Buda Aneta, Międzobrodzki Jacek
Department of Microbiology, Faculty of Biochemistry, Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland.
Pol J Microbiol. 2016 Aug 26;65(3):253-259. doi: 10.5604/17331331.1215600.
Staphylococcus aureus colonizes the mucous membrane of the nasal vestibule of a significant number of healthy people. These microorganisms are opportunistic pathogens, that in favorable conditions, may cause infections of various course, location or manifestation. Secondary infections emerge in cases when other risk factors contribute to such a change. One of the diseases during which S. aureus changes its saprophytic character to a pathogenic one is atopic dermatitis (AD), an allergic skin condition of a chronic and recurrent nature. Patients with AD are highly predisposed to secondary staphylococcal infections due to active S. aureus colonization of the stratum corneum, damage of the skin barrier or a defective immune response. Microorganisms present in skin lesions destroy the tissue by secreting enzymes and toxins, and additionally stimulate secondary allergic reactions. The toxins secreted by strains of S. aureus also act as superantigens and penetrate the skin barrier contributing to a chronic inflammation of the atopic skin lesions. The S. aureus species also releases proinflammatory proteins, including enzymes that cause tissue damage. When initiating treatment it is particularly important to properly assess that the onset of the secondary bacterial infection is caused by S. aureus and thus justifying the inclusion of antibiotic therapy. Depending on the severity and extent of the staphylococcal infection, topical antibiotics are used, usually mupirocin or fusidic acid, or general antibiotic treatment is introduced. Another therapeutic strategy without antibiotics has given a positive effect in patients.
金黄色葡萄球菌在大量健康人的鼻前庭黏膜定植。这些微生物是机会致病菌，在有利条件下，可能引发各种病程、部位或表现的感染。当其他风险因素促使这种变化发生时，就会出现继发性感染。金黄色葡萄球菌从腐生菌转变为致病菌的疾病之一是特应性皮炎（AD），这是一种具有慢性复发性的过敏性皮肤病。由于角质层中存在活跃的金黄色葡萄球菌定植、皮肤屏障受损或免疫反应缺陷，AD患者极易发生继发性葡萄球菌感染。皮肤病变中的微生物通过分泌酶和毒素破坏组织，此外还会刺激继发性过敏反应。金黄色葡萄球菌菌株分泌的毒素还作为超抗原，穿透皮肤屏障，导致特应性皮肤病变的慢性炎症。金黄色葡萄球菌还会释放促炎蛋白，包括导致组织损伤的酶。在开始治疗时，正确评估继发性细菌感染的发作是由金黄色葡萄球菌引起的，从而证明使用抗生素治疗的合理性尤为重要。根据葡萄球菌感染的严重程度和范围，使用局部抗生素，通常是莫匹罗星或夫西地酸，或者采用全身抗生素治疗。另一种不使用抗生素的治疗策略在患者中取得了积极效果。
