POSSIBLE ROLE OF STAPHYLOCOCCUS-AUREUS IN SEVERE ORAL MUCOSITIS AMONGELDERLY DEHYDRATED PATIENTS

Although sometimes isolated from the mouth, Staphylococcus aureus is n ot part of the normal oral microbiota. This paper describes five elder ly patients (aged 68-87 yrs), all of whom were dehydrated and receivin g intravenous fluids, who presented with severe oral mucositis. S. aur eus was isolated from the mouths of all five patients. Phage typing sh owed these strains to be heterogeneous. Three of the strains produced toxic shock syndrome toxin (TSST-1); one produced staphylococcal enter otoxin C; and one isolate produced enterotoxin A. Two of the three pat ients infected with TSST-1-producing strains were negative for antibod y to TSST-1. Treatment of two of the patients with flucloxacillin resu lted in a dramatic improvement in their oral mucositis. Those for whom flucloxacillin was withheld deteriorated. Culture of oral swabs from 27 elderly control patients (aged 63-96 yrs) without mucositis reveale d S. aureus in 11 (40 per cent). Three of these control isolates produ ced TSST-1 and one isolate produced staphylococcal enterotoxin D. Thus , in the elderly, the mouth is a potential source of S. aureus, some s trains of which produce TSST-1 and staphylococcal enterotoxins. These oral isolates may play a local role in causing oral mucosal disease, b ut should also be considered a potential source of the organism in pat ients with systemic signs and symptoms of Toxic Shock Syndrome.