Staphylococcal Enterotoxin B Toxic Shock Syndrome Induced by Community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA)

Takeru Kashiwada; Ken Kikuchi; Shinji Abe; Hidehito Kato; Hiroki Hayashi; Taisuke Morimoto; Koichiro Kamio; Jiro Usuki; Shinhiro Takeda; Keiji Tanaka; Ken'ichi Imanishi; Junji Yagi; Arata Azuma; Akihiko Gemma

doi:10.2169/internalmedicine.51.7295

CASE REPORTS

Staphylococcal Enterotoxin B Toxic Shock Syndrome Induced by Community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA)

Takeru Kashiwada, Ken Kikuchi, Shinji Abe, Hidehito Kato, Hiroki Hayashi, Taisuke Morimoto, Koichiro Kamio, Jiro Usuki, Shinhiro Takeda, Keiji Tanaka, Ken'ichi Imanishi, Junji Yagi, Arata Azuma, Akihiko Gemma

Author information

Takeru Kashiwada
Internal Medicine, Department of Pulmonary Medicine/Infection and Oncology, Nippon Medical School, Japan
Ken Kikuchi
Department of Infection Control Science, Faculty of Medicine, Juntendo University, Japan
Shinji Abe
Internal Medicine, Department of Pulmonary Medicine/Infection and Oncology, Nippon Medical School, Japan
Hidehito Kato
Department of Microbiology and Immunology, Tokyo Women's Medical University School of Medicine, Japan
Hiroki Hayashi
Internal Medicine, Department of Pulmonary Medicine/Infection and Oncology, Nippon Medical School, Japan
Taisuke Morimoto
Internal Medicine, Department of Pulmonary Medicine/Infection and Oncology, Nippon Medical School, Japan
Koichiro Kamio
Internal Medicine, Department of Pulmonary Medicine/Infection and Oncology, Nippon Medical School, Japan
Jiro Usuki
Internal Medicine, Department of Pulmonary Medicine/Infection and Oncology, Nippon Medical School, Japan
Shinhiro Takeda
Division of Intensive Care Unit and Coronary Care Unit, Nippon Medical School, Japan
Keiji Tanaka
Division of Intensive Care Unit and Coronary Care Unit, Nippon Medical School, Japan
Ken'ichi Imanishi
Department of Microbiology and Immunology, Tokyo Women's Medical University School of Medicine, Japan
Junji Yagi
Department of Microbiology and Immunology, Tokyo Women's Medical University School of Medicine, Japan
Arata Azuma
Internal Medicine, Department of Pulmonary Medicine/Infection and Oncology, Nippon Medical School, Japan
Akihiko Gemma
Internal Medicine, Department of Pulmonary Medicine/Infection and Oncology, Nippon Medical School, Japan

Keywords: toxic shock syndrome, staphylococcal enterotoxin B, T-cell antigen receptor, methicillin resistant Staphylococcus aureus, swine-origin influenza A H1N1 virus

JOURNAL OPEN ACCESS

2012 Volume 51 Issue 21 Pages 3085-3088

DOI https://doi.org/10.2169/internalmedicine.51.7295

Details

Abstract

We herein report a case of toxic shock syndrome (TSS) associated with the 2009 pandemic H1N1 (pH1N1) influenza virus and a community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection in a 16-year-old Vietnamese girl. Staphylococcal enterotoxin B (SEB) was detected in the patient's serum, and the level of anti-SEB antibodies was found to be elevated. A flow cytometric analysis showed evidence of activated SEB-reactive Vβ3⁺ and Vβ12⁺ T cells. These data suggest that the CA-MRSA-induced activation of SEB-reactive T cells may cause TSS in patients with pH1N1 virus infection. Moreover, this is the first report describing immunological confirmation of SEB contributing directly to TSS in a patient fulfilling the diagnostic criteria of TSS.

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