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Searching the Staphylococcal Toxic Shock Syndrome Toxin -1 in Septic Children with negative Cultures: A Comparative
Samileh Noorbakhsh1, Ali Asghar Rabiei2, Ali Akbar Rahbarimanesh3
1Department of Pediatric Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran.
Insights
Staphylococcal Toxic Shock Syndrome Toxin-1 (TSST-1) may play a role in pediatric sepsis, even with negative blood cultures. Early anti-staphylococcal treatment is crucial for toxic children presenting with sepsis symptoms.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Immunology
Background:
- Bacterial sepsis is a significant concern in pediatric populations.
- Staphylococcus aureus produces exotoxins like TSST-1, a superantigen (SAg), implicated in T cell activation and inflammation.
- SAgs are increasingly recognized for their role in pediatric sepsis and septic shock pathogenesis.
Purpose of the Study:
- To compare the prevalence of staphylococcal TSST-1 (SAgs) in children with sepsis symptoms and negative blood cultures against a control group.
- To investigate the association between TSST-1 and sepsis/septic shock in pediatric patients.
Main Methods:
- A cross-sectional study conducted over two years in Tehran, Iran.
- Involved 44 children with sepsis symptoms and 45 controls.
- TSST-1 (SAgs) detection using polymerase chain reaction (PCR) in blood samples; data analyzed with SPSS-16.
Main Results:
- TSST-1 was detected in 14% of sepsis cases with negative blood cultures for S. aureus.
- This prevalence was significantly higher compared to the control group (2%, P=0.05).
- Other bacteria were identified in 5 cases with negative TSST-1.
Conclusions:
- TSST-1 (SAgs) likely contributes to the progression of sepsis and septic shock in children, particularly when blood cultures are negative for S. aureus.
- Prompt anti-staphylococcal treatment is recommended for toxic pediatric patients with sepsis symptoms, irrespective of blood culture results.
- Targeting SAgs with suppressants may offer therapeutic benefits against downstream inflammatory events.
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 the 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 And Methods:
This cross-sectional study was conducted 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 were compared. Data were analyzed by SPSS-16software. Chi-square or Fisher test was used to compare the 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 was detected 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 presentations, even in cases with negative blood cultures. Indeed, the clinical use against SAgs suppressants of downstream cell-destructive events might be helpful.
