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Tuffs SW, Dufresne K, Rishi A, Walton NR, McCormick JK. Novel insights into the immune response to bacterial T cell superantigens. Nat Rev Immunol 2024; 24:417-434. [PMID: 38225276 DOI: 10.1038/s41577-023-00979-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/17/2024]
Abstract
Bacterial T cell superantigens (SAgs) are a family of microbial exotoxins that function to activate large numbers of T cells simultaneously. SAgs activate T cells by direct binding and crosslinking of the lateral regions of MHC class II molecules on antigen-presenting cells with T cell receptors (TCRs) on T cells; these interactions alter the normal TCR-peptide-MHC class II architecture to activate T cells in a manner that is independent of the antigen specificity of the TCR. SAgs have well-recognized, central roles in human diseases such as toxic shock syndrome and scarlet fever through their quantitative effects on the T cell response; in addition, numerous other consequences of SAg-driven T cell activation are now being recognized, including direct roles in the pathogenesis of endocarditis, bloodstream infections, skin disease and pharyngitis. In this Review, we summarize the expanding family of bacterial SAgs and how these toxins can engage highly diverse adaptive immune receptors. We highlight recent findings regarding how SAg-driven manipulation of the adaptive immune response may operate in multiple human diseases, as well as contributing to the biology and life cycle of SAg-producing bacterial pathogens.
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Affiliation(s)
- Stephen W Tuffs
- Department of Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada
- Department of Biochemistry and Microbiology, University of Victoria, Victoria, British Columbia, Canada
| | - Karine Dufresne
- Department of Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada
| | - Aanchal Rishi
- Department of Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada
| | - Nicholas R Walton
- Department of Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada
| | - John K McCormick
- Department of Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada.
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2
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Atchade E, De Tymowski C, Grall N, Tanaka S, Montravers P. Toxic Shock Syndrome: A Literature Review. Antibiotics (Basel) 2024; 13:96. [PMID: 38247655 PMCID: PMC10812596 DOI: 10.3390/antibiotics13010096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/23/2024] Open
Abstract
Toxic shock syndrome (TSS) is a rare, life-threatening, toxin-mediated infectious process linked, in the vast majority of cases, to toxin-producing strains of Staphylococcus aureus or Streptococcus pyogenes. The pathophysiology, epidemiology, clinical presentation, microbiological features, management and outcome of TSS are described in this review. Bacterial superantigenic exotoxins induces unconventional polyclonal lymphocyte activation, which leads to rapid shock, multiple organ failure syndrome, and death. The main described superantigenic exotoxins are toxic shock syndrome toxin-1 (TSST-1) and enterotoxins for Staphylococcus aureus and Streptococcal pyrogenic exotoxins (SpE) A, B, and C and streptococcal superantigen A (SsA) for Streptococcus pyogenes. Staphylococcal TSS can be menstrual or nonmenstrual. Streptococcal TSS is linked to a severe group A streptococcal infection and, most frequently, to a necrotizing soft tissue infection. Management of TSS is a medical emergency and relies on early detection, immediate resuscitation, source control and eradication of toxin production, bactericidal antibiotic treatment, and protein synthesis inhibiting antibiotic administration. The interest of polyclonal intravenous immunoglobulin G administration as an adjunctive treatment for TSS requires further evaluation. Scientific literature on TSS mainly consists of observational studies, clinical cases, and in vitro data; although more data on TSS are required, additional studies will be difficult to conduct due to the low incidence of the disease.
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Affiliation(s)
- Enora Atchade
- DMU PARABOL, Bichat-Claude Bernard Hospital, AP-HP, 75018 Paris, France; (C.D.T.); (S.T.); (P.M.)
| | - Christian De Tymowski
- DMU PARABOL, Bichat-Claude Bernard Hospital, AP-HP, 75018 Paris, France; (C.D.T.); (S.T.); (P.M.)
- UFR Diderot, Paris Cité University, 75018 Paris, France;
- INSERM UMR 1149, Immunoreceptor and Renal Immunopathology, Bichat-Claude Bernard Hospital, 75018 Paris, France
| | - Nathalie Grall
- UFR Diderot, Paris Cité University, 75018 Paris, France;
- Bacteriology Department, Bichat Claude Bernard Hospital, AP-HP, Paris Cité University, 75018 Paris, France
- INSERM UMR 1137 Infection, Antimicrobials, Modelling, Evolution, 75018 Paris, France
| | - Sébastien Tanaka
- DMU PARABOL, Bichat-Claude Bernard Hospital, AP-HP, 75018 Paris, France; (C.D.T.); (S.T.); (P.M.)
- INSERM, UMR 1188, Diabetes Atherothrombosis Réunion Océan Indien (DéTROI), la Réunion University, 97400 Saint-Denis de la Réunion, France
| | - Philippe Montravers
- DMU PARABOL, Bichat-Claude Bernard Hospital, AP-HP, 75018 Paris, France; (C.D.T.); (S.T.); (P.M.)
- UFR Diderot, Paris Cité University, 75018 Paris, France;
- INSERM UMR 1152 ANR 10—LABX-17, Pathophysiology and Epidemiology of Respiratory Diseases, 75018 Paris, France
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3
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Hochwalt AE, Abbinante-Nissen JM, Bohman LC, Hattersley AM, Hu P, Streicher-Scott JL, Teufel AG, Woeller KE. The safety assessment of tampons: illustration of a comprehensive approach for four different products. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1167868. [PMID: 37408999 PMCID: PMC10319135 DOI: 10.3389/frph.2023.1167868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/17/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction We illustrate a comprehensive tampon safety assessment approach that assures products can be used safely. Material biocompatibility, vaginal mucosa assessment, vaginal microbiome evaluation, and in vitro assessment of potential risk of staphylococcal toxic shock syndrome expressed through growth of Staphylococcus aureus (S. aureus) and production of TSST-1 are the four essential portions of the approach. Post-marketing surveillance informs of possible health effects that warrant follow up. The approach meets or exceeds US and international regulatory guidance and is described through the example of four tampon products. Methods/Results Each product is comprised mostly of large molecular weight components (cotton, rayon, polymers) that cannot pass the vaginal mucosa, are widely used across the industry, and replete with a vast body of safety data and a long history of safe use in the category. Quantitative risk assessment of all small molecular weight components assured a sufficient margin of safety supporting their use. Vaginal mucosa assessment confirmed that pressure points, rough edges and/or sharp contact points were absent. A randomized cross-over clinical trial (ClinicalTrials.gov Identifier: NCT03478371) revealed favorable comfort ratings, and few complaints of irritation, burning, stinging, or discomfort upon insertion, wear, and removal. Adverse events were few, mild in severity, self-limited and resolved without treatment. Vaginal microbiota assessment in vitro presented no adverse effect on microbial growth. Culture-independent microbiome analyses from vaginal swab samples obtained during the clinical trial showed no differences attributable to tampon usage, but instead due to statistically significant subject-to-subject variability. Growth of S. aureus and TSST-1 toxin production in the presence of any of the four products in vitro were statistically significantly reduced when compared to medium control alone. Discussion The data from the four elements of the comprehensive safety assessment approach illustrated herein confirm that tampons evaluated using this system can be used safely for menstrual protection. A post-marketing surveillance system that monitors and responds to in-market experiences indicated in-use tolerability of the product among consumers, thus confirming the conclusions of the pre-marketing safety assessment.
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Affiliation(s)
| | - Joan M. Abbinante-Nissen
- Baby, Feminine and Family Care, Global Product Stewardship, The Procter & Gamble Company, Cincinnati, OH, United States
| | - Lisa C. Bohman
- Data Modeling and Sciences, The Procter & Gamble Company, Mason, OH, United States
| | - Anne M. Hattersley
- Global Safety Surveillance and Analysis, The Procter & Gamble Company, Mason, OH, United States
| | - Ping Hu
- Corporate Biosciences, The Procter & Gamble Company, Mason, OH, United States
| | - Jan L. Streicher-Scott
- Baby, Feminine and Family Care Clinical Sciences, The Procter & Gamble Company, Cincinnati, OH, United States
| | - Amber G. Teufel
- Baby, Feminine and Family Care Microbiology, The Procter & Gamble Company, Cincinnati, OH, United States
| | - Kara E. Woeller
- Baby, Feminine and Family Care, Global Product Stewardship, The Procter & Gamble Company, Cincinnati, OH, United States
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4
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Angurana SK, Awasthi P, K C S, Nallasamy K, Bansal A, Jayashree M. Clinical Profile, Intensive Care Needs, and Short-Term Outcome of Toxic Shock Syndrome Among Children: A 10-Year Single-Centre Experience from North India. Indian J Pediatr 2023; 90:334-340. [PMID: 35804287 PMCID: PMC9266086 DOI: 10.1007/s12098-022-04271-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/04/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To describe the clinical and laboratory profile, management, intensive care needs, and outcome of children with toxic shock syndrome (TSS) admitted to the pediatric intensive care unit (PICU) of a tertiary care center in North India. METHODS This retrospective study was conducted in the PICU of a tertiary care hospital in North India over a period of 10 y (January 2011-December 2020) including children < 12 y with TSS (n = 63). RESULTS The median (interquartile range, IQR) age was 5 (2-9) y, 58.7% were boys, and Pediatric Risk of Mortality III (PRISM-III) score was 15 (12-17). The primary focus of infection was identified in 60.3% children, 44.5% had skin and soft tissue infections, and 17.5% (n = 11) had growth of Staphylococcus aureus. Common manifestations were shock (100%), rash (95.2%), thrombocytopenia (79.4%), transaminitis (66.7%), coagulopathy (58.7%), and acute kidney injury (AKI) (52.4%); and involvement of gastrointestinal (61.9%), mucus membrane (55.5%), respiratory (47.6%), musculoskeletal (41.3%), and central nervous system (CNS) (31.7%). The treatment included fluid resuscitation (100%), vasoactive drugs (92.1%), clindamycin (96.8%), intravenous immunoglobulin (IVIG) (92.1%), blood products (74.6%), mechanical ventilation (58.7%), and renal replacement therapy (31.7%). The mortality was 27% (n = 17). The duration of PICU and hopsital stay was 5 (4-10) and 7 (4-11) d, respectively. Higher proportion of nonsurvivors had CNS involvement, transaminitis, thrombocytopenia, coagulopathy, and AKI; required mechanical ventilation and blood products; and had higher vasoactive-inotropic score. CONCLUSION TSS is not uncommon in children in Indian setup. The management includes early recognition, intensive care, antibiotics, source control, and adjunctive therapy (IVIG and clindamycin). Multiorgan dysfunction and need for organ supportive therapies predicted mortality.
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Affiliation(s)
- Suresh Kumar Angurana
- Division of Pediatric Emergency and Critical Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Puspraj Awasthi
- Division of Pediatric Emergency and Critical Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Sudeep K C
- Division of Pediatric Emergency and Critical Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Karthi Nallasamy
- Division of Pediatric Emergency and Critical Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Arun Bansal
- Division of Pediatric Emergency and Critical Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Muralidharan Jayashree
- Division of Pediatric Emergency and Critical Care, Department of Pediatrics, Advanced Pediatrics Center, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
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Salah E. TEN mimics: Classification and practical approach to toxic epidermal necrolysis-like dermatoses. Indian J Dermatol Venereol Leprol 2022; 89:337-346. [PMID: 36688885 DOI: 10.25259/ijdvl_244_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/01/2022] [Indexed: 12/15/2022]
Abstract
Toxic epidermal necrolysis (TEN) is an acute life-threatening dermatologic emergency. However, many dermatoses can present with a TEN-like eruption. Those "TEN-mimics" are a true diagnostic challenge and an alarming differential diagnosis to such a serious condition. Herein, we will expose and classify the landscape of TEN-mimics. Also, the key differentiating clinical and/or laboratory points will be highlighted to help an accurate diagnosis of either a TEN or a TEN-like presentation.
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Affiliation(s)
- Eman Salah
- Department of Dermatology, Venereology & Andrology, Faculty of Medicine, Zagazig University, Egypt
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6
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Ortiz Rojas H, García-Perdomo H. Association between tampons and toxic shock syndrome in menstruating women: A systematic review and meta-analysis. SEXOLOGIES 2022. [DOI: 10.1016/j.sexol.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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7
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A Rare Case of Staphylococcal Toxic Shock Syndrome in a Neonate. Case Rep Infect Dis 2022; 2022:8111620. [PMID: 35686114 PMCID: PMC9173913 DOI: 10.1155/2022/8111620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/13/2022] [Indexed: 11/17/2022] Open
Abstract
Staphylococcus toxic shock syndrome (TSS) is not well described in neonates. The present criteria for diagnosis of TSS have not yet been validated in neonates. Here, we present a case of a 13-day-old female baby who presented with acute kidney injury (AKI). She had a pus-draining lesion on the head, and the pus grew Staphylococcus aureus. Based on the clinical criteria of fever, desquamation, hypotension, and AKI and laboratory criteria of absence of growth of any organisms in blood and cerebrospinal fluid, we diagnosed the case as TSS. She was treated with antibiotics, oxygen, and fluids, along with inotropic support and mechanical ventilation, and she recovered fully and was discharged on day 17 of admission. As there is no single test to diagnose TSS and it is uncommon in neonates, physicians should be familiar with the clinical presentation of the disease to make early diagnosis.
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8
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Taki Y, Watanabe S, Sato'o Y, Tan XE, Ono HK, Kiga K, Aiba Y, Sasahara T, Azam AH, Thitiananpakorn K, Veeranarayanan S, Li FY, Zhang Y, Kawaguchi T, Hossain S, Maniruzzaman, Hu DL, Cui L. The Association Between Onset of Staphylococcal Non-menstrual Toxic Shock Syndrome With Inducibility of Toxic Shock Syndrome Toxin-1 Production. Front Microbiol 2022; 13:765317. [PMID: 35369432 PMCID: PMC8964310 DOI: 10.3389/fmicb.2022.765317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Non-menstrual toxic shock syndrome (non-mTSS) is a life-threatening disease caused by Staphylococcus aureus strains producing superantigens, such as staphylococcal enterotoxins A, B, C, and toxic shock syndrome toxin-1 (TSST-1). However, little is known about why the TSS cases are rare, although S. aureus strains frequently carry a tst gene, which encodes TSST-1. To answer this question, the amount of TSST-1 produced by 541 clinical isolates was measured in both the presence and absence of serum supplementation to growth media. Then a set of S. aureus strains with similar genetic backgrounds isolated from patients presenting with non-mTSS and those with clinical manifestations other than non-mTSS was compared for their TSST-1 inducibility by human serum, and their whole-genome sequences were determined. Subsequently, the association of mutations identified in the tst promoter of non-mTSS strains with TSST-1 inducibility by human serum was evaluated by constructing promoter replacement mutants and green fluorescent protein (GFP) reporter recombinants. Results showed that 39 out of 541 clinical isolates (7.2%), including strains isolated from non-mTSS patients, had enhanced production of TSST-1 in the presence of serum. TSST-1 inducibility by human serum was more clearly seen in non-mTSS strains of clonal complex (CC)-5. Moreover, the whole-genome sequence analysis identified a set of sequence variations at a putative SarA-binding site of the tst promoter. This sequence variation was proven to be partially responsible for the induction of TSST-1 production by human serum. We conclude that the onset of staphylococcal toxic shock syndrome caused by TSST-1-producing CC-5 strains seem at least partially initiated by serum induction of TSST-1, which is regulated by the mutation of putative SarA-binding site at the tst promoter.
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Affiliation(s)
- Yusuke Taki
- Division of Bacteriology, Jichi Medical School, Tochigi, Japan.,Department of Gastroenterological Surgery, Shizuoka General Hospital, Shizuoka, Japan
| | - Shinya Watanabe
- Division of Bacteriology, Jichi Medical School, Tochigi, Japan
| | - Yusuke Sato'o
- Division of Bacteriology, Jichi Medical School, Tochigi, Japan
| | - Xin-Ee Tan
- Division of Bacteriology, Jichi Medical School, Tochigi, Japan
| | - Hisaya K Ono
- Department of Zoonoses, School of Veterinary Medicine, Kitasato University, Towada, Japan
| | - Kotaro Kiga
- Division of Bacteriology, Jichi Medical School, Tochigi, Japan
| | - Yoshifumi Aiba
- Division of Bacteriology, Jichi Medical School, Tochigi, Japan
| | - Teppei Sasahara
- Division of Bacteriology, Jichi Medical School, Tochigi, Japan
| | | | | | | | - Feng-Yu Li
- Division of Bacteriology, Jichi Medical School, Tochigi, Japan
| | - Yuancheng Zhang
- Division of Bacteriology, Jichi Medical School, Tochigi, Japan
| | | | - Sarah Hossain
- Division of Bacteriology, Jichi Medical School, Tochigi, Japan
| | - Maniruzzaman
- Division of Bacteriology, Jichi Medical School, Tochigi, Japan
| | - Dong-Liang Hu
- Department of Zoonoses, School of Veterinary Medicine, Kitasato University, Towada, Japan
| | - Longzhu Cui
- Division of Bacteriology, Jichi Medical School, Tochigi, Japan
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In Vitro Study to Assess Effective Cleaning Techniques for Removing Staphylococcus aureus from Menstrual Cups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031450. [PMID: 35162481 PMCID: PMC8835062 DOI: 10.3390/ijerph19031450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/04/2022]
Abstract
Background: We sought to determine the effectiveness of common cleaning procedures in eliminating S. aureus from silicone menstrual cups. Methods: In this in vitro study, we tested four cleaning techniques: (1) cold water; (2) cold water and liquid soap; (3) cold water followed by steeping the cup in boiled water for 5 min in a ceramic mug covered with a small plate; and (4) cold water and soap followed by steeping the cup in boiled water as in (3). Human blood was coated to the inner and outer surface of each cup, dried, and incubated with 106S. aureus colony-forming units (CFU/mL). All tests were performed in triplicate. Viable bacterial abundance was measured with decadic dilution and drop plate or surface plating. Results: Bacteria were most effectively eliminated by cleaning cups with soap and water and then steeping in boiled water (0 CFU/cup vs. 2.075 × 108/cup no cleaning, p = 0.005). This was not statistically significantly different from washing cups with water only and steeping 5 min in boiled water (14 CFU/cup). Raised lettering on the outer surface of the menstrual cups resulted in more bacterial recovery from pieces with lettering than without lettering. Conclusions: These results advance knowledge of between-period menstrual cup cleaning recommendations, suggesting that the logistical challenges of continuous boiling may be eliminated with steeping at least 5 min.
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Rice M, Ibrahim I, Aly MI. Haemofiltration in the Management of Severe Paediatric Burns - Experience in a UK Burns Centre and Systematic Review. J Burn Care Res 2021; 43:722-727. [PMID: 34637522 DOI: 10.1093/jbcr/irab181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Paediatric burns are life-threatening injuries due to the acute injury and secondary complications. In acute phase burns, hypovolaemia and vasoconstriction cause renal impairment. Sepsis and multi-organ failure compound the problem resulting in morbidity and mortality. This paper outlines 5 years' experience using haemofiltration in major paediatric burns, and a review of the current literature.Retrospective patient data collection was undertaken identifying relevant paediatric burns undergoing Continuous Veno-Venous Haemofiltration. Data were analysed to identify demographics, indication, duration of therapy, and outcomes. A systematic review was also performed using PRISMA principles. PubMed, Science Direct and OVID databases were explored and relevant papers were included.From January 2015-December 2019, haemofiltration was utilised in 5 cases. Age range 3-15 years (mean: 12), 4 males / 1 female, mean weight 56kg (12-125kg). TBSA 21-61% (mean: 37.6%), mechanism of injury was scald-60%, flame-40%. Overall survival was 100%. 3 patients were filtered for a brief period during the first 24 hours to correct metabolic acidosis and control temperature. 2 patients required prolonged therapy. All patients recovered without further long term renal support. A total of 3814 papers were identified for systematic review. 3 were considered relevant for inclusion.This paper reflects the benefits of haemofiltration in the management of severe paediatric burns. Renal replacement therapy is useful in managing metabolic acidosis, temperature control and renal failure. The current literature supports judicious use on a patient-by-patient basis. Given the lack of evidence in the literature, further studies are required to establish guidelines for the use of haemofiltration in paediatric burns.
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Affiliation(s)
- Michael Rice
- Department of Paediatric Burns Surgery, Royal Manchester Childrens' Hospital, UK
| | - Ibrahim Ibrahim
- Department of Paediatric Burns Surgery, Royal Manchester Childrens' Hospital, UK
| | - Mohamed Ismail Aly
- Department of Paediatric Burns Surgery, Royal Manchester Childrens' Hospital, UK
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11
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Leung J, Abrams JY, Maddox RA, Godfred-Cato S, Schonberger LB, Belay ED. Toxic Shock Syndrome in Patients Younger than 21 Years of Age, United States, 2006-2018. Pediatr Infect Dis J 2021; 40:e125-e128. [PMID: 33464017 PMCID: PMC8842798 DOI: 10.1097/inf.0000000000003011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We examined the incidence of toxic shock syndrome in the United States during 2006-2018 among persons <21 years old with commercial or Medicaid-insurance using administrative data. There were 1008 commercially-insured and 481 Medicaid-insured toxic shock syndrome cases. The annual rate was 1 per 100,000 and stable over time. Rates were even lower in children <5 years old and stable over time.
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Affiliation(s)
- Jessica Leung
- Division of Viral Diseases, National Center for
Immunization and Respiratory Diseases, Centers for Disease Control and Prevention,
Atlanta, GA
| | - Joseph Y. Abrams
- Division of High-Consequence Pathogens and Pathology,
National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease
Control and Prevention, Atlanta, GA
| | - Ryan A. Maddox
- Division of High-Consequence Pathogens and Pathology,
National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease
Control and Prevention, Atlanta, GA
| | - Shana Godfred-Cato
- National Center on Birth Defects and Developmental
Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lawrence B. Schonberger
- Division of High-Consequence Pathogens and Pathology,
National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease
Control and Prevention, Atlanta, GA
| | - Ermias D. Belay
- Division of High-Consequence Pathogens and Pathology,
National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease
Control and Prevention, Atlanta, GA
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12
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Duane TM, Huston JM, Collom M, Beyer A, Parli S, Buckman S, Shapiro M, McDonald A, Diaz J, Tessier JM, Sanders J. Surgical Infection Society 2020 Updated Guidelines on the Management of Complicated Skin and Soft Tissue Infections. Surg Infect (Larchmt) 2021; 22:383-399. [PMID: 33646051 DOI: 10.1089/sur.2020.436] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: The Surgical Infection Society (SIS) Guidelines for the treatment of complicated skin and soft tissue infections (SSTIs) were published in October 2009 in Surgical Infections. The purpose of this project was to provide a succinct update on the earlier guidelines based on an additional decade of data. Methods: We reviewed the previous guidelines eliminating bite wounds and diabetic foot infections including their associated references. Relevant articles on the topic of complicated SSTIs from 2008-2020 were reviewed and graded individually. Comparisons were then made between the old and the new graded recommendations with review of the older references by two authors when there was disparity between the grades. Results: The majority of new studies addressed antimicrobial options and duration of therapy particularly in complicated abscesses. There were fewer updated studies on diagnosis and specific operative interventions. Many of the topics addressed in the original guidelines had no new literature to evaluate. Conclusions: Most recommendations remain unchanged from the original guidelines with the exception of increased support for adjuvant antimicrobial therapy after drainage of complex abscess and increased data for the use of alternative antimicrobial agents.
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Affiliation(s)
| | - Jared M Huston
- Departments of Surgery and Science Education, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | | | - Adam Beyer
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sara Parli
- Department of Pharmacy Services, University of Kentucky, Lexington, Kentucky, USA
| | - Sara Buckman
- Department of Surgery, Washington University, St. Louis, Missouri, USA
| | - Mark Shapiro
- Acute Care Surgery, Portsmouth, New Hampshire, USA
| | - Amy McDonald
- Department of Veterans Affairs, Cleveland, Ohio, USA
| | - Jose Diaz
- Department of Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Jeffrey M Tessier
- Division of Infectious Diseases, University of Texas Southwestern, Dallas Texas, USA
| | - James Sanders
- Department of Pharmacy and Division of Infectious Diseases, University of Texas Southwestern, Dallas, Texas, USA
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13
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Maul X, Dincer BC, Wu AW, Thamboo AV, Higgins TS, Scangas GA, Oliveira K, Ho AS, Mallen-St Clair J, Walgama E. A Clinical Decision Analysis for Use of Antibiotic Prophylaxis for Nonabsorbable Nasal Packing. Otolaryngol Head Neck Surg 2021; 165:647-654. [PMID: 33588621 DOI: 10.1177/0194599820988740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Nonabsorbable nasal packing is often placed for the treatment of epistaxis or after sinonasal or skull base surgery. Antibiotics are often prescribed to prevent toxic shock syndrome (TSS), a rare, potentially fatal occurrence. However, the risk of TSS must be balanced against the major risk of antibiotic use, specifically Clostridium difficile colitis (CDC). The purpose of this study is to evaluate in terms of cost-effectiveness whether antibiotics should be prescribed when nasal packing is placed. STUDY DESIGN A clinical decision analysis was performed using a Markov model to evaluate whether antibiotics should be given. SETTING Patients with nonabsorbable nasal packing placed. METHODS Utility scores, probabilities, and costs were obtained from the literature. We assess the cost-effectiveness of antibiotic use when the risk of community-acquired CDC is balanced against the risk of TSS from nasal packing. Sensitivity analysis was performed for assumptions used in the model. RESULTS The incremental cost-effectiveness ratio for antibiotic use was 334,493 US dollars (USD)/quality-adjusted life year (QALY). Probabilistic sensitivity analysis showed that not prescribing antibiotics was cost-effective in 98.0% of iterations at a willingness to pay of 50,000 USD/QALY. Sensitivity analysis showed that when the risk of CDC from antibiotics was greater than 910/100,000 or when the incidence of TSS after nasal packing was less than 49/100,000 cases, the decision to withhold antibiotics was cost-effective. CONCLUSIONS Routine antibiotic prophylaxis in the setting of nasal packing is not cost-effective and should be reconsidered. Even if antibiotics are assumed to prevent TSS, the risk of complications from antibiotic use is of greater consequence. LEVEL OF EVIDENCE 3a.
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Affiliation(s)
- Ximena Maul
- Division of Otolaryngology, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Otolaryngology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Berkay C Dincer
- Department of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, California, USA.,School of Medicine, Hacettepe University, Ankara, Turkey
| | - Arthur W Wu
- Department of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, California, USA
| | - Andrew V Thamboo
- Division of Otolaryngology, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas S Higgins
- Department of Otolaryngology-Head and Neck, University of Louisville, Louisville, Kentucky, USA
| | - George A Scangas
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Kristin Oliveira
- Department of General Surgery, Trauma, and Surgical Critical Care, Yale School of Medicine, New Haven, Connecticut, USA
| | - Allen S Ho
- Department of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, California, USA
| | - Jon Mallen-St Clair
- Department of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, California, USA
| | - Evan Walgama
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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14
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Vaginal Tampon Colonization by Staphylococcus aureus in Healthy Women. Appl Environ Microbiol 2020; 86:AEM.01249-20. [PMID: 32680868 DOI: 10.1128/aem.01249-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/08/2020] [Indexed: 11/20/2022] Open
Abstract
Tampons recovered from a cohort of 737 healthy women (median age, 32 years) were analyzed for the presence of Staphylococcus aureus A total of 198 tampons (27%) were colonized by S. aureus, 28 (4%) by a strain producing toxic shock syndrome toxin 1 (TSST-1). S. aureus was detected more frequently in tampons that did not require an applicator for their insertion (74/233 [32%] versus 90/381 [24%]; odds ratio [OR] = 1.51 [95% confidence interval, 1.04 to 2.17]) and in women who used an intrauterine device for contraception (53/155 [34%] versus 145/572 [27%]; OR = 1.53 [95% confidence interval, 1.05 to 2.24]). The S. aureus strains isolated from tampons belonged to 22 different clonal complexes (CCs). The most prevalent CC was CC398 agr1 (n = 57 [27%]), a clone that does not produce superantigenic toxins, followed by CC30 agr3 (n = 27, 13%), producing TSST-1 (24/27 [89%]), the principal clone of S. aureus involved in menstrual toxic shock syndrome (MTSS).IMPORTANCE Menstrual toxic shock syndrome (MTSS) is an uncommon severe acute disease that occurs in healthy menstruating women colonized by TSST-1-producing S. aureus who use intravaginal protection, such as tampons and menstrual cups. The catamenial product collected by the protection serves as a growth medium for S. aureus and allows TSST-1 production. Previous studies evaluated the prevalence of genital colonization by S. aureus by vaginal swabbing, but they did not examine tampon colonization. This study demonstrated a high prevalence of tampon colonization by S. aureus and the presence of the CC30 TSST-1 S. aureus clone responsible for MTSS in tampons from healthy women. The results support the vaginal carriage of this lineage in healthy women. In addition, the higher prevalence of S. aureus within tampons that do not require an applicator indicates a crucial role for handwashing before tampon handling to decrease the risk of tampon contamination.
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15
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Singh‐Grewal D, Lucas R, Macartney K, Cheng AC, Wood N, Ostring G, Britton P, Crawford N, Burgner D. Update on the COVID-19-associated inflammatory syndrome in children and adolescents; paediatric inflammatory multisystem syndrome-temporally associated with SARS-CoV-2. J Paediatr Child Health 2020; 56:1173-1177. [PMID: 32735721 PMCID: PMC7436879 DOI: 10.1111/jpc.15049] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 01/12/2023]
Abstract
We provide an update on the state of play with regards a newly described inflammatory condition which has arisen during the current SARS-CoV-2 pandemic. The condition has been named paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 or multisystem inflammatory syndrome in children. This condition has shown significant similarities to Kawasaki disease and toxic shock syndrome.
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Affiliation(s)
- Davinder Singh‐Grewal
- Department of RheumatologyThe Sydney Children's Hospitals NetworkSydneyNew South WalesAustralia,Paediatrics and Child HealthThe University of SydneySydneyNew South WalesAustralia,School of Maternal and Child HealthUniversity of New South WalesSydneyNew South WalesAustralia,Department of PaediatricsJohn Hunter Children's HospitalNewcastleNew South WalesAustralia
| | - Ryan Lucas
- Department of RheumatologyThe Sydney Children's Hospitals NetworkSydneyNew South WalesAustralia,Paediatrics and Child HealthThe University of SydneySydneyNew South WalesAustralia
| | - Kristine Macartney
- Children's Hospital Westmead Clinical School, The University of SydneySydneyNew South WalesAustralia,National Centre for Immunisation Research and SurveillanceWestmeadNew South WalesAustralia
| | - Allen C Cheng
- Department of Infectious DiseasesAlfred HealthMelbourneVictoriaAustralia,School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Nicholas Wood
- Department of RheumatologyThe Sydney Children's Hospitals NetworkSydneyNew South WalesAustralia,Paediatrics and Child HealthThe University of SydneySydneyNew South WalesAustralia
| | - Genevieve Ostring
- Paediatric RheumatologyStarship Children's HospitalAucklandNew Zealand,University of AucklandPaediatrics Child and Youth HealthAucklandNew Zealand
| | - Philip Britton
- Department of RheumatologyThe Sydney Children's Hospitals NetworkSydneyNew South WalesAustralia,Paediatrics and Child HealthThe University of SydneySydneyNew South WalesAustralia
| | - Nigel Crawford
- Infection and ImmunityMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Immunisation ServiceRoyal Children's HospitalMelbourneVictoriaAustralia,University of MelbourneMelbourneVictoriaAustralia
| | - David Burgner
- Infection and ImmunityMurdoch Children's Research InstituteMelbourneVictoriaAustralia,Infectious Diseases UniversityRoyal Children's HospitalMelbourneVictoriaAustralia,Department of PaediatricsUniversity of MelbourneMelbourneVictoriaAustralia,Department of PaediatricsMonash UniversityMelbourneVictoriaAustralia
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16
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Toxic Shock Syndrome after Surgery: Case Presentation and Systematic Review of the Literature. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e2499. [PMID: 33133879 PMCID: PMC7572075 DOI: 10.1097/gox.0000000000002499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/26/2019] [Indexed: 02/03/2023]
Abstract
Supplemental Digital Content is available in the text. Toxic shock syndrome (TSS) is an underrecognized but highly fatal cause of septic shock in postoperative patients. Although it may present with no overt source of infection, its course is devastating and rapidly progressive. Surgeon awareness is needed to recognize and treat this condition appropriately. In this paper, we aim to describe a case of postoperative TSS, present a systematic review of the literature, and provide an overview of the disease for the surgeon.
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Abstract
In the 1980s, menstrual toxic shock syndrome (mTSS) became a household topic, particularly among mothers and their daughters. The research performed at the time, and for the first time, exposed the American public as well as the biomedical community, in a major way, to understanding disease progression and investigation. Those studies led to the identification of the cause, Staphylococcus aureus and the pyrogenic toxin superantigen TSS toxin 1 (TSST-1), and many of the risk factors, for example, tampon use. Those studies in turn led to TSS warning labels on the outside and inside of tampon boxes and, as important, uniform standards worldwide of tampon absorbency labeling. This review addresses our understanding of the development and conclusions related to mTSS and risk factors. We leave the final message that even though mTSS is not commonly in the news today, cases continue to occur. Additionally, S. aureus strains cycle in human populations in roughly 10-year intervals, possibly dependent on immune status. TSST-1-producing S. aureus bacteria appear to be reemerging, suggesting that physician awareness of this emergence and mTSS history should be heightened.
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18
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Schlievert PM. Menstrual TSS remains a dangerous threat. EClinicalMedicine 2020; 21:100316. [PMID: 32382715 PMCID: PMC7201014 DOI: 10.1016/j.eclinm.2020.100316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/02/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Patrick M Schlievert
- University of Iowa, Carver College of Medicine, 51 Newton Road, Iowa City, Iowa 52242, USA
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19
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Billon A, Gustin MP, Tristan A, Bénet T, Berthiller J, Gustave CA, Vanhems P, Lina G. Association of characteristics of tampon use with menstrual toxic shock syndrome in France. EClinicalMedicine 2020; 21:100308. [PMID: 32382713 PMCID: PMC7201028 DOI: 10.1016/j.eclinm.2020.100308] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Menstrual tampons are widely used in western countries. Indirect evidence suggests that tampon misuse could be associated with an increased risk of menstrual toxic shock syndrome (MTSS). The aim of this study was to determine what characteristics of tampon use are associated with increased risk of menstrual toxic shock syndrome (MTSS). METHODS A nationwide, case-control study in France, was conducted with women that use tampons with MTSS diagnoses according to the CDC diagnostic criteria (n = 55, from January 2011, to December 2017) and a control group of women with no MTSS history (n = 126, from February to December 2017). Information regarding tampon use during a 6-month period was collected. Associations between tampon use and MTSS were assessed using logistic regression models stratified by residential area. FINDINGS Compared to controls, women diagnosed with MTSS more frequently reported maximum tampon wear of >6 h (62% vs. 41%; P = 0.02), overnight tampon use (77% vs. 54%; P = 0.006), and neither read nor followed tampon instructions in case of reading (65% vs. 42%; P = 0.006). In univariate analysis, MTSS risk was two-fold higher with tampon use for >6 consecutive hours (odds ratio, 2.3 [95% CI, 1.2-4.5]), and three-fold higher with tampon use during sleep for >8 h (odds ratio, 3.2 [95% CI, 1.4-7.7]). In multivariate logistic regression analysis, only maximum tampon use for >6 h (odds ratio, 2.03 [95% CI, 1.04-3.98]), and neither read nor followed the tampon instructions in case of reading (odds ratio, 2.25 [95% CI, 1.15-4.39]) were independently associated with MTSS. INTERPRETATION Our study suggests that the risk of MTSS was associated with using tampons for more than 6 h, overnight tampon use during sleep, and neither read nor followed tampon insertion instructions in case of reading. FUNDING LABEX ECOFECT (ANR-11-LABX-0048) of Université de Lyon within the programme "Investissements d'Avenir" (ANR-11-IDEX-0007) operated by the French National Research Agency (ANR).
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Affiliation(s)
- Amaury Billon
- Centre National de Référence de Staphylocoques - Institut des Agents Infectieux, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
| | - Marie-Paule Gustin
- Equipe Epidémiologie et Santé Internationale, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS, UMR 5308, ENS de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Anne Tristan
- Centre National de Référence de Staphylocoques - Institut des Agents Infectieux, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Equipe Pathogénie des Staphylocoques, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS, UMR 5308, ENS de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Thomas Bénet
- Service d'Hygiène, Épidémiologie, Infectiovigilance et Prévention, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Julien Berthiller
- Unité d'Appui Méthodologique - EPICIME - Cellule Innovation DRCi, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Claude Alexandre Gustave
- Centre National de Référence de Staphylocoques - Institut des Agents Infectieux, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Equipe Pathogénie des Staphylocoques, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS, UMR 5308, ENS de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Philippe Vanhems
- Equipe Epidémiologie et Santé Internationale, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS, UMR 5308, ENS de Lyon, Université Claude Bernard Lyon 1, Lyon, France
- Service d'Hygiène, Épidémiologie, Infectiovigilance et Prévention, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- Unité d'Appui Méthodologique - EPICIME - Cellule Innovation DRCi, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Gerard Lina
- Centre National de Référence de Staphylocoques - Institut des Agents Infectieux, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Equipe Pathogénie des Staphylocoques, Centre International de Recherche en Infectiologie, INSERM U1111, CNRS, UMR 5308, ENS de Lyon, Université Claude Bernard Lyon 1, Lyon, France
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Verdú-Expósito C, Romanyk J, Cuadros-González J, TesfaMariam A, Copa-Patiño JL, Pérez-Serrano J, Soliveri J. Study of susceptibility to antibiotics and molecular characterization of high virulence Staphylococcus aureus strains isolated from a rural hospital in Ethiopia. PLoS One 2020; 15:e0230031. [PMID: 32163464 PMCID: PMC7067403 DOI: 10.1371/journal.pone.0230031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 02/19/2020] [Indexed: 11/20/2022] Open
Abstract
We characterised 80 Staphylococcus aureus strains isolated from human patients with SSTIs at a rural hospital in Ethiopia. Susceptibility to antibiotic of all strains was tested. The MLST method was used to type and a phylogenetic analysis was conducted employing the sequences of 7 housekeeping genes. PCR amplification was used to investigate the presence of the following virulence genes in all strains: hla (α-haemolysin), tstH (toxic shock syndrome toxin), luk PV (Panton-Valentine leukocidin), fnbA (fibronectin binding protein A) and mecA (methicillin resistance). Most of the strains were resistant to penicillin and ampicillin, but only 3 strains were resistant to oxacillin, and 1 of them was a true MRSA. The MLST results showed a high diversity of sequence types (ST), 55% of which were new, and ST152 was the most prevalent. A phylogeny study showed that many of the new STs were phylogenetically related to other previously described STs, but bore little relationship to the only ST from Ethiopia described in the database. Virulence gene detection showed a high prevalence of strains encoding the hla, fnbA and pvl genes (98.77%, 96.3% and 72.84%, respectively), a low prevalence of the tst gene (13.58%) and a markedly low prevalence of MRSA (1.25%). S. aureus strains isolated from patients in a rural area in Ethiopia showed low levels of antibiotic resistance, except to penicillin. Moreover, this study reveals new STs in Eastern Africa that are phylogenetically related to other previously described STs, and confirm the high prevalence of the pvl gene and the low prevalence of MRSA on the continent.
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Affiliation(s)
- Cristina Verdú-Expósito
- Department of Biomedicine and Biotechnology, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Juan Romanyk
- Microbiology Service, Hospital Universitario Príncipe de Asturias, Alcalá-Meco, Alcalá de Henares, Madrid, Spain
| | - Juan Cuadros-González
- Microbiology Service, Hospital Universitario Príncipe de Asturias, Alcalá-Meco, Alcalá de Henares, Madrid, Spain
| | - Abraham TesfaMariam
- Department of General Medicine, Gambo General Rural Hospital, West-Arsi, Ethiopia
| | - José Luis Copa-Patiño
- Department of Biomedicine and Biotechnology, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Jorge Pérez-Serrano
- Department of Biomedicine and Biotechnology, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - Juan Soliveri
- Department of Biomedicine and Biotechnology, University of Alcalá, Alcalá de Henares, Madrid, Spain
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Abstract
BACKGROUND Toxic shock syndrome (TSS) is an acute, severe, toxin-mediated disease, characterized by fever, hypotension, and multiorgan system involvement. Toxic shock syndrome has made headlines because of its high associated morbidity and mortality rate in previously healthy young females. Incidence peaked in the early 1980s owing to increased usage of ultra-absorbent tampons. After improved patient education and tampon labeling, the incidence of menstrual TSS has declined. CASE A previously healthy 14-year-old girl presented to an urgent care center with a 2-day history of fever, erythematous maculopapular rash, vomiting, diarrhea, and malaise. She was found to be tachycardic and hypotensive. Investigations revealed thrombocytopenia, an elevated white count and lactate, and acute kidney injury, consistent with septic shock. Recent tampon usage with menstruation was reported, and a pelvic examination revealed purulent vaginal discharge. The patient was transferred to a pediatric intensive care unit for antibiotic and vasopressor therapy. Vaginal swabs later tested positive for Staphylococcus aureus and TSS toxin-1. CONCLUSIONS Although the incidence of TSS has decreased in recent years, it is crucial that clinicians rapidly recognize and treat this life-threatening condition. Emergency physicians should always have a high index of suspicion for TSS in young females presenting without another obvious cause of shock. A pelvic examination should always be completed in these cases.
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22
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van Eijk AM, Zulaika G, Lenchner M, Mason L, Sivakami M, Nyothach E, Unger H, Laserson K, Phillips-Howard PA. Menstrual cup use, leakage, acceptability, safety, and availability: a systematic review and meta-analysis. Lancet Public Health 2019; 4:e376-e393. [PMID: 31324419 PMCID: PMC6669309 DOI: 10.1016/s2468-2667(19)30111-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/15/2019] [Accepted: 06/17/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Girls and women need effective, safe, and affordable menstrual products. Single-use products are regularly selected by agencies for resource-poor settings; the menstrual cup is a less known alternative. We reviewed international studies on menstrual cup leakage, acceptability, and safety and explored menstrual cup availability to inform programmes. METHODS In this systematic review and meta-analysis, we searched PubMed, Cochrane Library, Web of Science, Popline, Cinahl, Global Health database, Emerald, Google Scholar, Science.gov, and WorldWideScience from database inception to May 14, 2019, for quantitative or qualitative studies published in English on experiences and leakage associated with menstrual cups, and adverse event reports. We also screened the Manufacturer and User Facility Device Experience database from the US Food and Drug Administration for events related to menstrual cups. To be eligible for inclusion, the material needed to have information on leakage, acceptability, or safety of menstrual cups. The main outcome of interest was menstrual blood leakage when using a menstrual cup. Safety outcomes of interest included serious adverse events; vaginal abrasions and effects on vaginal microflora; effects on the reproductive, digestive, or urinary tract; and safety in poor sanitary conditions. Findings were tabulated or combined by use of forest plots (random-effects meta-analysis). We also did preliminary estimates on costs and environmental savings potentially associated with cups. This systematic review is registered on PROSPERO, number CRD42016047845. FINDINGS Of 436 records identified, 43 studies were eligible for analysis (3319 participants). Most studies reported on vaginal cups (27 [63%] vaginal cups, five [12%] cervical cups, and 11 [25%] mixed types of cups or unknown) and 15 were from low-income and middle-income countries. 22 studies were included in qualitative or quantitative syntheses, of which only three were of moderate-to-high quality. Four studies made a direct comparison between menstrual cups and usual products for the main outcome of leakage and reported leakage was similar or lower for menstrual cups than for disposable pads or tampons (n=293). In all qualitative studies, the adoption of the menstrual cup required a familiarisation phase over several menstrual cycles and peer support improved uptake (two studies in developing countries). In 13 studies, 73% (pooled estimate: n=1144; 95% CI 59-84, I2=96%) of participants wished to continue use of the menstrual cup at study completion. Use of the menstrual cup showed no adverse effects on the vaginal flora (four studies, 507 women). We identified five women who reported severe pain or vaginal wounds, six reports of allergies or rashes, nine of urinary tract complaints (three with hydronephrosis), and five of toxic shock syndrome after use of the menstrual cup. Dislodgement of an intrauterine device was reported in 13 women who used the menstrual cup (eight in case reports, and five in one study) between 1 week and 13 months of insertion of the intrauterine device. Professional assistance to aid removal of menstrual cup was reported among 47 cervical cup users and two vaginal cup users. We identified 199 brands of menstrual cup, and availability in 99 countries with prices ranging US$0·72-46·72 (median $23·3, 145 brands). INTERPRETATION Our review indicates that menstrual cups are a safe option for menstruation management and are being used internationally. Good quality studies in this field are needed. Further studies are needed on cost-effectiveness and environmental effect comparing different menstrual products. FUNDING UK Medical Research Council, Department for International Development, and Wellcome Trust.
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Affiliation(s)
- Anna Maria van Eijk
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Garazi Zulaika
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Madeline Lenchner
- Population Health Sciences, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Linda Mason
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Muthusamy Sivakami
- Centre for Health and Social Sciences, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, Maharashtra, India
| | - Elizabeth Nyothach
- Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya
| | - Holger Unger
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, UK; Department of Obstetrics and Gynaecology, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Kayla Laserson
- Bill & Melinda Gates Foundation, India Country Office, New Delhi, India
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The Role of Streptococcal and Staphylococcal Exotoxins and Proteases in Human Necrotizing Soft Tissue Infections. Toxins (Basel) 2019; 11:toxins11060332. [PMID: 31212697 PMCID: PMC6628391 DOI: 10.3390/toxins11060332] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/04/2019] [Accepted: 06/10/2019] [Indexed: 12/31/2022] Open
Abstract
Necrotizing soft tissue infections (NSTIs) are critical clinical conditions characterized by extensive necrosis of any layer of the soft tissue and systemic toxicity. Group A streptococci (GAS) and Staphylococcus aureus are two major pathogens associated with monomicrobial NSTIs. In the tissue environment, both Gram-positive bacteria secrete a variety of molecules, including pore-forming exotoxins, superantigens, and proteases with cytolytic and immunomodulatory functions. The present review summarizes the current knowledge about streptococcal and staphylococcal toxins in NSTIs with a special focus on their contribution to disease progression, tissue pathology, and immune evasion strategies.
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Dugourd PM, Dupont A, Hubiche T, Chiaverini C, Alkhalifa A, Roudiere L, Tristan A, Gustave CA, Del Giudice P. [Staphylococcal toxic shock syndrome should be considered in the event of diffuse erythema with fever and shock]. Ann Dermatol Venereol 2019; 146:287-291. [PMID: 30691878 DOI: 10.1016/j.annder.2018.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/24/2018] [Accepted: 12/03/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Toxic shock syndrome (TSS) was first described by Todd in 1978. The relevant Lancet publication reported 7 cases of children with fever, exanthema, hypotension and diarrhoea associated with multiple organ failure. An association between TSS and use of hyper-absorbent tampons in menstruating women was discovered in the 1980s. Following the market withdrawal of such tampons, TSS virtually disappeared. Herein we report a new case of TSS in a 15-year-old girl. PATIENTS AND METHODS A 15-year-old patient was admitted to intensive care for severe sepsis and impaired consciousness associated with diffuse abdominal pain. Dermatological examination revealed diffuse macular exanthema. Laboratory tests showed hepatic cytolysis (ASAT 101 U/L, ALAT 167 U/L, total bilirubin 68μmol/L) and an inflammatory syndrome. Lumbar puncture and blood cultures were sterile while thoraco-abdomino-pelvic and brain scans were normal. The patient was menstruating and had been using a tampon over the previous 24hours. Vaginal sampling and tampon culture revealed TSST-1 toxin-producing S. aureus. Management consisted of intensive care measures and treatment with amoxicillin-clavulanic acid and clindamycin for 10 days. CONCLUSION In case of septic shock associated with diffuse macular exanthema a diagnosis of TSS must be envisaged, particularly in menstruating women.
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Affiliation(s)
- P-M Dugourd
- Service de dermatologie-infectiologie, CHI Fréjus Saint-Raphaël, 240, avenue de Saint-Lambert, 83600 Fréjus, France.
| | - A Dupont
- Service de rénimation-pédiatrique, CHU de Nice Lenval, 06000 Nice, France
| | - T Hubiche
- Service de dermatologie-infectiologie, CHI Fréjus Saint-Raphaël, 240, avenue de Saint-Lambert, 83600 Fréjus, France
| | - C Chiaverini
- Service de dermatologie, CHU d'Archet 2, 06200 Nice, France
| | - A Alkhalifa
- Service de dermatologie, CHU d'Archet 2, 06200 Nice, France
| | - L Roudiere
- Service de biologie médicale, CHI Fréjus Saint-Raphaël, 83600 Fréjus, France
| | - A Tristan
- Centre de biologie et pathologie Nord, Centre national de référence des staphylocoques, institut des agents infectieux, CHU de Lyon, 69317 Lyon, France
| | - C-A Gustave
- Centre de biologie et pathologie Nord, Centre national de référence des staphylocoques, institut des agents infectieux, CHU de Lyon, 69317 Lyon, France
| | - P Del Giudice
- Service de dermatologie-infectiologie, CHI Fréjus Saint-Raphaël, 240, avenue de Saint-Lambert, 83600 Fréjus, France
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Sharma H, Smith D, Turner CE, Game L, Pichon B, Hope R, Hill R, Kearns A, Sriskandan S. Clinical and Molecular Epidemiology of Staphylococcal Toxic Shock Syndrome in the United Kingdom. Emerg Infect Dis 2019; 24. [PMID: 29350159 PMCID: PMC5782905 DOI: 10.3201/eid2402.170606] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Staphylococcal toxic shock syndrome (TSS) was originally described in menstruating women and linked to TSS toxin 1 (TSST-1)-producing Staphylococcus aureus. Using UK national surveillance data, we ascertained clinical, molecular and superantigenic characteristics of TSS cases. Average annual TSS incidence was 0.07/100,000 population. Patients with nonmenstrual TSS were younger than those with menstrual TSS but had the same mortality rate. Children <16 years of age accounted for 39% of TSS cases, most caused by burns and skin and soft tissue infections. Nonmenstrual TSS is now more common than menstrual TSS in the UK, although both types are strongly associated with the tst+ clonal complex (CC) 30 methicillin-sensitive S. aureus lineage, which accounted for 49.4% of all TSS and produced more TSST-1 and superantigen bioactivity than did tst+ CC30 methicillin-resistant S. aureus strains. Better understanding of this MSSA lineage and infections in children could focus interventions to prevent TSS in the future.
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Pierson JD, Hansmann MA, Davis CC, Forney LJ. The effect of vaginal microbial communities on colonization by Staphylococcus aureus with the gene for toxic shock syndrome toxin 1 (TSST-1): a case-control study. Pathog Dis 2018; 76:4919727. [PMID: 29762733 DOI: 10.1093/femspd/fty015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 02/26/2018] [Indexed: 11/13/2022] Open
Abstract
Menstrual toxic shock syndrome is associated with vaginal colonization by Staphylococcus aureus strains that encode toxic shock syndrome toxin 1 (tst+). Interestingly, a small proportion of women are colonized by S. aureus tst+ but do not have symptoms of toxic shock syndrome. Here we sought to determine if differences in the species composition of vaginal bacterial communities reflect a differential risk of colonization by S. aureus capable of producing toxic shock syndrome toxin 1 (TSST-1). The composition of vaginal communities of women that were or were not colonized with S. aureus tst+ were compared based on terminal restriction fragment length polymorphism (T-RFLP) profiles and sequences of cloned 16S rRNA genes. There were no detectable differences in community composition or species rank abundance between communities of women vaginally colonized with S. aureus tst+ as compared to those that were not. Phylogenetic analysis of cloned 16S rRNA gene sequences showed that the predominant members of communities of women colonized with S. aureus tst+ were indistinguishable from those of other healthy women. The data suggest that the numerically dominant members of vaginal communities do not preclude colonization and proliferation of S. aureus tst+ within indigenous microbial communities of the vagina.
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Affiliation(s)
- Jacob D Pierson
- Institute for Bioinformatics and Evolutionary Studies and Department of Biological Sciences University of Idaho, Moscow, ID 83844-3051, USA
| | - Melanie A Hansmann
- FemCare Product Safety and Regulatory Affairs, The Procter and Gamble Company, Cincinnati, OH 45224, USA
| | - Catherine C Davis
- FemCare Product Safety and Regulatory Affairs, The Procter and Gamble Company, Cincinnati, OH 45224, USA
| | - Larry J Forney
- Institute for Bioinformatics and Evolutionary Studies and Department of Biological Sciences University of Idaho, Moscow, ID 83844-3051, USA
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Abstract
ABSTRACT
Fulminant staphylococcal infection indicates an explosive, intense, and severe infection occurring in a patient whose previous condition and antecedent would never have caused any anticipation of life-threatening development. This includes necrotizing pneumonia, necrotizing fasciitis, and to some extent toxic shock syndrome and infective endocarditis. In the three former diseases, toxin production plays a major role whereas in the latter (fulminant presentation of infective endocarditis), association with any particular toxinic profile has never been demonstrated. This article reviews the clinical, pathophysiological, and therapeutic aspects of these diseases.
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So N, Leavitt E, Aleshin M, Worswick S. The use of etanercept for treatment of toxic epidermal necrolysis when toxic shock syndrome is in the differential. Dermatol Ther 2018; 31:e12684. [PMID: 30175438 DOI: 10.1111/dth.12684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 07/06/2018] [Accepted: 07/16/2018] [Indexed: 11/27/2022]
Abstract
Toxic shock syndrome (TSS) can sometimes mimic Steven Johnsons syndrome/toxic epidermal necrolysis (SJS/TEN). Tumor necrosis factor (TNF) alpha is thought to play a role in the pathogenesis of both TSS and SJS/TEN. Etanercept, a TNF-alpha inhibitor has been recently shown to treat and decrease mortality of SJS/TEN. We report a 51-year-old female with history of SJS presenting with painful skin and bullae 2 days following cystoscopy with botulinum toxin injection into the bladder. Due to initial concern for SJS/TEN, the patient was treated with 50 mg of subcutaneous etanercept. Punch biopsies were not consistent with SJS, and the patient fulfilled five out of five criteria for a confirmed case of TSS. The patient ultimately had a favorable outcome despite etanercept treatment. Ultimately, TNF-alpha antagonists are an emerging therapy to treat SJS/TEN, and are unlikely to worsen TSS prognosis. Given that etanercept can be used to successfully treat SJS/TEN and TNF-alpha levels are elevated in TSS, if a dermatologist chooses to treat TEN with etanercept, consideration of TSS on the differential should not necessarily exclude etanercept as a reasonable treatment option.
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Affiliation(s)
- Naomi So
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Erica Leavitt
- Department of Medicine, Division of Dermatology, University of California Los Angeles, Los Angeles, California
| | - Maria Aleshin
- Department of Medicine, Division of Dermatology, University of California Los Angeles, Los Angeles, California
| | - Scott Worswick
- Department of Medicine, Division of Dermatology, University of California Los Angeles, Los Angeles, California
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Jacquemond I, Muggeo A, Lamblin G, Tristan A, Gillet Y, Bolze PA, Bes M, Gustave CA, Rasigade JP, Golfier F, Ferry T, Dubost A, Abrouk D, Barreto S, Prigent-Combaret C, Thioulouse J, Lina G, Muller D. Complex ecological interactions of Staphylococcus aureus in tampons during menstruation. Sci Rep 2018; 8:9942. [PMID: 29967393 PMCID: PMC6028614 DOI: 10.1038/s41598-018-28116-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/11/2018] [Indexed: 01/08/2023] Open
Abstract
Menstrual toxic shock syndrome (mTSS) is a severe disease that occurs in healthy women vaginally colonized by Staphylococcus aureus producing toxic shock toxin 1 and who use tampons. The aim of the present study was to determine the impact of the composition of vaginal microbial communities on tampon colonisation by S. aureus during menses. We analysed the microbiota in menstrual fluids extracted from tampons from 108 healthy women and 7 mTSS cases. Using culture, S. aureus was detected in menstrual fluids of 40% of healthy volunteers and 100% of mTSS patients. Between class analysis of culturomic and 16S rRNA gene metabarcoding data indicated that the composition of the tampons' microbiota differs according to the presence or absence of S. aureus and identify discriminating genera. However, the bacterial communities of tampon fluid positive for S. aureus did not cluster together. No difference in tampon microbiome richness, diversity, and ecological distance was observed between tampon vaginal fluids with or without S. aureus, and between healthy donors carrying S. aureus and mTSS patients. Our results show that the vagina is a major niche of. S. aureus in tampon users and the composition of the tampon microbiota control its virulence though more complex interactions than simple inhibition by lactic acid-producing bacterial species.
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Affiliation(s)
- Isaline Jacquemond
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, INRA, VetAgro Sup, UMR Ecologie Microbienne, 43 bd du 11 Novembre, F-69622, Villeurbanne, France
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
| | - Anaëlle Muggeo
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
| | - Gery Lamblin
- Department of Gynecology, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | - Anne Tristan
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
- Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Yves Gillet
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
- Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
- Department of Pediatric Emergency, Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Bron, France
| | - Pierre Adrien Bolze
- Department of Gynecological Surgery and Oncology, Obstetrics, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Michèle Bes
- Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Claude Alexandre Gustave
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
- Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Jean-Philippe Rasigade
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
- Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - François Golfier
- Department of Gynecological Surgery and Oncology, Obstetrics, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Tristan Ferry
- Service des maladies infectieuses et tropicales, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
| | - Audrey Dubost
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, INRA, VetAgro Sup, UMR Ecologie Microbienne, 43 bd du 11 Novembre, F-69622, Villeurbanne, France
| | - Danis Abrouk
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, INRA, VetAgro Sup, UMR Ecologie Microbienne, 43 bd du 11 Novembre, F-69622, Villeurbanne, France
| | - Samuel Barreto
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, INRA, VetAgro Sup, UMR Ecologie Microbienne, 43 bd du 11 Novembre, F-69622, Villeurbanne, France
- Université Lyon 1, CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France
| | - Claire Prigent-Combaret
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, INRA, VetAgro Sup, UMR Ecologie Microbienne, 43 bd du 11 Novembre, F-69622, Villeurbanne, France
| | - Jean Thioulouse
- Université Lyon 1, CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Villeurbanne, France
| | - Gérard Lina
- CIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France.
- Centre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.
| | - Daniel Muller
- Université de Lyon, Université Claude Bernard Lyon 1, CNRS, INRA, VetAgro Sup, UMR Ecologie Microbienne, 43 bd du 11 Novembre, F-69622, Villeurbanne, France.
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Vázquez-Martínez ER, García-Gómez E, Camacho-Arroyo I, González-Pedrajo B. Sexual dimorphism in bacterial infections. Biol Sex Differ 2018; 9:27. [PMID: 29925409 PMCID: PMC6011518 DOI: 10.1186/s13293-018-0187-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/08/2018] [Indexed: 12/21/2022] Open
Abstract
Background Sex differences are important epidemiological factors that impact in the frequency and severity of infectious diseases. A clear sexual dimorphism in bacterial infections has been reported in both humans and animal models. Nevertheless, the molecular mechanisms involved in this gender bias are just starting to be elucidated. In the present article, we aim to review the available data in the literature that report bacterial infections presenting a clear sexual dimorphism, without considering behavioral and social factors. Main body The sexual dimorphism in bacterial infections has been mainly attributed to the differential levels of sex hormones between males and females, as well as to genetic factors. In general, males are more susceptible to gastrointestinal and respiratory bacterial diseases and sepsis, while females are more susceptible to genitourinary tract bacterial infections. However, these incidences depend on the population evaluated, animal model and the bacterial species. Female protection against bacterial infections and the associated complications is assumed to be due to the pro-inflammatory effect of estradiol, while male susceptibility to those infections is associated with the testosterone-mediated immune suppression, probably via their specific receptors. Recent studies indicate that the protective effect of estradiol depends on the estrogen receptor subtype and the specific tissue compartment involved in the bacterial insult, suggesting that tissue-specific expression of particular sex steroid receptors contributes to the susceptibility to bacterial infections. Furthermore, this gender bias also depends on the effects of sex hormones on specific bacterial species. Finally, since a large number of genes related to immune functions are located on the X chromosome, X-linked mosaicism confers a highly polymorphic gene expression program that allows women to respond with a more expanded immune repertoire as compared with men. Conclusion Notwithstanding there is increasing evidence that confirms the sexual dimorphism in certain bacterial infections and the molecular mechanisms associated, further studies are required to clarify conflicting data and to determine the role of specific hormone receptors involved in the gender bias of bacterial infections, as well as their potential as therapeutic targets.
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Affiliation(s)
- Edgar Ricardo Vázquez-Martínez
- Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología-Facultad de Química, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
| | - Elizabeth García-Gómez
- Unidad de Investigación en Reproducción Humana, Consejo Nacional de Ciencia y Tecnología (CONACyT)-Instituto Nacional de Perinatología, Ciudad de México, Mexico
| | - Ignacio Camacho-Arroyo
- Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología-Facultad de Química, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
| | - Bertha González-Pedrajo
- Departamento de Genética Molecular, Instituto de Fisiología Celular, UNAM, Ciudad Universitaria, Av. Universidad 3000, Coyoacán, 04510, Ciudad de México, Mexico.
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Tuffs SW, Haeryfar SMM, McCormick JK. Manipulation of Innate and Adaptive Immunity by Staphylococcal Superantigens. Pathogens 2018; 7:pathogens7020053. [PMID: 29843476 PMCID: PMC6027230 DOI: 10.3390/pathogens7020053] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 12/15/2022] Open
Abstract
Staphylococcal superantigens (SAgs) constitute a family of potent exotoxins secreted by Staphylococcus aureus and other select staphylococcal species. SAgs function to cross-link major histocompatibility complex (MHC) class II molecules with T cell receptors (TCRs) to stimulate the uncontrolled activation of T lymphocytes, potentially leading to severe human illnesses such as toxic shock syndrome. The ubiquity of SAgs in clinical S. aureus isolates suggests that they likely make an important contribution to the evolutionary fitness of S. aureus. Although the apparent redundancy of SAgs in S. aureus has not been explained, the high level of sequence diversity within this toxin family may allow for SAgs to recognize an assorted range of TCR and MHC class II molecules, as well as aid in the avoidance of humoral immunity. Herein, we outline the major diseases associated with the staphylococcal SAgs and how a dysregulated immune system may contribute to pathology. We then highlight recent research that considers the importance of SAgs in the pathogenesis of S. aureus infections, demonstrating that SAgs are more than simply an immunological diversion. We suggest that SAgs can act as targeted modulators that drive the immune response away from an effective response, and thus aid in S. aureus persistence.
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Affiliation(s)
- Stephen W Tuffs
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada.
| | - S M Mansour Haeryfar
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada.
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON N6A 3K7, Canada.
- Centre for Human Immunology, Western University, London, ON N6A 3K7, Canada.
- Lawson Health Research Institute, London, ON N6C 2R5, Canada.
| | - John K McCormick
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada.
- Centre for Human Immunology, Western University, London, ON N6A 3K7, Canada.
- Lawson Health Research Institute, London, ON N6C 2R5, Canada.
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Abstract
Staphylococcal and streptococcal toxic shock syndrome (TSS) are associated with significant morbidity and mortality. There has been considerable progress in understanding the pathophysiology and delineating optimal management and treatment. This article reviews the management of TSS, outlining the 'Seven Rs of Managing and Treating TSS': Recognition, Resuscitation, Removal of source of infection, Rational choice of antibiotics, Role of adjunctive treatment (clindamycin and intravenous immunoglobulin), Review of progress and Reduce risk of secondary cases in close contacts.
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Affiliation(s)
- Amanda L Wilkins
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Andrew C Steer
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia; Infectious Diseases & Microbiology and Group A Streptococcal Research Groups, Murdoch Children's Research Institute, Parkville, Australia; Centre for International Child Health, University of Melbourne, Melbourne, Australia
| | - Pierre R Smeesters
- Centre for International Child Health, University of Melbourne, Melbourne, Australia; Paediatric Department, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium; Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Nigel Curtis
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia; Infectious Diseases & Microbiology and Group A Streptococcal Research Groups, Murdoch Children's Research Institute, Parkville, Australia.
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33
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Gottlieb M, Long B, Koyfman A. The Evaluation and Management of Toxic Shock Syndrome in the Emergency Department: A Review of the Literature. J Emerg Med 2018; 54:807-814. [PMID: 29366615 DOI: 10.1016/j.jemermed.2017.12.048] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 12/17/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Toxic shock syndrome (TSS) is a severe, toxin-mediated illness that can mimic several other diseases and is lethal if not recognized and treated appropriately. OBJECTIVE This review provides an emergency medicine evidence-based summary of the current evaluation and treatment of TSS. DISCUSSION The most common etiologic agents are Staphylococcus aureus and Streptococcus pyogenes. Sources of TSS include postsurgical wounds, postpartum, postabortion, burns, soft tissue injuries, pharyngitis, and focal infections. Symptoms are due to toxin production and infection focus. Early symptoms include fever, chills, malaise, rash, vomiting, diarrhea, and hypotension. Diffuse erythema and desquamation may occur later in the disease course. Laboratory assessment may demonstrate anemia, thrombocytopenia, elevated liver enzymes, and abnormal coagulation studies. Diagnostic criteria are available to facilitate the diagnosis, but they should not be relied on for definitive diagnosis. Rather, specific situations should trigger consideration of this disease process. Treatment involves intravenous fluids, source control, and antibiotics. Antibiotics should include a penicillinase-resistant penicillin, cephalosporin, or vancomycin (in methicillin-resistant S. aureus prevalent areas) along with either clindamycin or linezolid. CONCLUSION TSS is a potentially deadly disease requiring prompt recognition and treatment. Focused history, physical examination, and laboratory testing are important for the diagnosis and management of this disease. Understanding the evaluation and treatment of TSS can assist providers with effectively managing these patients.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
| | - Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
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34
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Strom MA, Hsu DY, Silverberg JI. Prevalence, comorbidities and mortality of toxic shock syndrome in children and adults in the USA. Microbiol Immunol 2017; 61:463-473. [DOI: 10.1111/1348-0421.12539] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/11/2017] [Accepted: 09/07/2017] [Indexed: 02/01/2023]
Affiliation(s)
- Mark A. Strom
- Department of Dermatology; Feinberg School of Medicine at Northwestern University; 676 N Saint Clair, St Suite 1600 Chicago IL 60611 USA
| | - Derek Y. Hsu
- Department of Dermatology; Feinberg School of Medicine at Northwestern University; 676 N Saint Clair, St Suite 1600 Chicago IL 60611 USA
| | - Jonathan I. Silverberg
- Departments of Dermatology; Preventive Medicine and Medical Social Sciences; Feinberg School of Medicine at Northwestern University; 676 N Saint Clair, St Suite 1600 Chicago IL 60611 USA
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35
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Epidemiology and hospital readmission associated with complications of Staphylococcus aureus bacteremia in pediatrics over a 25-year period. Epidemiol Infect 2017; 145:2631-2639. [PMID: 28748772 DOI: 10.1017/s0950268817001571] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
We sought to comprehensively assess the prevalence and outcomes of complications associated with Staphylococcus aureus bacteremia (SAB) in children. Secondarily, prevalence of methicillin resistance and outcomes of complications from methicillin-resistant S. aureus (MRSA) vs. methicillin-susceptible S. aureus SAB were assessed. This is a single-center cross-sectional study of 376 patients ⩽18 years old with SAB in 1990-2014. Overall, 197 (52%) patients experienced complications, the most common being osteomyelitis (33%), skin and soft tissue infection (31%), and pneumonia (25%). Patients with complications were older (median 3 vs. 0·7 years, P = 0·05) and more had community-associated SAB (66% vs. 34%, P = 0·001). Fewer patients with complications had a SAB-related emergency department or hospital readmission (10% vs. 19%, P = 0·014). Prevalence of methicillin resistance increased from 1990-1999 to 2000-2009, but decreased in 2010-2014. Complicated MRSA bacteremia resulted in more intensive care unit admissions (66% vs. 47%, P = 0·03) and led to increased likelihood of having ⩾2 foci (58% vs. 26%, P < 0·001). From multivariate analysis, community-associated SAB increased risk and concurrent infections decreased risk of complications (odds ratio (OR) 1·82 (1·1-3·02), P = 0·021) and (OR 0·58 (0·34-0·97), P = 0·038), respectively. In conclusion, children with SAB should be carefully evaluated for complications. Methicillin resistance remains associated with poor outcomes but have decreased in overall prevalence.
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36
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Komuro H, Kato T, Okada S, Nakatani K, Matsumoto R, Nishida K, Iida H, Iida M, Tsujimoto S, Suganuma T. Toxic shock syndrome caused by suture abscess with methicillin-resistant Staphylococcus aureus (MRSA) with late onset after Caesarean section. IDCases 2017; 10:12-14. [PMID: 28791216 PMCID: PMC5536821 DOI: 10.1016/j.idcr.2017.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 07/12/2017] [Accepted: 07/12/2017] [Indexed: 11/28/2022] Open
Abstract
Toxic shock syndrome (TSS) is a rare but life-threatening multisystem disease known to develop in the early postoperative period after various surgery. We report a rare case in which a patient who underwent Caesarean section developed TSS caused by methicillin-resistant Staphylococcus aureus (MRSA) on the 39th postoperative day. She was treated with debridement because of the possible diagnosis of necrotizing soft tissue infections. Culture test from the resected specimen was positive for MRSA. She was diagnosed with TSS caused by suture abscess and was treated with intensive care including antimicrobials. After a good postoperative course, she was discharged on the 30th postoperative day. TSS occurring 4 weeks after operation is extremely rare, but late-onset of suture abscess is known to occur. We should becognizant of development with TSS beyond early postoperative period.
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Affiliation(s)
- Hiroyasu Komuro
- Department of Surgery, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka City, Kanagawa 238-8567, Japan
| | - Takaharu Kato
- Department of Surgery, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka City, Kanagawa 238-8567, Japan
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan
- Corresponding author at: Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama 330-8503, Japan.Department of SurgeryYokosuka General Hospital Uwamachi2-36 UwamachiYokosuka CityKanagawa238-8567Japan
| | - Shinichiro Okada
- Department of Surgery, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka City, Kanagawa 238-8567, Japan
| | - Kensuke Nakatani
- Department of Surgery, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka City, Kanagawa 238-8567, Japan
| | - Risa Matsumoto
- Department of Surgery, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka City, Kanagawa 238-8567, Japan
| | - Kazuhiro Nishida
- Department of Surgery, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka City, Kanagawa 238-8567, Japan
| | - Hiroyuki Iida
- Department of Internal Medicine, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka, Kanagawa 238-8567, Japan
| | - Maki Iida
- Department of Pathology, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka, Kanagawa 238-8567, Japan
| | - Shiro Tsujimoto
- Department of Pathology, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka, Kanagawa 238-8567, Japan
| | - Toshiyuki Suganuma
- Department of Surgery, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka City, Kanagawa 238-8567, Japan
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Nanishi E, Nishio H, Takada H, Yamamura K, Fukazawa M, Furuno K, Mizuno Y, Saigo K, Kadoya R, Ohbuchi N, Onoe Y, Yamashita H, Nakayama H, Hara T, Ohno T, Takahashi Y, Hatae K, Harada T, Shimose T, Kishimoto J, Ohga S, Hara T. Clarithromycin Plus Intravenous Immunoglobulin Therapy Can Reduce the Relapse Rate of Kawasaki Disease: A Phase 2, Open-Label, Randomized Control Study. J Am Heart Assoc 2017; 6:JAHA.116.005370. [PMID: 28684643 PMCID: PMC5586277 DOI: 10.1161/jaha.116.005370] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background We previously reported that biofilms and innate immunity contribute to the pathogenesis of Kawasaki disease. Therefore, we aimed to assess the efficacy of clarithromycin, an antibiofilm agent, in patients with Kawasaki disease. Methods and Results We conducted an open‐label, multicenter, randomized, phase 2 trial at 8 hospitals in Japan. Eligible patients included children aged between 4 months and 5 years who were enrolled between days 4 and 8 of illness. Participants were randomly allocated to receive either intravenous immunoglobulin (IVIG) or IVIG plus clarithromycin. The primary end point was the duration of fever after the initiation of IVIG treatment. Eighty‐one eligible patients were randomized. The duration of the fever did not differ between the 2 groups (mean±SD, 34.3±32.4 and 31.1±31.1 hours in the IVIG plus clarithromycin group and the IVIG group, respectively [P=0.66]). The relapse rate of patients in the IVIG plus clarithromycin group was significantly lower than that in the IVIG group (12.5% versus 30.8%, P=0.046). No serious adverse events occurred during the study period. In a post hoc analysis, the patients in the IVIG plus clarithromycin group required significantly shorter mean lengths of hospital stays than those in the IVIG group (8.9 days versus 10.3 days, P=0.049). Conclusions Although IVIG plus clarithromycin therapy failed to shorten the duration of fever, it reduced the relapse rate and shortened the duration of hospitalization in patients with Kawasaki disease. Clinical Trial Registration URL: http://www.umin.ac.jp/ctr/index.htm. Unique identifier: UMIN000015437.
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Affiliation(s)
- Etsuro Nanishi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hisanori Nishio
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan .,Center for the Study of Global Infection, Kyushu University Hospital, Fukuoka, Japan
| | - Hidetoshi Takada
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Perinatal and Pediatric Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichiro Yamamura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Kenji Furuno
- Kawasaki Disease Center, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Yumi Mizuno
- Kawasaki Disease Center, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Kenjiro Saigo
- Department of Pediatrics, Yamaguchi Red Cross Hospital, Yamaguchi, Japan
| | - Ryo Kadoya
- Department of Pediatrics, Yamaguchi Red Cross Hospital, Yamaguchi, Japan
| | - Noriko Ohbuchi
- Department of Pediatrics, Yamaguchi Red Cross Hospital, Yamaguchi, Japan
| | - Yasuhiro Onoe
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Kitakyushu, Japan
| | - Hironori Yamashita
- Department of Pediatrics, National Hospital Organization Kokura Medical Center, Kitakyushu, Japan
| | - Hideki Nakayama
- Department of Pediatrics, Fukuoka Higashi Medical Center, Koga, Japan
| | - Takuya Hara
- Department of Pediatrics, Oita Prefectural Hospital, Oita, Japan
| | - Takuro Ohno
- Department of Pediatrics, Oita Prefectural Hospital, Oita, Japan
| | - Yasuhiko Takahashi
- Department of Pediatrics, Japan Community Healthcare Organization (JCHO) Kyushu Hospital, Kitakyushu, Japan
| | - Ken Hatae
- Department of Pediatrics, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | - Tatsuo Harada
- Department of Pediatrics, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | | | - Junji Kishimoto
- Department of Research and Development of Next Generation Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiro Hara
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Fukuoka Children's Hospital, Fukuoka, Japan
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Chatzopoulou M, Koufakis T, Ntava E, Gabranis I, Tsiakalou M. Intense, flu-like symptoms in women using menstrual devices: always think of staphylococcal Toxic Shock Syndrome. Oxf Med Case Reports 2017; 2017:omx020. [PMID: 28580155 PMCID: PMC5448456 DOI: 10.1093/omcr/omx020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/06/2017] [Accepted: 03/21/2017] [Indexed: 11/14/2022] Open
Abstract
Staphylococcal Toxic Shock Syndrome (TSS) is an exceptionally rare, toxin-induced,
life-threatening, clinical entity that has largely been associated with the use of tampons
and other menstrual devices. We, here, report a case of menstrual TSS in a young, female
patient who was successfully treated in our hospital. The patient was vaginally colonized
with Staphylococcus aureus and Escherichia coli and the
possible interactions between the two are discussed. An account of all the essential facts
that physicians should be aware of with regard to TSS is subsequently included.
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Affiliation(s)
| | | | - Evdokia Ntava
- General Hospital of Larisa, Internal Medicine, Larissa, Greece
| | | | - Maria Tsiakalou
- General Hospital of Larisa, Medical Microbiology, Larissa, Greece
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40
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Juma J, Nyothach E, Laserson KF, Oduor C, Arita L, Ouma C, Oruko K, Omoto J, Mason L, Alexander KT, Fields B, Onyango C, Phillips-Howard PA. Examining the safety of menstrual cups among rural primary school girls in western Kenya: observational studies nested in a randomised controlled feasibility study. BMJ Open 2017; 7:e015429. [PMID: 28473520 PMCID: PMC5566618 DOI: 10.1136/bmjopen-2016-015429] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Examine the safety of menstrual cups against sanitary pads and usual practice in Kenyan schoolgirls. DESIGN Observational studies nested in a cluster randomised controlled feasibility study. SETTING 30 primary schools in a health and demographic surveillance system in rural western Kenya. PARTICIPANTS Menstruating primary schoolgirls aged 14-16 years participating in a menstrual feasibility study. INTERVENTIONS Insertable menstrual cup, monthly sanitary pads or 'usual practice' (controls). OUTCOME MEASURES Staphylococcus aureus vaginal colonization, Escherichia coli growth on sampled used cups, toxic shock syndrome or other adverse health outcomes. RESULTS Among 604 eligible girls tested, no adverse event or TSS was detected over a median 10.9 months follow-up. S. aureusprevalence was 10.8%, with no significant difference over intervention time or between groups. Of 65 S.aureus positives at first test, 49 girls were retested and 10 (20.4%) remained positive. Of these, two (20%) sample isolates tested positive for toxic shock syndrome toxin-1; both girls were provided pads and were clinically healthy. Seven per cent of cups required replacements for loss, damage, dropping in a latrine or a poor fit. Of 30 used cups processed for E. coli growth, 13 (37.1%, 95% CI 21.1% to 53.1%) had growth. E. coli growth was greatest in newer compared with established users (53%vs22.2%, p=0.12). CONCLUSIONS Among this feasibility sample, no evidence emerged to indicate menstrual cups are hazardous or cause health harms among rural Kenyan schoolgirls, but large-scale trials and post-marketing surveillance should continue to evaluate cup safety.
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Affiliation(s)
- Jane Juma
- Center for Global Health, Kenya Medical Research Institute, Kisumu, Kenya
| | - Elizabeth Nyothach
- Center for Global Health, Kenya Medical Research Institute, Kisumu, Kenya
| | - Kayla F Laserson
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Clifford Oduor
- Center for Global Health, Kenya Medical Research Institute, Kisumu, Kenya
| | - Lilian Arita
- Center for Global Health, Kenya Medical Research Institute, Kisumu, Kenya
| | - Caroline Ouma
- Center for Global Health, Kenya Medical Research Institute, Kisumu, Kenya
| | - Kelvin Oruko
- Center for Global Health, Kenya Medical Research Institute, Kisumu, Kenya
| | - Jackton Omoto
- Siaya District Hospital, Ministry of Health, Siaya, Kenya
| | - Linda Mason
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Barry Fields
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Clayton Onyango
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Szabo PA, Goswami A, Mazzuca DM, Kim K, O'Gorman DB, Hess DA, Welch ID, Young HA, Singh B, McCormick JK, Haeryfar SMM. Rapid and Rigorous IL-17A Production by a Distinct Subpopulation of Effector Memory T Lymphocytes Constitutes a Novel Mechanism of Toxic Shock Syndrome Immunopathology. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2017; 198:2805-2818. [PMID: 28219889 PMCID: PMC6635948 DOI: 10.4049/jimmunol.1601366] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 01/25/2017] [Indexed: 01/13/2023]
Abstract
Toxic shock syndrome (TSS) is caused by staphylococcal and streptococcal superantigens (SAgs) that provoke a swift hyperinflammatory response typified by a cytokine storm. The precipitous decline in the host's clinical status and the lack of targeted therapies for TSS emphasize the need to identify key players of the storm's initial wave. Using a humanized mouse model of TSS and human cells, we herein demonstrate that SAgs elicit in vitro and in vivo IL-17A responses within hours. SAg-triggered human IL-17A production was characterized by remarkably high mRNA stability for this cytokine. A distinct subpopulation of CD4+ effector memory T (TEM) cells that secrete IL-17A, but not IFN-γ, was responsible for early IL-17A production. We found mouse "TEM-17" cells to be enriched within the intestinal epithelium and among lamina propria lymphocytes. Furthermore, interfering with IL-17A receptor signaling in human PBMCs attenuated the expression of numerous inflammatory mediators implicated in the TSS-associated cytokine storm. IL-17A receptor blockade also abrogated the secondary effect of SAg-stimulated PBMCs on human dermal fibroblasts as judged by C/EBP δ expression. Finally, the early IL-17A response to SAgs was pathogenic because in vivo neutralization of IL-17A in humanized mice ameliorated hepatic and intestinal damage and reduced mortality. Together, our findings identify CD4+ TEM cells as a key effector of TSS and reveal a novel role for IL-17A in TSS immunopathogenesis. Our work thus elucidates a pathogenic, as opposed to protective, role for IL-17A during Gram-positive bacterial infections. Accordingly, the IL-17-IL-17R axis may provide an attractive target for the management of SAg-mediated illnesses.
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Affiliation(s)
- Peter A Szabo
- Department of Microbiology and Immunology, Western University, London, Ontario N6A 5C1, Canada
| | - Ankur Goswami
- Department of Microbiology and Immunology, Western University, London, Ontario N6A 5C1, Canada
| | - Delfina M Mazzuca
- Department of Microbiology and Immunology, Western University, London, Ontario N6A 5C1, Canada
| | - Kyoungok Kim
- Department of Microbiology and Immunology, Western University, London, Ontario N6A 5C1, Canada
| | - David B O'Gorman
- Cell and Molecular Biology Laboratory, Roth | McFarlane Hand and Upper Limb Centre, Western University, London, Ontario N6A 4V2, Canada
- Department of Biochemistry, Western University, London, Ontario N6A 5C1, Canada
- Lawson Health Research Institute, London, Ontario N6C 2R5, Canada
- Department of Surgery, Western University, London, Ontario N6A 4V2, Canada
| | - David A Hess
- Department of Physiology and Pharmacology, Western University, London, Ontario N6A 5C1, Canada
- Krembil Centre for Stem Cell Biology, Molecular Medicine Research Group, Robarts Research Institute, London, Ontario N6A 5B7, Canada
| | - Ian D Welch
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia V6T 2B5, Canada
| | - Howard A Young
- Cancer and Inflammation Program, Center for Cancer Research, National Cancer Institute-Frederick, Frederick, MD 21702
| | - Bhagirath Singh
- Department of Microbiology and Immunology, Western University, London, Ontario N6A 5C1, Canada
- Lawson Health Research Institute, London, Ontario N6C 2R5, Canada
- Centre for Human Immunology, Western University, London, Ontario N6A 5C1, Canada; and
| | - John K McCormick
- Department of Microbiology and Immunology, Western University, London, Ontario N6A 5C1, Canada
- Lawson Health Research Institute, London, Ontario N6C 2R5, Canada
- Centre for Human Immunology, Western University, London, Ontario N6A 5C1, Canada; and
| | - S M Mansour Haeryfar
- Department of Microbiology and Immunology, Western University, London, Ontario N6A 5C1, Canada;
- Lawson Health Research Institute, London, Ontario N6C 2R5, Canada
- Centre for Human Immunology, Western University, London, Ontario N6A 5C1, Canada; and
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario N6A 5A5, Canada
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Abstract
Staphylococcus aureus, although generally identified as a commensal, is also a common cause of human bacterial infections, including of the skin and other soft tissues, bones, bloodstream, and respiratory tract. The history of S. aureus treatment is marked by the development of resistance to each new class of antistaphylococcal antimicrobial drugs, including the penicillins, sulfonamides, tetracyclines, glycopeptides, and others, complicating therapy. S. aureus isolates identified in the 1960s were sometimes resistant to methicillin, a ß-lactam antimicrobial active initially against a majority S. aureus strains. These MRSA isolates, resistant to nearly all ß-lactam antimicrobials, were first largely confined to the health care environment and the patients who attended it. However, in the mid-1990s, new strains, known as community-associated (CA-) MRSA strains, emerged. CA-MRSA organisms, compared with health care-associated (HA-) MRSA strain types, are more often susceptible to multiple classes of non ß-lactam antimicrobials. While infections caused by methicillin-susceptible S. aureus (MSSA) strains are usually treated with drugs in the ß-lactam class, such as cephalosporins, oxacillin or nafcillin, MRSA infections are treated with drugs in other antimicrobial classes. The glycopeptide drug vancomycin, and in some countries teicoplanin, is the most common drug used to treat severe MRSA infections. There are now other classes of antimicrobials available to treat staphylococcal infections, including several that have been approved after 2009. The antimicrobial management of invasive and noninvasive S. aureus infections in the ambulatory and in-patient settings is the topic of this review. Also discussed are common adverse effects of antistaphylococcal antimicrobial agents, advantages of one agent over another for specific clinical syndromes, and the use of adjunctive therapies such as surgery and intravenous immunoglobulin. We have detailed considerations in the therapy of noninvasive and invasive S. aureus infections. This is followed by sections on specific clinical infectious syndromes including skin and soft tissue infections, bacteremia, endocarditis and intravascular infections, pneumonia, osteomyelitis and vertebral discitis, epidural abscess, septic arthritis, pyomyositis, mastitis, necrotizing fasciitis, orbital infections, endophthalmitis, parotitis, staphylococcal toxinoses, urogenital infections, and central nervous system infections.
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Abstract
Toxic shock syndrome (TSS) represents a heterogeneous group of disorders that results in hypotension, multiorgan system involvement, and a characteristic rash or soft tissue infection caused by staphylococcal or streptococcal exotoxins and enterotoxins. Staphylococcal TSS emerged in the late 1970s as an illness associated with highly absorbent tampons; subsequently it has been described with postoperative infections, burns, and various viral illnesses. Although the morbidity rate associated with staphylococcal TSS may be high, the mortality rate approximates 5%. Streptococcal TSS has emerged in the 1980s and into the 1990s as a disorder that results in rapid progression of soft tissue infection in the form of cellulitis, myositis, or necrotizing fasciitis due to pyogenic streptococcal group A exotoxin. The rapidity of progression of local infection to hypotension and multiorgan failure results in a mortality rate of 30–70%. In both forms of TSS, staphylococcal and streptococcal exotoxins function as superantigens, a unique mechanism of immune activation that results in an exuberant T-cell response and profound cytokine expression. The role of antibiotics is reviewed. The use of clindamycin in streptococcal TSS and the potential therapeutic role of intravenous immunoglobulin in both forms of this disorder are discussed as well.
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Affiliation(s)
- Paul F. Dellaripa
- Section of Pulmonary and Critical Care Medicine and Section of Rheumatology, Lahey Clinic Medical Center, Burlington, MA
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Nanishi E, Hirata Y, Lee S, Kaku N, Momii K, Kubota K, Nishio H, Maehara Y, Hara T. Polymyxin-B immobilized column-direct hemoperfusion for adolescent toxic shock syndrome. Pediatr Int 2016; 58:1051-1054. [PMID: 27804246 DOI: 10.1111/ped.13087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/02/2016] [Accepted: 03/28/2016] [Indexed: 11/30/2022]
Abstract
Toxic shock syndrome (TSS) is a critical illness associated with toxin from Staphylococcus aureus. Despite recent advances in critical care, mortality remains high and additional effective therapy is required. We report an adolescent case of TSS successfully treated with direct hemoperfusion using polymyxin-B immobilized fiber (PMX-DHP). The patient with spina bifida also had ischial pressure ulcer, and developed TSS associated with methicillin-resistant S. aureus. Despite conventional treatment, the patient developed refractory shock, which was immediately improved with PMX-DHP. PMX-DHP has been widely used for the treatment of sepsis to remove circulating endotoxins produced by Gram-negative bacteria, but beneficial effects have also been reported for Gram-positive bacterial infection. To our knowledge, this is the first report on PMX-DHP for TSS in an adolescent patient, and we propose that PMX-DHP could be a new treatment strategy for severe TSS in children as well.
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Affiliation(s)
- Etsuro Nanishi
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. .,Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan.
| | - Yuichirou Hirata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Sooyoung Lee
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Noriyuki Kaku
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Kenta Momii
- Department of Orthopedics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Kensuke Kubota
- Department of Orthopedics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Hisanori Nishio
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Toshiro Hara
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Vaughn VM, Callahan SJ, Pile J, Kazanjian P, Odden A. Caught red-handed. J Hosp Med 2016; 11:583-6. [PMID: 27043230 DOI: 10.1002/jhm.2583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/19/2016] [Accepted: 02/20/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Valerie M Vaughn
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
- The Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Health System, Ann Arbor, Michigan
| | - Sean J Callahan
- Department of Internal Medicine, University of Virginia Health System, Charlottesville, Virginia
| | - James Pile
- Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Powel Kazanjian
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Andrew Odden
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
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46
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Yoshida M, Takazono T, Tashiro M, Saijo T, Morinaga Y, Yamamoto K, Nakamura S, Imamura Y, Miyazaki T, Sawai T, Nishino T, Izumikawa K, Yanagihara K, Mukae H, Kohno S. Recurrent Streptococcus agalactiae Toxic Shock Syndrome Triggered by a Tumor Necrosis Factor-α Inhibitor. Intern Med 2016; 55:3211-3214. [PMID: 27803422 PMCID: PMC5140877 DOI: 10.2169/internalmedicine.55.6787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Streptococcal toxic shock syndrome caused by group B streptococcus (GBS) is a rare, but lethal disease. We experienced a 45-year-old woman with pustular psoriasis who developed toxic shock-like syndrome during infliximab treatment. Surprisingly, similar episodes recurred three times in one year with restarting of infliximab treatments. In the third episode, GBS were detected in blood, urine, and vaginal secretion cultures. These episodes of shock syndrome were possibly due to GBS. To the best of our knowledge, this is the first case report of recurrent streptococcal toxic shock syndrome possibly caused by GBS which was induced by anti-TNF-α inhibitor therapy. The restarting of biological agents in patients with a history of toxic shock syndrome should therefore be avoided as much as possible.
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Affiliation(s)
- Masataka Yoshida
- The Second Department of Internal Medicine, Nagasaki University Hospital, Japan
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Woeller KE, Miller KW, Robertson-Smith AL, Bohman LC. Impact of Advertising on Tampon Wear-time Practices. CLINICAL MEDICINE INSIGHTS. WOMEN'S HEALTH 2015; 8:29-38. [PMID: 26688668 PMCID: PMC4664207 DOI: 10.4137/cmwh.s25123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 06/17/2015] [Accepted: 07/08/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVES (1) To determine whether advertising nighttime tampon use for up to eight hours was understood to be consistent with label recommendations and (2) to determine whether television and print advertising with this message affected tampon wear times in adults and teens. METHODS (1) A comprehension study (online advertising and follow-up questionnaire) among women aged 14-49 years (300 per group) who viewed either the test or a control advertising message; (2) Diary-based surveys of tampon wear times performed prior to (n = 292 adults, 18-49 years, 74 teens, 12-17 years) and after (n = 287 adults, 104 teens) the launch of national advertising. RESULTS Significantly more test message viewers than controls stated tampons should be worn less than or equal to eight hours (93.6% vs. 88.6%, respectively, P = 0.049). A directionally higher percentage of test message viewers said they would use a pad if sleeping longer than eight hours (52% vs. 42% of controls). Among the women who used tampons longer than eight hours when sleeping, 52% reported they would wake up and change compared with 45% of controls. No significant difference between baseline and follow-up diary surveys was found among teens or adults in various measures of tampon wear time (mean wear times; usage intervals from less than two hours to more than 10 hours; percentage of tampons used for more than or equal to eight hours; frequency of wearing at least one tampon more than eight hours). CONCLUSIONS Advertising nighttime tampon wear for up to eight hours effectively communicated label recommendations but did not alter tampon wear times. The informational intervention had limited impact on established habits.
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Affiliation(s)
- Kara E Woeller
- Global Product Stewardship, Feminine Care Business Unit, The Procter & Gamble Company, Cincinnati, OH, USA
| | - Kenneth W Miller
- Global Product Stewardship, Feminine Care Business Unit, The Procter & Gamble Company, Cincinnati, OH, USA
| | | | - Lisa C Bohman
- Quantitative and Clinical Sciences, The Procter & Gamble Company, Cincinnati, OH, USA
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49
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Abstract
Staphylococcal enterotoxin B is one of the most potent bacterial superantigens that exerts profound toxic effects upon the immune system, leading to stimulation of cytokine release and inflammation. It is associated with food poisoning, nonmenstrual toxic shock, atopic dermatitis, asthma, and nasal polyps in humans. Currently, there is no treatment or vaccine available. Passive immunotherapy using monoclonal antibodies made in several different species has shown significant inhibition in in vitro studies and reduction in staphylococcal enterotoxin B-induced lethal shock in in vivo studies. This should encourage future endeavors to develop these antibodies as therapeutic reagents.
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50
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A fatal case of staphylococcal toxic shock syndrome. Med J Armed Forces India 2015; 71:S107-10. [PMID: 26265799 DOI: 10.1016/j.mjafi.2013.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 05/28/2013] [Indexed: 11/22/2022] Open
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