Title:Searching the Staphylococcal Toxic Shock Syndrome Toxin -1 in Septic Children with negative Cultures: A Comparative Study in Tehran, Iran
Volume: 21
Issue: 2
Author(s): Samileh Noorbakhsh*, Ali Asghar Rabiei, Ali Akbar Rahbarimanesh, Morteza Haghighi and Sarvenaz Ashouri
Affiliation:
- Department of Pediatric Infectious Diseases, Iran University of Medical Sciences, Tehran,Iran
Keywords:
Staphylococcus aureus, super antigens (SAgs), TSST-1, PCR, sepsis, septic shock, children.
Abstract:
Background: 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.
Materials and Methods: 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.
Results: 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).
Conclusion: 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.
