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Exfoliative toxin A staphylococcal scalded skin syndrome in preterm infants

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Abstract

Staphylococcal scalded skin syndrome (SSSS) demonstrates dermal symptoms due to exfoliative toxin (ET) A or ETB produced by Staphylococcus aureus. We examined the association between anti-ETA antibodies and SSSS onset in neonates. Three preterm infants carried an ETA-producing strain of S. aureus, manifesting as either SSSS or bullous impetigo; a full-term infant carrying the same strain was asymptomatic. The infants (n=106) were categorized into three groups according to their gestational age (GA) as follows: <30 weeks, 30–37 weeks, and >37 weeks. The measured levels of anti-ETA antibody in the three infants displaying SSSS were low before the onset of dermal symptoms; only the asymptomatic full-term infant displayed a high antibody level. Anti-ETA antibody levels in the preterm group with a GA of <30 weeks were statistically lower than those in the term infant group; the prevalences of anti-ETA antibodies above a cutoff value in the three groups of neonates were 55 % (18/33) among preterm infants with a GA <30 weeks, 73 % (25/34) among those with a GA of 30–37 weeks, and 90 % (35/39) among infants with a GA >37 weeks. Conclusion: The presence of anti-ETA antibodies below a particular cutoff level might be associated with SSSS onset in preterm infants.

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Fig. 1
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Abbreviations

BI:

Bullous impetigo

ELISA:

Enzyme-linked immunosorbent assay

ET:

Exfoliative toxin

ELBW:

Extremely low birth weight

GA:

Gestational age

MSSA:

Methicillin-sensitive Staphylococcus aureus

NICU:

Neonatal intensive care unit

OD:

Optical density

SSSS:

Staphylococcal scalded skin syndrome

VLBW:

Very low birth weight

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Conflict of interest

The authors declare that they have no conflicts of interest to report.

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Authors and Affiliations

  1. Department of Pediatrics Shinshu, University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan

    Ken Saida, Kanae Hirabayashi, Yohei Akazawa, Mai Kusakari, Takefumi Ishida, Masatomo Kitamura, Atsushi Baba & Kenichi Koike

  2. Department of Laboratory Medicine, Shinshu University Hospital, Nagano, Japan

    Kenji Kawasaki, Seiko Kubota & Eriko Kasuga

Authors
  1. Ken Saida
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  2. Kenji Kawasaki
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  3. Kanae Hirabayashi
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  4. Yohei Akazawa
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  5. Seiko Kubota
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  6. Eriko Kasuga
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  7. Mai Kusakari
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  8. Takefumi Ishida
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  9. Masatomo Kitamura
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  10. Atsushi Baba
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  11. Kenichi Koike
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Corresponding author

Correspondence to Ken Saida.

Additional information

Communicated by David Nadal

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Saida, K., Kawasaki, K., Hirabayashi, K. et al. Exfoliative toxin A staphylococcal scalded skin syndrome in preterm infants. Eur J Pediatr 174, 551–555 (2015). https://doi.org/10.1007/s00431-014-2414-3

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  • DOI: https://doi.org/10.1007/s00431-014-2414-3

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