Okada T, Furukawa S, Miwa K, Sakai R, Sugiyama J
Division of Pediatrics, National Kagawa Children's Hospital.
Kansenshogaku Zasshi. 1999 Sep;73(9):893-900. doi: 10.11150/kansenshogakuzasshi1970.73.893.
Recently, in Japan newly neonatal exanthematous disease was elucidated to be caused by staphyloccocal supcrantigcnic exotoxins, mainly TSST-1. We studied exotoxins producibility of 43 strains of S. aureus isolated from neonates with exanthematous disease and examined antibody titers to staphylococcal enterotoxin A, B, C (SEA, SEB, SEC) and toxic shock syndrome toxin 1 (TSST-1) of the patients and control (umbilical cord blood from term infants). The results were as follows 1.34 of 43 strains (79%) isolated from the patients were SEC and TSST-1 producing MRSA, 5 strains (12%) were SEB, SEC, and TSST-1 producing MRSA, 1 strain (2%) was SEB and TSST-1 producing MRSA, 2 strains (12%) were SEB producing MSSA and did not produce TSST-1. The 1 strain (2%) was MSSA which produced SEC and TSST-1. 2. 16 neonates with exanthematous disease, who showed typical clinical signs and laboratry findings of thrombocytopenia, with SEC and TSST-1 producing MRSA isolates had significantly low anti-TSST-1 antibody titers at onset (p < 0.05), compared with the control (umbilical cord blood from term infants): TSST-1 appeared to the causative agent for the disease. In two neonates with exanthematous disease, with SEB- and non- TSST-1-producing MSSA isolates, anti-SEB antibody titers were low at onset, so SEB appeared to the causative agent for the disease. 3. In Japan, low anti-TSST-1 antibody titers were found in the umbilical blood samples from about 70% of term infants; and low anti-SEB or anti-SEC antibody titers were found in samples from only about 10% of them, that is, a number of term infants had anti-SEB and anti-SEC antibodies. The majority of S. aureus isolated from neonates with exanthematous disease were enterotoxin- and TSST-1-producing MRSAs. The results of our study by measuring antitoxin antibody titers suggested that SEB and SEC might not be pathogenically responsible, but TSST-1 was considered to be responsible for the majority of exanthematous disease. Prevalence of TSST-1-producing MRSA in the neonatal and premature baby ward is the main cause for the high incidence of this disease in Japan, whereas the low antibody titer to TSST-1 in the mother, in comparison with the anti-enterotoxin antibody titers, may also be a predisposing factor.
最近，在日本，一种新的新生儿发疹性疾病被阐明是由葡萄球菌超抗原外毒素引起的，主要是毒性休克综合征毒素-1（TSST-1）。我们研究了从患有发疹性疾病的新生儿中分离出的43株金黄色葡萄球菌的外毒素产生能力，并检测了患者和对照组（足月儿脐带血）针对葡萄球菌肠毒素A、B、C（SEA、SEB、SEC）和毒性休克综合征毒素1（TSST-1）的抗体滴度。结果如下：1. 从患者中分离出的43株菌株中，34株（79%）是产生SEC和TSST-1的耐甲氧西林金黄色葡萄球菌（MRSA），5株（12%）是产生SEB、SEC和TSST-1的MRSA，1株（2%）是产生SEB和TSST-1的MRSA，2株（5%）是产生SEB的甲氧西林敏感金黄色葡萄球菌（MSSA）且不产生TSST-1。1株（2%）是产生SEC和TSST-1的MSSA。2. 16例患有发疹性疾病的新生儿，表现出典型的临床症状和血小板减少的实验室检查结果，其分离出的产生SEC和TSST-1的MRSA菌株在发病时抗TSST-1抗体滴度显著较低（p<0.05），与对照组（足月儿脐带血）相比：TSST-1似乎是该疾病的病原体。在2例患有发疹性疾病的新生儿中，其分离出的是产生SEB但不产生TSST-1的MSSA菌株，发病时抗SEB抗体滴度较低，所以SEB似乎是该疾病的病原体。3. 在日本，约70%的足月儿脐带血样本中抗TSST-1抗体滴度较低；而只有约10%的样本中抗SEB或抗SEC抗体滴度较低，也就是说，许多足月儿具有抗SEB和抗SEC抗体。从患有发疹性疾病的新生儿中分离出的大多数金黄色葡萄球菌是产生肠毒素和TSST-1的MRSA。我们通过测量抗毒素抗体滴度的研究结果表明，SEB和SEC可能没有致病性，但TSST-1被认为是大多数发疹性疾病的病因。在新生儿和早产儿病房中产生TSST-1的MRSA的流行是日本这种疾病高发病率的主要原因，而与抗肠毒素抗体滴度相比，母亲体内对TSST-1的抗体滴度较低也可能是一个易感因素。
