TSST-1⁺Staphylococcus aureus in Bullous Pemphigoid

Area of Science:

• Dermatology
• Microbiology
• Immunology

Background:

• Bullous pemphigoid (BP) is an autoimmune blistering disease.
• The role of bacterial infections, specifically Staphylococcus aureus, in BP pathogenesis remains under investigation.

Purpose of the Study:

• To investigate the prevalence and characteristics of Staphylococcus aureus colonization in patients with new-onset bullous pemphigoid.

Main Methods:

• Compared S. aureus colonization rates in BP lesions, patient nares/skin, and healthy controls.
• Analyzed toxin production (toxic shock syndrome toxin-1, enterotoxin gene clusters) of lesional S. aureus isolates.
• Assessed the impact of antibiotics on S. aureus colonization and clinical outcomes.

Main Results:

• S. aureus colonization was significantly higher (3-6 fold) in BP lesions compared to patient skin/nares and controls.
• 96% of lesional isolates produced toxic shock syndrome toxin-1; many also expressed enterotoxin gene clusters.
• Antibiotic treatment targeting S. aureus led to bacterial elimination and clinical improvement in BP patients.

Conclusions:

• Toxic shock syndrome toxin-1 positive S. aureus is frequently found in bullous pemphigoid lesions.
• Early antibiotic intervention may be beneficial for BP patients by reducing S. aureus colonization.
• S. aureus colonization may act as an infection source in BP, especially in immunosuppressed individuals.