Ann Lab Med.  2015 Jan;35(1):89-93. 10.3343/alm.2015.35.1.89.

Prevalence of Antibody to Toxic Shock Syndrome Toxin-1 in Burn Patients

• Park JY
• Kim JS
• Woo H

• KMID: 2363153
• DOI: http://doi.org/10.3343/alm.2015.35.1.89

Abstract

BACKGROUND
Burn wounds lack normal barriers that protect against pathogenic bacteria, and burn patients are easily colonized and infected by Staphylococcus aureus. Toxic shock syndrome (TSS) is a rare but fatal disease caused by S. aureus. A lack of detectable antibodies to TSS toxin-1 (TSST-1) in serum indicates susceptibility to TSS.
METHODS
A total of 207 patients (169 men and 38 women; median age, 42.5 yr) admitted to a burn center in Korea were enrolled in this study. The serum antibody titer to TSST-1 was measured by sandwich ELISA. S. aureus isolates from the patients' nasal swab culture were tested for TSST-1 toxin production by PCR-based detection of the TSST-1 toxin gene.
RESULTS
One hundred seventy-four (84.1%) patients showed positive results for antibody against TSST-1. All patients aged > or =61 yr (n=28) and <26 months (n=7) were positive for the anti-TSST-1 antibody. S. aureus was isolated from 70 patients (33.8%), and 58.6% of the isolates were methicillin resistant. Seventeen patients were colonized with TSST-1-producing S. aureus. The antibody positivity in these 17 carriers was 88.2%, and the positivity in the non-carriers was 83.7%.
CONCLUSIONS
Most burn patients had antibody to TSST-1, and nasal colonization with TSST-1-producing S. aureus was associated with positive titers of anti-TSST-1 antibody. Additionally, patients with negative titers of anti-TSST-1 antibody might be susceptible to TSS.

Keyword

Burns; Toxic shock syndrome; Toxic shock syndrome toxin-1; Staphylococcus aureus; Antibodies; Prevalence

MeSH Terms

Adolescent
Adult
Aged
Aged, 80 and over
Antibodies, Bacterial/*blood
Bacterial Toxins/genetics/immunology/*metabolism
Burns/blood/*immunology/*microbiology/pathology
Child
Child, Preschool
Enterotoxins/genetics/immunology/*metabolism
Enzyme-Linked Immunosorbent Assay
Female
Humans
Infant
Male
Middle Aged
Nasal Cavity/microbiology
Polymerase Chain Reaction
Prevalence
Staphylococcal Infections/epidemiology
Staphylococcus aureus/isolation & purification/*metabolism
Superantigens/genetics/immunology/*metabolism
Young Adult
Antibodies, Bacterial
Bacterial Toxins
Enterotoxins
Superantigens

Figure

• 

  Fig. 1 Distribution of antibody titers to TSST-1 in burn patients colonized with or without TSST-1-producing Staphylococcus aureus.Abbreviation: TSST-1, toxic shock syndrome toxin-1.

Reference

1. Weber J. Infection control in burn patients. Burns. 2004; 30:A16–A24. PMID: 15555784.

2. Shupp JW, Ortiz RT, Moffatt LT, Jo DY, Randad PR, Njimoluh KL, et al. Treatment with an oxazolidinone antibiotic inhibits toxic shock syndrome toxin-1 production in MRSA-infected burn wounds. J Burn Care Res. 2013; 34:267–273. PMID: 23370994.

3. Lee HG, Jang J, Choi JE, Chung DC, Han JW, Woo H, et al. Bloodstream infections in patients in the burn intensive care unit. Infect Chemother. 2013; 45:194–201. PMID: 24265967.

4. Murray CK, Holmes RL, Ellis MW, Mende K, Wolf SE, McDougal LK, et al. Twenty-five year epidemiology of invasive methicillin-resistant Staphylococcus aureus (MRSA) isolates recovered at a burn center. Burns. 2009; 35:1112–1117. PMID: 19477601.

5. Marples RR, Wieneke AA. Enterotoxins and toxic-shock syndrome toxin-1 in non enteric staphylococcal disease. Epidemiol Infect. 1993; 110:477–488. PMID: 8519313.

6. McCormick JK, Yarwood JM, Schlievert PM. Toxic shock syndrome and bacterial superantigens: an update. Annu Rev Microbiol. 2001; 55:77–104. PMID: 11544350.

7. DeVries AS, Lesher L, Schlievert PM, Rogers T, Villaume LG, Danila R, et al. Staphylococcal toxic shock syndrome 2000-2006: epidemiology, clinical features, and molecular characteristics. PLoS One. 2011; 6:e22997. PMID: 21860665.

8. Andrews MM, Parent EM, Barry M, Parsonnet J. Recurrent nonmenstrual toxic shock syndrome: clinical manifestations, diagnosis, and treatment. Clin Infect Dis. 2001; 32:1470–1479. PMID: 11317249.

9. Lappin E, Ferguson AJ. Gram-positive toxic shock syndrome. Lancet Infect Dis. 2009; 9:281–290. PMID: 19393958.

10. Quan L, Morita R, Kawakami S. Toxic shock syndrome toxin-1 (TSST-1) antibody levels in Japanese children. Burns. 2010; 36:716–721. PMID: 20036064.

11. Parsonnet J, Hansmann MA, Delaney ML, Modern PA, Dubois AM, Wieland-Alter W, et al. Prevalence of toxic shock syndrome toxin 1-producing Staphylococcus aureus and the presence of antibodies to this superantigen in menstruating women. J Clin Microbiol. 2005; 43:4628–4634. PMID: 16145118.

12. Parsonnet J, Goering RV, Hansmann MA, Jones MB, Ohtagaki K, Davis CC, et al. Prevalence of toxic shock syndrome toxin 1 (TSST-1)-producing strains of Staphylococcus aureus and antibody to TSST-1 among healthy Japanese women. J Clin Microbiol. 2008; 46:2731–2738. PMID: 18550735.

13. Choi JH, Choi JH, Kim DI, Kim JS, Choi EH. A case of toxic shock syndrome caused by methicillin-resistant Staphylococcus aureus (MRSA) following a burn injury. Korean J Pediatr Infect Dis. 2009; 16:205–209.

14. Mehrotra M, Wang G, Johnson WM. Multiplex PCR for detection of genes for Staphylococcus aureus enterotoxins, exfoliative toxins, toxic shock syndrome toxin 1, and methicillin resistance. J Clin Microbiol. 2000; 38:1032–1035. PMID: 10698991.

15. Xu SX, McCormick JK. Staphylococcal superantigens in colonization and disease. Front Cell Infect Microbiol. 2012; 2:52. PMID: 22919643.

16. Kooistra-Smid M, Nieuwenhuis M, van Belkum A, Verbrugh H. The role of nasal carriage in Staphylococcus aureus burn wound colonization. FEMS Immunol Med Microbiol. 2009; 57:1–13. PMID: 19486150.

17. Bonventre PF, Linnemann C, Weckbach LS, Staneck JL, Buncher CR, Vigdorth E, et al. Antibody responses to toxic-shock-syndrome (TSS) toxinby patients with TSS and by healthy staphylococcal carriers. J Infect Dis. 1984; 150:662–666. PMID: 6491377.

18. Dinges MM, Orwin PM, Schlievert PM. Exotoxins of Staphylococcus aureus. Clin Microbiol Rev. 2000; 13:16–34. PMID: 10627489.

19. Park BG, Lee MK. Nasal carriage of methicillin-resistant Staphylococcus aureus among healthcare workers and community students in 1997 and 2006. Korean J Nosocomial Infect Control. 2007; 12:85–90.

20. Kim JS, Lee SH, Jeong J, Roh KH, Lee HK, Jang SJ, et al. Nasal colonization and molecular characterization of methicillin-resistant Staphylococcus aureus among hemodialysis patients in 7 Korean hospitals. Korean J Nosocomial Infect Control. 2013; 18:51–56.

21. Peck KR, Baeck JY, Song JH, Ko KS. Comparison of genotypes and enterotoxin genes between Staphylococcus aureus isolated from blood and nasal colonizers in a Korean hospital. J Korean Med Sci. 2009; 24:585–591. PMID: 19654937.