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Nursery outbreak of scalded-skin syndrome. Scarlatiniform rash due to phage group I Staphylococcus aureus
Insights
A nursery outbreak of staphylococcal scalded-skin syndrome in neonates was caused by Staphylococcus aureus (group I). This finding suggests a shared toxin production mechanism across different Staphylococcus aureus groups.
Area of Science:
- Neonatal infectious diseases
- Bacteriology
- Dermatology
Background:
- Staphylococcal scalded-skin syndrome (SSSS) is typically associated with phage group II Staphylococcus aureus.
- Understanding the causative agents of SSSS is crucial for effective treatment and prevention in neonatal intensive care units.
Observation:
- Four neonates developed scarlatiniform eruptions, a mild form of SSSS, during an outbreak.
- Clinical presentation included generalized erythema and mild epidermal peeling, resolving with antibiotic treatment.
Findings:
- Cultures identified Staphylococcus aureus, phage type 29/52/79/86/D11/81 (group I), from affected infants.
- This group I Staphylococcus aureus strain induced epidermal exfoliation in suckling mice models.
- The outbreak was linked to group I staphylococci, differing from the usual group II association.
Implications:
- This study implicates phage group I Staphylococcus aureus in SSSS outbreaks, challenging previous associations.
- The findings suggest a common mechanism for exfoliative toxin production in both phage group I and II staphylococci.
- This expands the understanding of SSSS pathogenesis and potential causative agents in neonatal settings.
Abstract:
From Aug 6 to 14, 1973, scariatiniform eruptions that were considered to be mild forms of the staphylococcal scalded-skin syndrome developed in four neonates. One infant had mild epidermal peeling. All had generalized, finely papular erythema that cleared rapidly after treatment with antibiotics. Cultures from the umbilical stumps or anterior nares of three of the infants yielded colonies of group I Staphylococcus aureus, phage type 29/52/79/86/D11/81, that were able to produce epidermal exfoliation in suckling mice. These data indicate that the nursery outbreak was caused by phage group I staphylococci rather than group II organisms previously associated with staphylococcal scalded-skin syndrome. The demonstration that a group I Staphylococcus can produce exfoliative toxin suggests that the same mechanism for toxin production may exist for phage groups I and II staphylococci.