Department of Pediatric Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran.
Pediatric Infectious Disease; Pediatrics Department, Shahre kord University of Medical Sciences, Shahre kord, Iran.
Infect Disord Drug Targets. 2021;21(2):187-192. doi: 10.2174/1871526520666200731180641.
Bacteria induced sepsis is common in infants and children. Staphylococcus aureus produces numerous exotoxins, like staphylococcal Toxic shock syndrome toxin (TSST- 1), which stimulate the immune system by T cell activation and inflammation in various organs. Recent studies suggest that staphylococcal toxins, generally named super antigens (SAgs), may also have a significant role in the pathogenesis of some pediatric disorders especially in the clinical presentation of sepsis and septic shock. This study was carried out in order to compare staphylococcal TSST- 1 (SAgs) in children with sepsis symptoms (and septic shock) with negative blood culture versus a control group.
This cross-sectional study was conducted during 2 years (2014 -2016) in two referral hospitals (Rasoul Akram and Bahrami hospitals) in Tehran, Iran. We selected 44 children) mean age of 4 years) who were admitted in pediatrics and PICUs wards with sepsis symptoms- /+septic shock. Forty-five children (mean age of 3.9 years) were selected as a control group. All cases with blood samples were examined for TSST-1 (SAgs) by polymerase chain reaction (PCR) method in both case and control groups and results were compared. Data were analyzed by SPSS-16software. Chi-square or Fisher test was used to compare the variables. P-value < 0.05 was considered as a valuable tool.
Positive blood cultures with other bacteria, Streptococcus pneumonia, Haemophilus influenzae, Pseudomonas aeruginosa, Escherichia coli, were detected in 5 cases with negative TSST-1 in blood samples. S.aureus isolated from blood culture was detected in 2 cases with positive TSST- 1.Positive TSST-1 (SAgs) was detected in 6 cases (14%) with negative blood culture for S.aureus; it was significantly higher in cases (14% vs. 2%; P value = 0.05).
This study indicates the probable role of TSST-1(SAgs) in the progression of sepsis (and septic shock) in toxic children with negative blood culture for S.aureus. Anti-staphylococcal treatment is immediately required, especially in toxic children with related clinical presentations, even in cases with negative blood cultures. Indeed, the clinical use against SAgs suppressants of downstream cell-destructive events might be helpful.
细菌引起的败血症在婴儿和儿童中很常见。金黄色葡萄球菌产生许多外毒素，如葡萄球菌中毒性休克综合征毒素（TSST-1），通过 T 细胞激活和各种器官的炎症刺激免疫系统。最近的研究表明，葡萄球菌毒素，通常称为超抗原（SAgs），在某些儿科疾病的发病机制中也可能具有重要作用，特别是在败血症和感染性休克的临床表现中。这项研究旨在比较具有败血症症状（和感染性休克）的儿童与阴性血培养的金黄色葡萄球菌 TSST-1（SAgs）与对照组之间的差异。
这项横断面研究在 2014 年至 2016 年期间在伊朗德黑兰的两家转诊医院（Rasoul Akram 和 Bahrami 医院）进行。我们选择了 44 名（平均年龄为 4 岁）患有败血症症状-/+感染性休克的儿科和 PICU 病房的儿童。选择 45 名（平均年龄为 3.9 岁）儿童作为对照组。所有病例均采用聚合酶链反应（PCR）法检测血样中的 TSST-1（SAgs），并比较结果。数据采用 SPSS-16 软件进行分析。采用卡方检验或 Fisher 检验比较变量。P 值<0.05 被认为是有价值的工具。
在 5 例血培养阴性的患儿中，检测到其他细菌（肺炎链球菌、流感嗜血杆菌、铜绿假单胞菌、大肠杆菌）阳性血培养。从血培养中分离出金黄色葡萄球菌，在 2 例 TSST-1 阳性患儿中检测到。在 6 例（14%）血培养阴性的金黄色葡萄球菌患儿中检测到 TSST-1（SAgs）阳性；这在病例中明显更高（14%比 2%；P 值=0.05）。
本研究表明，在金黄色葡萄球菌阴性血培养的中毒性儿童中，TSST-1（SAgs）可能在败血症（和感染性休克）的进展中发挥作用。立即需要进行抗葡萄球菌治疗，特别是在有相关临床表现的中毒性儿童中，即使在血培养阴性的情况下也是如此。事实上，针对下游细胞破坏性事件的 SAg 抑制剂的临床应用可能会有所帮助。
