. Among multiple virulence factors, staphylococci secrete several exotoxins directly associated with particular disease symptoms. These include toxic shock syndrome toxin 1 (TSST-1), enterotoxins, and exfoliative toxins (ETs). The latter are particularly interesting as the sole agents responsible for staphylococcal scalded skin syndrome (SSSS), a disease predominantly affecting infants and characterized by the loss of superficial skin layers, dehydration, and secondary infections. The molecular basis of the clinical symptoms of SSSS is well understood. ETs are serine proteases with high substrate specificity, which selectively recognize and hydrolyze desmosomal proteins in the skin. The fascinating road leading to the discovery of ETs as the agents responsible for SSSS and the characterization of the molecular mechanism of their action, including recent advances in the field, are reviewed in this article.
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Affiliation(s)
- Michal Bukowski
- Department of Analytical Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland; (M.B.); (B.W.)
| | - Benedykt Wladyka
- Department of Analytical Biochemistry, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland; (M.B.); (B.W.)
| | - Grzegorz Dubin
- Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland
- Author to whom correspondence should be addressed; ; Tel.: +48-12-664-63-62; Fax: +48-12-664-69-02
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Bridier A, Léauté-Labrèze C, Lehours P, Sarlangue J. Épidermolyse staphylococcique et impétigo bulleux chez des jumeaux nouveau-nés contaminés par le lait maternel. Arch Pediatr 2007; 14:1213-5. [PMID: 17644355 DOI: 10.1016/j.arcped.2007.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 04/01/2007] [Accepted: 06/04/2007] [Indexed: 11/26/2022]
Abstract
Staphylococcus aureus is often responsible for late septic infections, more rarely of toxinic ones, occurring in neonatal period. We report a case of staphylococcal scalded skin syndrome and bullous impetigo in newborn twins infected by breast milk from their asymptomatic mother. This transmission was confirmed by molecular biology method. This case emphasizes the potential part of the mother in staphylococcal nosocomial infections and the complexity of toxinic mechanisms.
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Affiliation(s)
- A Bridier
- Unité de néonatalogie B, hôpital des enfants de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France.
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Abstract
Some infectious diseases may cause rapidly fatal eruptions that need to be diagnosed and treated in an early phase for patient survival. The main life-threatening eruptions of infectious etiology include Rocky Mountain spotted fever, meningococcemia, toxic shock syndrome, streptococcal toxic shock syndrome, and staphylococcal scalded skin syndrome.
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Affiliation(s)
- Marcia Ramos-e-Silva
- Sector of Dermatology and Post-Graduation Course, HUCFF-UFRJ and School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Abstract
Humans are a natural reservoir for Staphylococcal aureus. Colonization begins soon after birth and predisposes to infection. S. aureus is one of the most common causes of skin infection, giving rise to folliculitis, furunculosis, carbuncles, ecthyma, impetigo, cellulitis and abscesses. In addition, S. aureus may cause a number of toxin-mediated life-threatening diseases, including staphylococcal scalded skin syndrome (SSSS). Epidermolytic toxins released by certain S. aureus strains cause SSSS by cleaving the epidermal cell adhesion molecule, desmogelin-1, resulting in superficial skin erosion. Recent experiments have revealed similarities in the pathophysiology of SSSS and pemphigus foliaceus, an autoimmune disorder that is characterized by antibodies targeting the same epidermal attachment protein. SSSS typically affects neonates and infants but may also occur in predisposed adults. It is painful and distressing for the patient and parents, although most cases respond to antibiotic treatment. Mortality is low in infants but can be as high as 67% in adults, and is dependent on the extent of skin involvement and the comorbid state. Thus, the management of adults who develop SSSS remains a major therapeutic challenge. The antibody response against the toxins neutralizes their effect and prevents recurrence or limits the effects to the area of infection, which is known as bullous impetigo.
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Affiliation(s)
- Girish K Patel
- Department of Dermatology, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, UK.
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Dobson CM, King CM. Adult staphylococcal scalded skin syndrome: histological pitfalls and new diagnostic perspectives. Br J Dermatol 2003; 148:1068-9. [PMID: 12786851 DOI: 10.1046/j.1365-2133.2003.05323.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Cutaneous infections continue to represent a large proportion of inpatient dermatology. Though most infectious skin diseases do not warrant hospitalization, some do and can rapidly become fatal if not treated promptly. A selected group of infections are reviewed--primary cutaneous infections, exotoxin-mediated syndromes, and systemic infections--that warrant hospitalization. Dermatologists play a critical role in the synthesis of patient history and appreciation of morphologic skin disease, which, when coupled with appropriate lab tests, may help to establish a diagnosis allowing for the timely implementation of effective and targeted therapy.
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Affiliation(s)
- E F Callahan
- Department of Dermatology, Cleveland Clinic Foundation, Ohio, USA
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Ladhani S, Joannou CL, Lochrie DP, Evans RW, Poston SM. Clinical, microbial, and biochemical aspects of the exfoliative toxins causing staphylococcal scalded-skin syndrome. Clin Microbiol Rev 1999; 12:224-42. [PMID: 10194458 PMCID: PMC88916 DOI: 10.1128/cmr.12.2.224] [Citation(s) in RCA: 168] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The exfoliative (epidermolytic) toxins of Staphylococcus aureus are the causative agents of the staphylococcal scalded-skin syndrome (SSSS), a blistering skin disorder that predominantly affects children. Clinical features of SSSS vary along a spectrum, ranging from a few localized blisters to generalized exfoliation covering almost the entire body. The toxins act specifically at the zona granulosa of the epidermis to produce the characteristic exfoliation, although the mechanism by which this is achieved is still poorly understood. Despite the availability of antibiotics, SSSS carries a significant mortality rate, particularly among neonates with secondary complications of epidermal loss and among adults with underlying diseases. The aim of this article is to provide a comprehensive review of the literature spanning more than a century and to cover all aspects of the disease. The epidemiology, clinical features, potential complications, risk factors, susceptibility, diagnosis, differential diagnoses, investigations currently available, treatment options, and preventive measures are all discussed in detail. Recent crystallographic data on the toxins has provided us with a clearer and more defined approach to studying the disease. Understanding their mode of action has important implications in future treatment and prevention of SSSS and other diseases, and knowledge of their specific site of action may provide a useful tool for physiologists, dermatologists, and pharmacologists.
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Affiliation(s)
- S Ladhani
- Division of Biomolecular Sciences, King's College London, London SE1 9RT, United
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Acland KM, Darvay A, Griffin C, Aali SA, Russell-Jones R. Staphylococcal scalded skin syndrome in an adult associated with methicillin-resistant Staphylococcus aureus. Br J Dermatol 1999; 140:518-20. [PMID: 10233278 DOI: 10.1046/j.1365-2133.1999.02721.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report the first adult case of staphylococcal scalded skin syndrome (SSSS) due to methicillin-resistant Staphylococcus aureus (MRSA). This case is particularly unusual as the MRSA produced toxic shock syndrome toxin 1 and enterotoxin, but not exfoliatoxin. SSSS was originally described in neonates and is thought to result from exfoliatins which produce subcorneal splitting of the epidermis and are only produced by certain strains of S. aureus. This case reflects the range of toxins that can be associated with SSSS and the clinical manifestations of MRSA infection in adult patients.
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Affiliation(s)
- K M Acland
- Department of Dermatology, Ealing Hospital Uxbridge Road, Middlesex UB1 3HW, UK
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Abstract
Staphylococcal scalded skin syndrome (SSSS), not previously recorded as a chronic disease, persisted for 2 years in a 50-year-old woman with epilepsy and cerebellar ataxia. Lesions initially suggestive of erythema multiforme and toxic epidermal necrolysis evolved over 2 years into those typical for SSSS, with extensive erosions and subcorneal blisters, showing an epidermal split at the granular cell layer. Exfoliatin A-producing phage I-III Staphylococcus aureus, previously linked only to acute mild adult cases of SSSS, was cultured from purulent discharge in the patient's eyes, ears and open skin lesions. The roles of epilepsy and antiepileptic medications are discussed as possible predisposing factors.
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Affiliation(s)
- E D Shelley
- Division of Dermatology, Department of Medicine, Medical College of Ohio, PO Box 10008, Toledo, OH 43699-0008, USA
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