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Infectious Disorders - Drug Targets

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ISSN (Print): 1871-5265
ISSN (Online): 2212-3989

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Research Article

Searching the Staphylococcal Toxic Shock Syndrome Toxin -1 in Septic Children with negative Cultures: A Comparative Study in Tehran, Iran

Author(s): Samileh Noorbakhsh*, Ali Asghar Rabiei, Ali Akbar Rahbarimanesh, Morteza Haghighi and Sarvenaz Ashouri

Volume 21, Issue 2, 2021

Published on: 31 July, 2020

Page: [187 - 192] Pages: 6

DOI: 10.2174/1871526520666200731180641

Price: $65

Abstract

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.

Keywords: Staphylococcus aureus, super antigens (SAgs), TSST-1, PCR, sepsis, septic shock, children.

Graphical Abstract

[1]
Martin, R.J.; Fanaroff, A.A.; Walsh, M.C. Neonatal-perinatal medicine.The Central Nervous System, 8th; Phialadelphia: Mosby, 2006, pp. 883-933.
[2]
Ethan, J.L.; Dobbs, K. Postnatal Bacterial Infection.Fanaroff and Martin’s Neonatal-Perinatal Medicine, 10th ed; Martin, R.J.; Fanaroff, A.A.; Walsh, M.C., Eds.; Elsevier Saunders: Philadelphia, PA, 2015, pp. 734-751.
[3]
Bone, R.C.; Balk, R.A.; Cerra, F.B.; Dellinger, R.P.; Fein, A.M.; Knaus, W.A.; Schein, R.M.; Sibbald, W.J. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee; American College of Chest Physicians/Society of Critical Care Medicine, 1992.
[4]
Saravanan, M.; Nanda, A. Incidence of methicillin resistant Staphylococcus aureus (MRSA) from septicemia suspected children. Indian J. Sci. Technol., 2009, 2(12), 36-39.
[5]
White, M.C.; Thornton, K.; Young, A.E. Early diagnosis and treatment of toxic shock syndrome in paediatric burns. Burns, 2005, 31(2), 193-197.
[http://dx.doi.org/10.1016/j.burns.2004.09.017] [PMID: 15683692]
[6]
Standage, S.W.; Wong, H.R. Biomarkers for pediatric sepsis and septic shock. Expert Rev. Anti Infect. Ther., 2011, 9(1), 71-79.
[http://dx.doi.org/10.1586/eri.10.154] [PMID: 21171879]
[7]
Hatzistilianou, M. Diagnostic and prognostic role of procalcitonin in infections. Sci World J, 2010, 10, 1941-1946.
[http://dx.doi.org/10.1100/tsw.2010.181] [PMID: 20890583]
[8]
Downes, K.J.; Shah, S.S. Biomarkers in infectious diseases. J. Pediatric Infect. Dis. Soc., 2012, 1(4), 343-346.
[http://dx.doi.org/10.1093/jpids/pis099] [PMID: 26619428]
[9]
Sherris Medical Microbiology, 4th; Ryan, K.J.; Ray, C.G., Eds.; McGraw Hill, 2004..
[10]
Wertheim, H.F.; Melles, D.C.; Vos, M.C.; van Leeuwen, W.; van Belkum, A.; Verbrugh, H.A.; Nouwen, J.L. The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect. Dis., 2005, 5(12), 751-762.
[http://dx.doi.org/10.1016/S1473-3099(05)70295-4] [PMID: 16310147]
[11]
Xu, S.X.; McCormick, J.K. Staphylococcal superantigens in colonization and disease. Front. Cell. Infect. Microbiol., 2012, 2, 52.
[http://dx.doi.org/10.3389/fcimb.2012.00052] [PMID: 22919643]
[12]
Ryan, K.J.; Ray, C.G. Medical microbiology; McGraw Hill, 2004, 4, p. 370.
[13]
Holtfreter, S.; Bröker, B.M. Staphylococcal superantigens: do they play a role in sepsis? Arch. Immunol. Ther. Exp. (Warsz.), 2005, 53(1), 13-27.
[PMID: 15761373]
[14]
Krakauer, T. Staphylococcal superantigens: pyrogenic toxins induce toxic shock. Toxins (Basel), 2019, 11(3), 178.
[http://dx.doi.org/10.3390/toxins11030178] [PMID: 30909619]
[15]
Taskapan, M.O.; Kumar, P. Role of staphylococcal superantigens in atopic dermatitis: from colonization to inflammation. Ann. Allergy Asthma Immunol., 2000, 84(1), 3-10.
[http://dx.doi.org/10.1016/S1081-1206(10)62731-7] [PMID: 10674558]
[16]
Bachert, C.; Zhang, N.; Patou, J.; van Zele, T.; Gevaert, P. Role of staphylococcal superantigens in upper airway disease. Curr. Opin. Allergy Clin. Immunol., 2008, 8(1), 34-38.
[http://dx.doi.org/10.1097/ACI.0b013e3282f4178f] [PMID: 18188015]
[17]
Yeung, R.S. Kawasaki disease: update on pathogenesis. Curr. Opin. Rheumatol., 2010, 22(5), 551-560.
[http://dx.doi.org/10.1097/BOR.0b013e32833cf051] [PMID: 20616737]
[18]
Merriman, J.A.; Schlievert, P.M. Identification, Purification, and Characterization of Staphylococcal Superantigens. InSuperantigens; Humana Press: New York, NY, 2016, pp. 19-33.
[19]
El-Ghodban, A.; Ghenghesh, K.S.; Márialigeti, K.; Esahli, H.; Tawil, A. PCR detection of toxic shock syndrome toxin of Staphylococcus aureus from Tripoli, Libya. J. Med. Microbiol., 2006, 55(Pt 2), 179-182.
[http://dx.doi.org/10.1099/jmm.0.46162-0] [PMID: 16434710]
[20]
Chapaval, L.; Moon, D.H.; Gomes, J.E.; Duarte, F.R.; Tsai, S.M. An alternative method for Staphylococcus aureus DNA isolation. Arq. Bras. Med. Vet. Zootec., 2008, 60(2), 299-306.
[http://dx.doi.org/10.1590/S0102-09352008000200004]
[21]
Harris, L.G.; Foster, S.J.; Richards, R.G. An introduction to Staphylococcus aureus, and techniques for identifying and quantifying S. aureus adhesins in relation to adhesion to biomaterials: review. Eur. Cell. Mater., 2002, 4(3), 39-60.
[http://dx.doi.org/10.22203/eCM.v004a04] [PMID: 14562246]
[22]
Krakauer, T. FDA-approved immunosuppressants targeting staphylococcal superantigens: mechanisms and insights. ImmunoTargets Ther., 2017, 6, 17-29.
[http://dx.doi.org/10.2147/ITT.S125429] [PMID: 28497030]
[23]
Mahallei, M.; Rezaee, M.A.; Mehramuz, B.; Beheshtirooy, S.; Abdinia, B. Clinical symptoms, laboratory, and microbial patterns of suspected neonatal sepsis cases in a children’s referral hospital in northwestern Iran. Medicine (Baltimore), 2018, 97(25)e10630
[http://dx.doi.org/10.1097/MD.0000000000010630] [PMID: 29923969]
[24]
Akbarian-Rad, Z.; Riahi, S.M.; Abdollahi, A.; Sabbagh, P.; Ebrahimpour, S.; Javanian, M.; Vasigala, V.; Rostami, A. Neonatal sepsis in Iran: A systematic review and meta-analysis on national prevalence and causative pathogens. PLoS One, 2020, 15(1)e0227570
[http://dx.doi.org/10.1371/journal.pone.0227570] [PMID: 31978069]
[25]
Gheybi, S.; Fakour, Z.; Karamyar, M.; Khashabi, J.; Ilkhanizadeh, B.; Asghari, S.F.; Mahmoudzadeh, H.; Majlesi, A.H. Coagulase negative staphylococcus, the most common cause of neonatal septicemia in Urmia, Iran. Iranian J. Pediatr., 2008. .
[26]
Shirvani, F.; Seifi, K.; Sanaei Dashti, A. SIRS Criteria for Sepsis Identification in Children. Does It Work? Arch. Clin. Infect. Dis., 14(5), e77216.
[http://dx.doi.org/10.5812/archcid.77216]
[27]
Rahimi, F.; Karimi, S. Characteristics of virulence factors in methicillin-resistant staphylococcus aureus strains isolated from a referral hospital in Tehran, Iran. Arch. Clin. Infect. Dis., 2016, 11(1)33220.
[http://dx.doi.org/10.5812/archcid.33220]
[28]
Noorbakhsh, S.; Farhadi, M.; Tabatabaei, A. Staphylococcal superantigens; toxic shock syndrome toxin-1 and enterotoxins in pediatric otitis media effusion: a brief report. Tehran Univ. Med. J., 2013, 70(12), 793-797.
[29]
Sh, J.N.; Gh, G. Superantigens in polyp tissue of patients with chronic rhino-sinusitis, a comparative study: a brief report. Med. J. TUMS Pub, 2012, 70(7), 452-456.
[30]
Noorbakhsh, S.; Talebi-Taher, M.; Tabatabaei, A. Identification of bacterial antigens and super antigens in synovial fluid of patients with arthritis: a cross sectional study. Med. J. Islam. Repub. Iran, 2013, 27(1), 12-16.
[PMID: 23483360]
[31]
Javadinia, S.; Asgarian, R.; Noorbaksh, S.; Soboti, B.; Shokrollahi, M.R.; Tabatabaee, A. Toxic shock syndrome toxin level in wound samples of hospitalized children with burn: a case control study. Tehran Univ. Med. J., 2014, 72(2), 113-120.

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