Exfoliative toxin A staphylococcal scalded skin syndrome in preterm infants.

Abstract

Staphylococcal scalded skin syndrome (SSSS) demonstrates dermal symptoms due to exfoliative toxin (ET) A or ETB produced by Staphylococcus aureus. We examined the association between anti-ETA antibodies and SSSS onset in neonates. Three preterm infants carried an ETA-producing strain of S. aureus, manifesting as either SSSS or bullous impetigo; a full-term infant carrying the same strain was asymptomatic. The infants(n=106) were categorized into three groups according to their gestational age (GA) as follows: <30weeks, 30-37weeks, and >37weeks. The measured levels of anti-ETA antibody in the three infants displaying SSSS were low before the onset of dermal symptoms; only the asymptomatic full-term infant displayed a high antibody level. Anti-ETA antibody levels in the preterm group witha GA of <30weeks were statistically lower than those in the term infant group; the prevalences of anti-ETA antibodies above a cutoff value in the three groups of neonates were 55% (18/33) among preterm infants with a GA <30weeks, 73% (25/34) among those with a GA of 30-37weeks, and 90% (35/39) among infants with a GA >37weeks. The presence of anti-ETA antibodies below a particular cutoff level might be associated with SSSS onset in preterm infants.