Staphylococcal toxic shock syndrome in a child. Case report

Toxic shock syndrome (TSS) is a complex of symptoms that includes fever, exanthem, multiple organ dysfunction syndrome, and hypotension. The most common causative agents are S. aureus and group A Streptococcus. TSS is characterized by severe course and high mortality in the lack of specific complex treatment. This article addresses a case report of staphylococcal TSS in a 5-year-old girl. The primary focus of infection (infected right leg wound) and breakthrough factors (the lack of adequate wound care) resulted in the dissemination of causative agent and TSS development. Despite disease severity, early complex etiological (antibiotics) and pathogenically-oriented (infusions, corticosteroids) treatment improved the patient’s condition and promoted recovery. This case report illustrating the classic presentations of staphylococcal TSS in children is helpful for pediatricians in terms of awareness of this pathological condition. KEYWORDS: infectious diseases, staphylococcus aureus, toxic shock syndrome, cytokine storm, multiple organ failure syndrome, pediatrics. FOR CITATION: Karpovich G.S., Kuimova I.V., Krasnova E.I. et al. Staphylococcal toxic shock syndrome in a child. Case report. Russian Journal of Woman and Child Health. 2021;4(3):302–307 (in Russ.). DOI: 10.32364/2618-8430-2021-4-3-302-307.

A Functional ClpXP Protease is Required for Induction of the Accessory Toxin Genes, tst, sed, and sec

Staphylococcal toxic shock syndrome is a potentially lethal illness attributed to superantigens produced by Staphylococcus aureus, in particular toxic shock syndrome toxin 1 (TSST-1), but staphylococcal enterotoxins (SEs) are also implicated. The genes encoding these important toxins are carried on mobile genetic elements, and the regulatory networks controlling expression of these toxins remain relatively unexplored. We show here that the highly conserved ClpXP protease stimulates transcription of tst (TSST-1), sec (SEC), and sed (SED) genes in the prototypical strains, SA564 and RN4282. In the wild-type cells, the post-exponential upregulation of toxin gene transcription was proposed to occur via RNAIII-mediated downregulation of the Rot repressor. Contradictive to this model, we showed that the post-exponential induction of tst, sed, and sec transcription did not occur in cells devoid of ClpXP activity, despite the Rot level being diminished. To identify transcriptional regulators with a changed expression in cells devoid of ClpXP activity, RNA sequencing was performed. The RNAseq analysis revealed a number of global virulence regulators that might act downstream of ClpXP, to control expression of tst and other virulence genes. Collectively, the results extend our understanding of the complex transcriptional regulation of the tst, sed, and sec genes.

Searching the staphylococcal toxic shock syndrome toxin -1 in septic children with negative cultures: A comparative study in Tehen,Iran

Background: Bacteria induced sepsis is common in infants and children Staphylococcus aureus produces numerous exotoxins; like staphylococcal Toxic shock syndrome toxin (TSST- 1) which stimulate the immune system by T cell activation and inflammation in various organs. Recent studies suggest that staphylococcal toxins; generally named super antigens (SAgs) may also have a significant role in the pathogenesis of some pediatric disorders especially in clinical presentation of sepsis and septic shock. This study was carried out in order to compare staphylococcal TSST- 1 (SAgs) in children with sepsis symptoms (and septic shock) with negative blood culture versus a control group. Materials & Methods: This cross sectional study was done during 2 years (2014 -2016) in two referral hospitals (Rasoul Akram and Bahrami hospitals) in Tehran, Iran. We selected 44 children )mean age of 4 years) who were admitted in pediatrics and PICUs wards with sepsis symptoms- /+septic shock. Forty five children (mean age of 3.9 years) were selected as a control group. All cases with blood samples were examined for TSST-1 (SAgs) by polymerase chain reaction (PCR) method in both case and control groups and results compared. Data were analyzed by SPSS-16software. Chi-square or Fisher test was used to compare variables. P-value < 0.05 was considered as a valuable tool. Results: Positive blood cultures with other bacteria; Streptococcus pneumonia, Haemophilus influenzae, Pseudomonas aeruginosa, Escherichia coli were detected in 5 cases with negative TSST-1 in blood samples. S.aureus isolated from blood culture in 2 cases with positive TSST- 1.Positive TSST-1 (SAgs ) was detected in 6 cases (14% ) with negative blood culture for S.aureus , It was significantly higher in cases ( 14% vs. 2%;P value = 0.05). Conclusion: This study indicates the probable role of TSST-1(SAgs) in the progression of sepsis (and septic shock) in toxic children with negative blood culture for S.aureus. Anti-staphylococcal treatment is immediately required, especially in toxic children with related clinical presentation even in cases with negative blood cultures. Indeed, the clinical use against SAgs suppressants of downstream cell-destructive events might be helpful.

Infections Due to Staphylococci

Staphylococci are nonsporulating, nonmotile, gram-positive cocci that have an average diameter of 1 µm. Microscopically, staphylococci tend to be larger and rounder than streptococci. Because cell division occurs on three planes, these organisms are typically found in grapelike clusters and tetrads, as well as in pairs and sometimes in short chains. Staphylococci are very hardy organisms and can withstand much more physical and chemical stress than pneumococci and streptococci. Because staphylococci are facultative anaerobes, they will grow in the presence or absence of oxygen. Staphylococci are catalase positive. Of the species of staphylococci, Staphylococcus aureus is by far the most important human pathogen. This review covers the epidemiology and pathogenesis of S. aureus, clinical infections associated with S. aureus, treatment of staphylococcal infections, and staphylococcal toxic shock syndrome. Clinically important coagulase-negative staphylococci such as S. epidermidis and S. saprophyticus are also discussed. Tables list antibiotic treatment for staphylococcal infections, clinical manifestations of staphylococcal toxic shock syndrome, and antibiotic treatment for staphylococcal toxic shock syndrome. This review contains 3 figures, 6 tables, and 54 references. Key words: Staphylococcus aureus; Staphylococcal infections; Coagulase-negative staphylococci; Skin and soft tissue infections; S. aureus bacteremia; MRSA; Methicillin-resistant S. aureus; Toxic shock syndrome