Staphylococcal enterotoxin B toxic shock syndrome induced by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA)

Takeru Kashiwada, Ken Kikuchi, Shinji Abe, Hidehito Kato, Hiroki Hayashi, Taisuke Morimoto, Koichiro Kamio, Jiro Usuki, Shinhiro Takeda, Keiji Tanaka, Ken'ichi Imanishi, Junji Yagi, Arata Azuma, Akihiko Gemma
Internal Medicine 2012, 51 (21): 3085-8
We herein report a case of toxic shock syndrome (TSS) associated with the 2009 pandemic H1N1 (pH1N1) influenza virus and a community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection in a 16-year-old Vietnamese girl. Staphylococcal enterotoxin B (SEB) was detected in the patient's serum, and the level of anti-SEB antibodies was found to be elevated. A flow cytometric analysis showed evidence of activated SEB-reactive Vβ3+ and Vβ12+ T cells. These data suggest that the CA-MRSA-induced activation of SEB-reactive T cells may cause TSS in patients with pH1N1 virus infection. Moreover, this is the first report describing immunological confirmation of SEB contributing directly to TSS in a patient fulfilling the diagnostic criteria of TSS.

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