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Updated: Aug 2, 2026

Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)
Published on: February 9, 2011
Evidence for superantigen involvement in severe group a streptococcal tissue infections
A Norrby-Teglund1, P Thulin, B S Gan
1Center for Infectious Medicine, Karolinska Institutet, Department of Medicine, Huddinge University Hospital, SE-141 86 Stockholm, Sweden. Anna.Norrby-Teglund@medhs.ki.se
Abstract:
Host-pathogen interactions were studied in tissue biopsy samples from patients with severe invasive group A streptococcus (GAS) infections. Skin, subcutaneous tissue, and fascia biopsy samples were divided into clinical grade 1 (no evidence of inflammation [n=7]) or clinical grade 2 (inflamed tissue--erythema and edema including cellulitis, fasciitis, and necrotizing fasciitis [n=24]). In situ imaging demonstrated significantly higher bacterial load in biopsy samples of higher clinical grade (P<.05), and the bacterial load correlated with the in vivo expression of the superantigen streptococcal pyrogenic exotoxin F (P<.02). Increased expression of the interleukin-1 cytokines and significantly higher expression of tumor necrosis factor-beta, interferon-gamma, and the homing receptors CC chemokine receptor 5, CD44, and cutaneous lymphocyte-associated antigen (P<.002-.05) were observed in biopsy samples of higher clinical grade. Thus, the cytokine profile at the local site of infection mimics that of a typical superantigen cytokine response. The findings of this study demonstrate a critical role for superantigens and Th1 cytokines in GAS tissue infections.
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