Effect of strain of Staphylococcus aureus on synergism with Candida albicans resulting in mouse mortality and morbidity.

Nine Staphylococcus aureus strains isolated from patients with toxic shock syndrome (TSS), two strains from non-disease-associated sources, and four strains from disease (not TSS)-associated sources were characterized for the intraperitoneal dose necessary to kill 50% of exposed animals (LD50) and toxic shock toxin production and studied for synergistic effects on mouse mortality and morbidity when combined with a sublethal dose of Candida albicans and inoculated intraperitoneally. Representative toxic shock toxin-producing strains (free of other enterotoxins) exhibited the following unique set of characteristics when inoculated intraperitoneally into mice and compared with all other strains tested: (i) lowest virulence when inoculated alone into mice as determined by the LD50; (ii) greatest synergistic decrease in LD50 (up to 70,000-fold as compared to up to 200-fold for other strains) when combined with C. albicans and injected intraperitoneally; and (iii) induced a characteristic, dose-independent, temporal death pattern in dually injected animals. When sublethal dual doses were used, animals receiving disease (TSS and not TSS)-associated S. aureus in combination with C. albicans developed symptoms, but some differences in symptomatologies, depending on the strain, were observed. The symptoms included conjunctivitis; gastrointestinal, neurological, and circulatory abnormalities; rash followed by desquamation; and patchy baldness. Although overlap in symptoms between animal treatment groups was observed, certain symptoms (neurological sequeae and petechial hemorrhages) were observed only in animals inoculated with a specific S. aureus strain combined with C. albicans. Animals receiving sublethal dual doses, which included non-disease-associated S. aureus, did not develop symptoms. When Staphylococcus epidermidis was combined with C. albicans and inoculated into mice, no synergistic effects on morbidity or mortality were observed.