Toxic Shock Syndrome and its causative agents in the Czech Republic
| Authors | |
|---|---|
| Year of publication | 2004 |
| Type | Article in Proceedings |
| Conference | 11th International Symposium on Staphylococci & Staphylococcal Infections. Plenary Summaries & Poster Abstracts |
| MU Faculty or unit | |
| Citation | |
| Web | http://www.isssi.org/ |
| Field | Genetics and molecular biology |
| Keywords | staphylococcus; TSST-1 toxin; toxic shock syndrome |
| Description | Staphylococcal Toxic Shock Syndrome (TSS) defined as a specific disease by Todd et al. in 1978 has emerged since the 1980s. TSS can be easily misdiagnosed since showing variable clinical symptoms. Only a few TSS cases have been reported to EPIDAT, the Czech nation-wide surveillance system, over 25 years. Since 1983 the Czech Reference Laboratory for Staphylococci has recorded 86 TSS cases with required clinical data and diagnosis confirmed by toxinogenicity screening of S. aureus isolates. The aim of this study was to investigate relevant characteristics of causative strains. The production of TSST-1 and enterotoxins A, B, C, D, [E], was detected by microslide-gel diffusion test and by the RPLA method. The production of hemolysins was detected based on either synergy or antagonism with beta-hemolysin of the S. intermedius standard strain. Phage-typing was performed by the standard method using the international set of phages. Resistance to 12 antibiotics was tested by the disk diffusion method. Selected TSST-1 producing strains from 1996 were genotyped by means of PFGE and PCR analyses. Etiological agents of 10 menstrual TSS cases were S. aureus strains producing TSST-1 mostly in parallel with enterotoxin A. The other 76 TSS cases were complications of staphylococcal infections, most being infected injury wounds and post-operative hospital infections, 19 of which were fatal. Causative agents were toxigenic S. aureus strains resistant to only erythromycin (25%), amoxicillin/clavulanic acid (14%), clindamycin and ciprofloxacin (both 12% of resistant strains). For this group 48 (63 %) produced TSST-1 either with or without enterotoxin. The other 28 (37%) strains produced considerable amounts of enterotoxins A, B, C, and D. Only 53% of strains produced alpha-hemolysin, and the phage-typing showed 65% typeable strains. In a pilot genotypic study, 13 randomly selected clinical isolates producing TSST-1 including two TSS causative strains from 1996 were characterized with PFGE analysis, PCR ribotyping, ERIC2-PCR typing and detection of tst gene. Of the 13 strains studied, 8 strains (including the two TSS causative agents) were highly similar in genetic characteristics to Bergdolls strain FRI 1169 isolated from a vaginal swab in the USA in 1980, suggesting persistence of this virulent clone. Ten out of 86 TSS cases recorded in the Czech Reference Laboratory for Staphylococci from 1983 to 2004 (May) were menstrual forms. Patients were young women using menstrual tampons. The remaining 76 TSS cases were nonmenstrual forms. As a life-threatening illness TSS should be more taken into account in differential diagnosis. Five of TSS cases were originally misdiagnosed and subsequently inadequately treated as meningitis, salmonellosis, apendicitis (with successful removal of a healthy appendix), and streptococcal infections. |
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