Norrby-Teglund A, Thulin P, Gan B S, Kotb M, McGeer A, Andersson J, Low D E
Center for Infectious Medicine, Karolinska Institutet, Department of Medicine, Huddinge University Hospital, SE-141 86 Stockholm, Sweden.
J Infect Dis. 2001 Oct 1;184(7):853-60. doi: 10.1086/323443. Epub 2001 Aug 15.
Host-pathogen interactions were studied in tissue biopsy samples from patients with severe invasive group A streptococcus (GAS) infections. Skin, subcutaneous tissue, and fascia biopsy samples were divided into clinical grade 1 (no evidence of inflammation [n=7]) or clinical grade 2 (inflamed tissue--erythema and edema including cellulitis, fasciitis, and necrotizing fasciitis [n=24]). In situ imaging demonstrated significantly higher bacterial load in biopsy samples of higher clinical grade (P<.05), and the bacterial load correlated with the in vivo expression of the superantigen streptococcal pyrogenic exotoxin F (P<.02). Increased expression of the interleukin-1 cytokines and significantly higher expression of tumor necrosis factor-beta, interferon-gamma, and the homing receptors CC chemokine receptor 5, CD44, and cutaneous lymphocyte-associated antigen (P<.002-.05) were observed in biopsy samples of higher clinical grade. Thus, the cytokine profile at the local site of infection mimics that of a typical superantigen cytokine response. The findings of this study demonstrate a critical role for superantigens and Th1 cytokines in GAS tissue infections.
在患有严重侵袭性A组链球菌（GAS）感染的患者的组织活检样本中研究了宿主与病原体的相互作用。皮肤、皮下组织和筋膜活检样本被分为临床1级（无炎症证据[n = 7]）或临床2级（发炎组织——包括蜂窝织炎、筋膜炎和坏死性筋膜炎的红斑和水肿[n = 24]）。原位成像显示临床分级较高的活检样本中细菌载量显著更高（P <.05），并且细菌载量与超抗原链球菌致热外毒素F的体内表达相关（P <.02）。在临床分级较高的活检样本中观察到白细胞介素-1细胞因子的表达增加以及肿瘤坏死因子-β、干扰素-γ和归巢受体CC趋化因子受体5、CD44和皮肤淋巴细胞相关抗原的表达显著更高（P <.002-.05）。因此，感染局部部位的细胞因子谱类似于典型的超抗原细胞因子反应。本研究结果表明超抗原和Th1细胞因子在GAS组织感染中起关键作用。
