Chronic staphylococcal scalded skin syndrome

The aim of this study was to evaluate the usefulness of the measurement of urinary excretion of the brush-border enzyme gamma glutamyl-transferase (GGT), in comparison with that of alanine aminopeptidase (AAP), as a marker for tubular toxicity due to contrast media (CM). Urinary activities of AAP and GGT were measured prior to the administration of CM and 1, 3 and 5 days after in forty-nine adult renal patients undergoing a radiological examination with intravascular administration of CM. The behavior of GGT was similar to that of AAP. In fact, urinary activities of both AAP and GGT increased greatly after CM. This effect was maximal on the 1st day and statistically significant for both enzymes. Furthermore, on the 1st day a relevant increase of enzyme activity (at least +50% over the basal value) was observed in the same number of patients (67%) for AAP and GGT. The concordance between GGT and AAP variations was high and statistically significant. Finally, different variables (osmolarity, dose of CM, and baseline renal function of the patients) had a similar effect on urinary excretion of AAP and GGT. The repeatability of duplicated determinations of GGT resulted better than that of AAP. In conclusion, the good concordance of the results of GGT with those of AAP justifies the use of GGT as a marker for tubular effects due to CM. Furthermore, the measurement of GGT has a better repeatability than that of AAP.     

Toxin involvement in staphylococcal scalded skin syndrome

The production of staphylococcal exfoliative toxin A (ETA) and toxin B (ETB), toxic shock syndrome toxin (TSST-1), and enterotoxins A-E was analyzed in 60 Staphylococcus aureus strains isolated from children with scalded skin syndrome (15 with generalized exfoliative syndrome, 28 with bullous impetigo, and 17 with staphylococcal scarlet fever). All strains isolated from patients with generalized exfoliative syndrome or bullous impetigo produced ETA and/or ETB and caused a Nikolsky's sign when injected subcutaneously into newborn mice. In contrast, exfoliative toxin was detected in an S. aureus strain from only one of 17 case of staphylococcal scarlet fever; the 16 other S. aureus strains produced TSST-1 and/or an enterotoxin. In conclusion, enterotoxins or TSST-1 are more frequently associated with staphylococcal scarlet fever than are exfoliative toxins. Hence staphylococcal scarlet fever may well represent an abortive form of toxic shock syndrome rather than a milder form of staphylococcal scalded skin syndrome.     

The staphylococcal scalded skin syndrome. An experimental histochemical and electron microscopic study

Histochemical and electron microscopic studies were carried out on the newborn mouse model of the staphylococcal scalded skin syndrome to investigate the mechanism of action of the staphylococcal epidermolytic toxin that causes it. Histochemical studies showed that an intra-epidermal split develops below the subcorneal zone which is rich in catabolic enzymes (the so-called esterase-acid phosphatase-rich band). However, histochemical alterations in the enzyme pattern could not be demonstrated. The earliest change revealed by electron microscopy was a widening of the intercellular space, with the formation of microvilli at the level between the stratum spinosum and stratum granulosum where the split later occurs. A clearing of the peripheral cytoplasm along the cell membranes was also revealed. In pre-split areas, adhesion between cell membranes of adjacent cells seems to be lost; desmosomes continue to hold the cells together but the split develops when these are broken by mechanical pressure. Later, damaged cell membranes may be seen. Extracellular keratinosomes remain unchanged. Although these findings do not agree with the already divergent results of other studies, they help support the findings of all groups that cases of the Lyell syndrome produced by staphylococci do not occur through necrolysis; it is therefore inappropriate to continue applying the term 'toxic epidermal necrolysis' to such cases.     

Staphylococcal scalded skin syndrome in an immunocompetent adult: possible implication of low-dosage prednisone

Staphylococcal scalded skin syndrome (SSSS) mainly affects infants and young children. Very few cases of adult SSSS have been reported. Adult SSSS is usually associated with immunosuppression, overwhelming sepsis, and kidney failure. We report the case of an immunocompetent 51-year-old woman without renal failure who sustained SSSS after a 7-day course of oral prednisone administered postoperatively.     

Pyomyositis and AIDS

After more than a decade of special treatment, HIV medicine is ready to enter the mainstream of medical practice in developed countries. Access to a conveniently located, well informed, primary care doctor who works well with an appropriate specialist is the cornerstone of best medical care for chronic illness, including HIV disease. Managing HIV is part of the second phase of a national educational program aimed at equipping more doctors with the skills to care for people with HIV.     

Pyomyositis in childhood: a case report

Pyomyositis is a primary infection of skeletal muscle. We report the case of a previously healthy six-year-old who suffered from pyomyositis in the right lower back. He presented with lower back pain and low-grade fever for one week. After a series of laboratory and imaging studies, the diagnosis of right multifidus muscle pyomyositis with abscess formation was made. The patient recovered rapidly after incision and drainage therapy, accompanied by antibiotic treatment. Methicillin-resistant Staphylococcus aureus was cultured from the abscess discharge. It was strongly suspected that herbal medicines and common cold medication the patient had been prescribed before admission to our hospital produced a masking effect that delayed the diagnosis.     

Detection of staphylococcal enterotoxin B and toxic shock syndrome toxin: PCR versus conventional methods

An equal accuracy of commercially available kits, i.e., the reverse passive latex agglutination test (RPLA-Oxoid) and the Enzyme-Linked Immunosorbent Assay (SET-EIA Riedel Haen, Germany) to identify the presence of the staphylococcal enterotoxin B and the toxic shock syndrome toxin TSST-1 as well as the PCR-technique to detect the presence of the seb and tst-genes was demonstrated in 18 Staphylococcus aureus isolates. Selection of a primer pair from the etb gene sequence allowing simultaneously detection of the etb and tst-genes in S. aureus using a rapid DNA extraction method is emphasized.     

Toxin-mediated streptococcal and staphylococcal disease

After several decades of seemingly decreasing virulence, streptococcal and staphylococcal infections have reemerged as a major source of morbidity and mortality. Within the past 2 decades, not only have well-established diseases such as rheumatic fever begun to reappear. but also many new entities, such as toxic shock syndrome, streptococcal toxic shock syndrome, recurrent toxin-mediated perineal erythema, and recalcitrant erythematous desquamating disorder have been described. Central to the renewed importance of these bacteria has been the production of circulating toxins, which often function as superantigens in causing the clinical manifestations, morbidity and mortality associated with these diseases.     

Stress and strain in staphylococcal nuclease

Protein molecules generally adopt a tertiary structure in which all backbone and side chain conformations are arranged in local energy minima; however, in several well-refined protein structures examples of locally strained geometries, such as cis peptide bonds, have been observed. Staphylococcal nuclease A contains a single cis peptide bond between residues Lys 116 and Pro 117 within a type VIa beta-turn. Alternative native folded forms of nuclease A have been detected by NMR spectroscopy and attributed to a mixture of cis and trans isomers at the Lys 116-Pro 117 peptide bond. Analyses of nuclease variants K116G and K116A by NMR spectroscopy and X-ray crystallography are reported herein. The structure of K116A is indistinguishable from that of nuclease A, including a cis 116-117 peptide bond (92% populated in solution). The overall fold of K116G is also indistinguishable from nuclease A except in the region of the substitution (residues 112-117), which contains a predominantly trans Gly 116-Pro 117 peptide bond (80% populated in solution). Both Lys and Ala would be prohibited from adopting the backbone conformation of Gly 116 due to steric clashes between the beta-carbon and the surrounding residues. One explanation for these results is that the position of the ends of the residue 112-117 loop only allow trans conformations where the local backbone interactions associated with the phi and psi torsion angles are strained. When the 116-117 peptide bond is cis, less strained backbone conformations are available. Thus the relaxation of the backbone strain intrinsic to the trans conformation compensates for the energetically unfavorable cis X-Pro peptide bond. With the removal of the side chain from residue 116 (K116G), the backbone strain of the trans conformation is reduced to the point that the conformation associated with the cis peptide bond is no longer favorable.     

Antibodies against staphylococcal nuclease--titres of persons with and without staphylococcal infections (author's transl)

Rabbits were immunized against staphylococcal nuclease by repeated intramuscular injections. After five weeks the peak of the antibody response was reached, after 17 weeks the titres are on the level of the starting point. Persons without staphylococcal infections showed titres between 1:200 and 1:300 (titre of normal). In patients with proved staphylococcal infection the peak of the titres is reached three month post infection. The level of the titre is influenced by the site of infection; deep infections gave higher values than superficial processes. The method of the AStaN-reaction was examined with respect of their reproducibility, clearness, specificity and diagnostic relevance. In proved staphylococcal infections the AStaN-reaction is more often positive than the AStaL-reaction.     

Immunohistochemical and virological study of skin in the papular-purpuric gloves and socks syndrome

The pathogenesis of viral exanthems remains unclear. We have undertaken an immunohistochemical study of lesional skin biopsies in patients with the papular-purpuric gloves and socks syndrome (PPGSS) secondary to parvovirus B19 infection. Intracytoplasmic staining of the dermal endothelial cells, keratinocytes, and sweat glands was shown with an antibody to parvovirus B19. There were perivascular dermal infiltrates with T cells, sometimes with exocytosis. By polymerase chain reaction, virus DNA was detected in all skin biopsies and in one serum sample. The cutaneous manifestations of parvovirus infection seem secondary to infection of the endothelium and epidermis.     

Pebbling of the skin: a marker of Hunter''s syndrome

Cancer patients typically experience fatigue while undergoing treatment for their disease. This study was an effort to identify a reliable and economical measure of fatigue. In particular, scores on the five subscales of the Multidimensional Fatigue Inventory (MFI-20) were analyzed for internal consistency and then correlated with scores on the Rhoten Fatigue Inventory to establish a measure of validity. Moderate-to-high Cronbach alphas coefficients were established for the General Fatigue subscale of the MFI-20 using a sample of 97 rural oncology outpatients (1). Partial associations with the Rhoten Fatigue Scale lend evidence to the validity of the MFI-20 measures.     

Several indices of non-specific immunity in staphylococcal sepsis and staphylococcal gastroenterocolitis in children of different ages

A study was made of some nonspecific immunity indices in staphylococcus sepsis and gastroenterocolitis during the infectious process in young children. Results of these investigations pointed to the depression of bactericidal and lysozyme activity of the blood serum and of the immunoadherence reaction at the acute period of the disease, and to some increase at the phase of recovery. There was also found an elevation of the phagocytic activity (of the phagocytolysis percentage) at the acute phase of the staphylococcus sepsis and gastroenterocolitis Antistaphylococcus gamma-globulin produced a positive effect on the lysozyme and bactericidal activity of the blood sera and promoted an increase of the blood phagocytic activity in the sick children.     

Klinefelter's syndrome as a model for skin changes in venous insufficiency

Chronic venous insufficiency is a common disease with skin changes, varicosity and leg ulceration. Several theories have been proposed to explain all the changes that occur. We recently saw several patients with Klinefelter's syndrome complicated by leg ulceration and all the typical skin changes of venous insufficiency. The underlying disease was however lacking. They all showed disturbances in their fibrinolytic parameters. In this article we discuss (local) fibrinolytic disturbances as a possible factor in the pathogenesis of the skin changes in chronic venous insufficiency.