TOXIN INVOLVEMENT IN STAPHYLOCOCCAL SCALDED SKIN SYNDROME

The production of staphylococcal exfoliative toxin A (ETA) and toxin B (ETB), toxic shock syndrome toxin (TSST-1), and enterotoxins A-E was analyzed in 60 Staphylococcus aureus strains isolated from children wi th scalded skin syndrome (15 with generalized exfoliative syndrome, 28 with bullous impetigo, and 17 with staphylococcal scarlet fever). All strains isolated from patients with generalized exfoliative syndrome or bullous impetigo produced ETA and/or ETB and caused a Nikolsky's si gn when injected subcutaneously into newborn mice. In contrast, exfoli ative toxin was detected in an S. aureus strain from only one of 17 ca ses of staphylococcal scarlet fever; the 16 other S. aureus strains pr oduced TSST-1 and/or an enterotoxin. In conclusion, enterotoxins or TS ST-1 are more frequently associated with staphylococcal scarlet fever than are exfoliative toxins. Hence staphylococcal scarlet fever may we ll represent an abortive form of toxic shock syndrome rather than a mi lder form of staphylococcal scalded skin syndrome.