Toxic Syndrome Research Articles

Assessment of Staphylococcal toxins acting as superantigens in different nasal specimens in the etiology of chronic rhinosinusitis

The mechanism of development of chronic rhinosinusitis(CRS) is not fully known. However, bacteria are thought to play an important role in this clinic. It has been suggested that toxins with superantigen(SAgs) properties produced by one of these bacteria, Staphylococcus aureus(S.aureus), play a role in the development of inflammation associated with sinusitis. In this study, S.aureus was isolated by taking endoscopic sinus biopsy samples and nasal swab samples from patients with CRS and the control group. It was aimed to examine the frequency of S.aureus presence in the samples taken, the presence of toxin genes showing superantigen quality in these isolated bacteria, and to evaluate the roles of these parameters in the development of CRS. More S.aureus was isolated in the samples taken from patients with CRS than in the control group. The isolated S.aureus samples were analysed by real-time PCR method. The presence of enterotoxin A, B, C and D genes in the S.aureus samples isolated from the patient group were found at the rates of 54%, 32%, 16% and 16%, respectively, while these rates were 46%, 24%, 14% and 14% in the control group. The Toxic Shock Syndrome Toxin-1(TSST-1) gene was detected in 20% of the samples isolated from the patient and 46% in the control group bacteria. The fact that S.aureus was isolated in 20% of the patients shows that this bacterium is not necessary for CRS. The frequency of superantigen toxin genes in S.aureus isolates shows that these toxins are not necessary for the development of the disease.

Tagraxofusp Maintenance Post-Hematopoietic Stem Cell Transplantation Provides Long-Term Survival and Manageable Safety for a Patient with Blastic Plasmacytoid Dendritic Cell Neoplasm

Introduction:Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare, clinically aggressive hematologic malignancy that commonly involves four major compartments: cutaneous, bone marrow/blood, lymph nodes, and central nervous system (CNS). Tagraxofusp (TAG) is a first-in-class therapy directed to CD123, a target expressed in BPDCN, and is the only drug approved to treat BPDCN in the US and EU. TAG has demonstrated high rates of durable response and bridge to allogeneic hematopoietic cell transplantation (allo-HCT)(Pemmaraju N et al NEJM 2019). Historically, patients that undergo allogeneic allo-HCT have been reported to have long-term remissions, particularly if transplanted while in complete response; however, ~50% of patients will relapse post-allo-HCT, and strategies are needed to minimize this risk. No clinical studies to date have been conducted to assess the rate of post-HCT relapse in patients who receive TAG maintenance therapy after allo-HCT. This case study reports on a patient who was successfully treated with TAG therapy after allo-HCT in a phase 2 trial (NCT04317781). Methods and Results: A 68-year-old woman with BPDCN underwent allo-HCT and was enrolled in a TAG post-allo-HCT maintenance trial at the MD Anderson Cancer Center in 2021. Therapy prior to allo-HCT included hydroxyurea and TAG + venetoclax + mini-HyperCVAD for 5 cycles. The patient was in morphologic complete remission with low positivity by flow cytometry (positive for minimal residual disease [MRD]) at the time of allo-HCT. After allo-HCT and prior to TAG maintenance therapy, the patient had persistent cytogenic abnormalities on a bone marrow next-generation sequencing (NGS) panel. The patient received TAG 9 mcg/kg for 3 days on a 28-day cycle after allo-HCT. The patient received TAG in the post-allo-HCT setting for a total of 16 cycles. At mid-treatment (post Cycle 6, prior to Cycle 7) with TAG, the disease was in complete remission, and the bone marrow NGS panel was negative for mutations (MRD negative). The patient did not experience any high-grade toxicity or capillary leak syndrome (CLS); the only toxicity observed was weight gain (Grade 0 per CTCAE), TAG was stopped for that cycle, and the event resolved. After Cycle 16, the patient withdrew consent due to the burden of traveling from another state. Bone marrow NGS testing was repeated prior to discontinuing study treatment, and the panel remained negative for MRD, with disease still in complete remission. Conclusions: This case report demonstrates a patient experiencing a clinically meaningful benefit with TAG maintenance therapy after allo-HCT. Both prolonged survival and manageable safety, in this case, highlight the feasibility of long-term TAG maintenance post-allo-HCT to control BPDCN.

Case Series With Streptococcus pyogenes -related Toxic Shock Syndrome in the Post-COVID Period [RETRACTED

After the COVID-19 pandemic restrictions are nullified, increasing bacterial infections are reported such as invasive pneumococcal diseases and Streptococcus pyogenes infections. Streptococcal infections are common in children and usually have a mild clinical course. It can also cause life-threatening invasive infections such as streptococcal toxic shock syndrome. Group A Streptococcus surveillance data was last reported by the Centers for Disease Control and Prevention in 2020. Although surveillance data are insufficient in our country, invasive streptococcal infections are seen with increasing frequency in our clinic in the postpandemic period, especially in the last weeks. In this case series, 3 patients with streptococcal toxic shock syndrome followed in the last 2 weeks are presented.

Antimicrobial peptidase lysostaphin at subinhibitory concentrations modulates staphylococcal adherence, biofilm formation, and toxin production

BackgroundThe ability of antimicrobial agents to affect microbial adherence to eukaryotic cell surfaces is a promising antivirulence strategy for combating the global threat of antimicrobial resistance. Inadequate use of antimicrobials has led to widespread instances of suboptimal antibiotic concentrations around infection sites. Therefore, we aimed to examine the varying effect of an antimicrobial peptidase lysostaphin (APLss) on staphylococcal adherence to host cells, biofilm biomass formation, and toxin production as a probable method for mitigating staphylococcal virulence.ResultsInitially, soluble expression in E. coli and subsequent purification by immobilized-Ni2+ affinity chromatography (IMAC) enabled us to successfully produce a large quantity of highly pure ~ 28-kDa His-tagged mature APLss. The purified protein exhibited potent inhibitory effects against both methicillin-sensitive and methicillin-resistant staphylococcal strains, with minimal inhibitory concentrations (MICs) ranging from 1 to 2 µg/mL, and ultrastructural analysis revealed that APLss-induced concentration-specific changes in the morphological architecture of staphylococcal surface membranes. Furthermore, spectrophotometric and fluorescence microscopy revealed that incubating staphylococcal strains with sub-MIC and MIC of APLss significantly inhibited staphylococcal adherence to human vaginal epithelial cells and biofilm biomass formation. Ultimately, transcriptional investigations revealed that APLss inhibited the expression of agrA (quorum sensing effector) and other virulence genes related to toxin synthesis.ConclusionsOverall, APLss dose-dependently inhibited adhesion to host cell surfaces and staphylococcal-associated virulence factors, warranting further investigation as a potential anti-staphylococcal agent with an antiadhesive mechanism of action using in vivo models of staphylococcal toxic shock syndrome.

Toxikus sokk szindróma gyermekkorban, – fókuszban a nekrotizáló fasciitis

Toxic Shock Syndrome (TSS) is an acute, toxin-mediated, severe illness with fever, hypotension, multi-organ failure, diffuse rash (diffuse macular erythroderma) and desquamation. Necrotizing fasciitis (NF) is a rapidly progressive soft tissue infection associated with fulminant tissue destruction, severe systemic toxicity and a high rate of mortality. It frequently is a diagnostic challenge because the initial symptoms are aspecific and superficial tissues may appear intact. Antibiotic therapy and early surgical intervention form the basis of appropriate treatment.

Comparison of Efficacy and Safety between Immediate Sequential and Delayed Sequential Bilateral Cataract Surgery

Purpose: We compared the efficacy and safety of immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS).Methods: We analyzed the best corrected visual acuity (BCVA), spherical equivalent (SE), and mean absolute error (MAE) in the ISBSC and DSBSC groups. The study population comprised 72 patients (144 eyes) who underwent ISBCS and 92 patients (184 eyes) who underwent DSBCS at Seoul St. Mary's Hospital between January 2019 and December 2021.Results: At 1 month postoperatively, the ISBCS group demonstrated a BCVA, SE, and MAE of 0.11 ± 0.09, -0.33 ± 0.42 diopters (D), and 0.38 ± 0.32 D, respectively; similarly, the DSBCS group exhibited a BCVA, SE, and MAE of 0.11 ± 0.15, -0.29 ± 0.56 D, and 0.41 ± 0.43 D, respectively. Furthermore, no significant differences were observed between the ISBCS and the DSBCS groups regarding SE and MAE at the 1-month follow-up for the first and second operated eyes. No cases of postoperative endophthalmitis and toxic anterior segment syndrome were reported.Conclusions: ISBCS is an effective and cost-effective approach that yields favorable postoperative outcomes when performed by an experienced surgeon supported by appropriate pre- and postoperative care, particularly in patients who demonstrate good cooperation.

Evaluating antibiotic regimens for streptococcal toxic shock syndrome in children.

Streptococcal toxic shock syndrome (STSS) is a severe consequence of infections from Streptococcus pyogenes. The early identification and timely intervention with appropriate anti-infective agents are pivotal for managing pediatric STSS. This study evaluates the effectiveness of various treatment regimens for STSS in children. Clinical data of children with STSS resulting from β-hemolytic streptococcal infections in two hospitals were retrospectively analyzed from January 2009 to April 2023. Additionally, literature from the China National Knowledge Infrastructure on pediatric STSS was examined. Antimicrobial treatments were categorized into four groups based on their compositions, with an additional categorization for adjunct therapeutic drugs. Of 32 confirmed STSS cases, all displayed sensitivity to ampicillin, β-lactam antibiotics, and vancomycin, but resistance to clindamycin, erythromycin, and tetracycline. From the literature, 23 studies with 50 cases were extracted, leading to a total of 82 patients for evaluation. The efficacy rates varied significantly among the four treatment groups. Notably, the standard penicillin-containing group exhibited the highest efficacy (86.4%), while the group with macrolides/unused antibiotics registered a 0% efficacy rate. The other two groups demonstrated efficacy rates of 32.1% and 42.3%. For pediatric STSS, Streptococcus pyogenes shows notable sensitivity to ampicillin. Implementing timely β-lactam antibiotics, specifically penicillin, in conjunction with clindamycin and intravenous immunoglobulins enhances the treatment success rate.

Anakinra and hepatotoxicity in pediatric rheumatology: a case series

BackgroundAnakinra is a recombinant interleukin-1 (IL-1) receptor antagonist used in systemic juvenile idiopathic arthritis (sJIA), refractory Kawasaki disease (KD) and cryopyrin-associated autoinflammatory syndrome (CAPS). Anakinra associated hepatotoxicity, while rare, has been described in several cases in daily practice. ​In this case series the authors describe three pediatric patients with this side effect in the setting of severe macrophage activation syndrome (MAS) in KD and sJIA.Case presentationThe first patient was a 12-year-old boy who presented with fever, maculo-papular exanthema and polyarthralgia. Tonsillitis, distal limb induration and tender cervical lymph nodes were observed. Erythrocyte-sedimentation rate (ESR), C-reactive protein (CRP), ferritin (11,975 ng/mL), D-dimers (5,98 mg/L FEU) and soluble CD25 (3645 pg/mL) levels were elevated. Exclusion of sepsis / toxic shock syndrome warranted introduction of IV methylprednisolone and immunoglobulin (IG IV), with partial response. A MAS secondary to KD was assumed, and anakinra 2 mg/kg/day was introduced. Twenty days later he developed new-onset nausea and severe cyto-cholestasis, normalizing after 2 months of drug discontinuation. Posterior onset of polyarthritis and evanescent lead to a final diagnosis of sJIA. The second patient was a 2-year-old boy with a 10-day history of fevers, generalized rash, hepatosplenomegaly and strawberry tongue. Leucocytosis with neutrophilia and elevated CRP were observed. Initial treatment with IVIG in the setting of incomplete KD was ineffective. Mild anaemia, leukopenia and very high serum ferritin (maximum 26,128 ng/mL) ensued. Presumptive sJIA associated MAS was treated with IV methylprednisolone and anakinra 2 mg/kg/day, with prompt response. Four weeks later transaminitis was detected, and temporary anakinra suspension led to normalisation of laboratorial values. The third case related to a 4-year-old boy presenting with fever, maculopapular rash and cervical lymphadenopathy. CRP and ESR were elevated, and KD was diagnosed. IVIG and methylprednisolone were initiated with clinical worsening, warranting for anakinra introduction at 2 mg/kg/day. After three weeks, liver enzymes progressively elevated, resolving on 2 weeks of anakinra discontinuation.ConclusionsTo the best of our knowledge, this is the first case series describing anakinra associated hepatotoxicity in pediatric patients with rheumatic diseases other than sJIA, bringing additional insight to therapeutic monitoring in patients undergoing this treatment.

Outbreak of Invasive Group A Streptococcus in Children-Colorado, October 2022-April 2023.

In the fall of 2022, we observed a sharp rise in pediatric Invasive Group A Streptococcus (iGAS) hospitalizations in Colorado. We compared the epidemiology, clinical features, and patient outcomes in this outbreak to prior years. Between October 2022 and April 2023, we prospectively identified and reviewed iGAS cases in hospitalized pediatric patients at Children's Hospital Colorado. Using laboratory specimen records, we also retrospectively compared the number of patients with sterile site GAS-positive cultures across three time periods: pre-COVID-19 (January 2015-March 2020), height of COVID-19 pandemic (April 2020-September 2022), and outbreak (October 2022-April 2023). Among 96 prospectively identified iGAS cases, median age was 5.7 years old; 66% were male, 70% previously healthy, 39% required critical care, and four patients died. Almost 60% had associated respiratory viral symptoms, 10% had toxic shock syndrome, and 4% had necrotizing fasciitis. Leukopenia, bandemia, and higher C-reactive protein values were laboratory findings associated with need for critical care. There were significantly more cases during the outbreak (9.9/month outbreak vs 3.9/month pre-pandemic vs 1.3/month pandemic), including more cases with pneumonia (28% outbreak vs 15% pre-pandemic vs 0% pandemic) and multifocal disease (17% outbreak vs 3% pre-pandemic vs 0% pandemic), P < .001 for all. Outbreak case numbers were almost triple the pre-pandemic baseline. The high percentage of cases with associated viral symptoms suggests a link to coinciding surges in respiratory viruses during this time. Invasive GAS can be severe and evolve rapidly; clinical and laboratory features may help in earlier identification of critically ill children.

Influenza enhances host susceptibility to non-pulmonary invasive Streptococcus pyogenes infections

ABSTRACT Streptococcus pyogenes (group A streptococcus; GAS) causes a variety of invasive diseases (iGAS) such as bacteremia, toxic shock syndrome, and pneumonia, which are associated with high mortality despite the susceptibility of the bacteria to penicillin ex vivo. Epidemiologic studies indicate that respiratory influenza virus infection is associated with an increase in the frequency of iGAS diseases, including those not directly involving the lung. We modified a murine model of influenza A (IAV)-GAS superinfection to determine if viral pneumonia increased the susceptibility of mice subsequently infected with GAS in the peritoneum. The results showed that respiratory IAV infection increased the morbidity (weight loss) of mice infected intraperitoneally (i.p.) with GAS 3, 5, and 10 d after the initial viral infection. Mortality was also significantly increased when mice were infected with GAS 3 and 5 d after pulmonary IAV infection. Increased mortality among mice infected with virus 5 d prior to bacterial infection correlated with increased dissemination of GAS from the peritoneum to the blood, spleen, and lungs. The interval was also associated with a significant increase in the pro-inflammatory cytokines IFN-γ, IL-12, TNF-α, MCP-1 and IL-27 in sera. We conclude, using a murine model, that respiratory influenza virus infection increases the likelihood and severity of systemic iGAS disease, even when GAS infection does not originate in the respiratory tract.

Explantation of a light-adjustable intraocular lens: case report with laboratorial analyses

Introduction: A case in which a light-adjustable lens (LAL) underwent explantation and extensive laboratory analyses is reported. Patient and Clinical Findings: A 61-year-old man underwent uneventful cataract surgery with in-the-bag implantation of a first-generation LAL in the right eye. Examination on the second postoperative day revealed limbus-to-limbus corneal edema, moderate anterior chamber cells, and a mid-dilated, minimally responsive pupil, suggesting toxic anterior segment syndrome (TASS). Diagnosis, Intervention, and Outcomes: Endothelial keratoplasty was performed 2 months after LAL implantation. The patient reported noncompliance with required UV-protective eyewear, and an attempted light adjustment confirmed macromer reserve depletion, likely secondary to ambient UV contamination. Gross and microscopic examinations of the explanted LAL showed a decentered round elevation on the optic. The light transmittance (%T) curve was normal, with 95.9%T on average in the visible spectrum. Optical coherence tomography revealed irregular curvatures of the anterior and posterior optic surfaces. Wavefront analysis displayed aberrations and large power variations, which corresponded to decreased focus and contrast through the optic. Conclusions: To the authors' knowledge, this is the first reported case of LAL implantation complicated by TASS, leading to a prolonged clinical course and nonadherence to proprietary UV-protective spectacles. Extensive laboratory analyses of the explanted LAL demonstrated findings that can be expected with uncontrolled polymerization of the LAL.

ASCRS clinical advisory on intracameral moxifloxacin injection for infection prophylaxis.

Moxifloxacin solution is frequently injected at the conclusion of cataract surgery for endophthalmitis prophylaxis. 2 different concentrations are most commonly available in the United States for intracameral (IC) use: 0.5% (5 mg/mL) and 0.1% (1 mg/mL). The recommended volume to be injected is different for the 2 concentrations, and incorrect dosing can increase the risk of toxic anterior segment syndrome or endophthalmitis. In addition, the U.S. Food and Drug Administration recently published an alert regarding potential adverse events associated with intraocular compounded moxifloxacin. This clinical advisory reviews the optimal dosing of IC moxifloxacin based on current evidence.

A Rare Case of TMP-SMX Induced DRESS and Clinical TSS in a Pediatric Patient

Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a rare and potentially life-threatening adverse drug reaction. We present a case of a 14-year-old girl with overlapping DRESS syndrome and Toxic Shock Syndrome (TSS) following Trimethoprim/Sulfamethoxazole treatment. The patient developed a generalized pruritic maculopapular rash, lymphadenopathy, fever, and facial swelling. Laboratory results showed leukocytosis, elevated liver enzymes, and C-reactive protein (CRP). Despite initial treatment with methylprednisolone, her condition worsened, necessitating a transfer to a higher level of care. She exhibited fever, hypotension, tachycardia, tachypnea, strawberry tongue, and perioral impetigo, consistent with TSS. Antibiotic therapy was initiated, but eosinophilia and an abdominal desquamative rash emerged, indicative of DRESS syndrome. Treatment involved discontinuing antibiotics, administering intravenous solumedrol for possible DRESS, and restarting antibiotics due to persistent TSS features. The patient’s symptoms improved, and she was discharged on tapering steroids and antibiotics. This case highlights the coexistence of DRESS and TSS in a pediatric patient and emphasizes the importance of promptly discontinuing the offending agent and appropriate management with steroids and antibiotics. Of the participants, 65.9% reported decreased activity levels, while 46.3% experienced weight gain. Notably, 64.2% of participants had an elevated risk score, signifying an increased vulnerability to T2D.

Hyperpyrexic Toxic Shock Syndrome in Association with TSST-1 Cross-Reactive Superantigen SE-like X-Producing Staphylococcus aureus: Case Report, Toxin Analysis and a Proposed Case Definition

Herein, we report two additional cases of extreme pyrexia and rapid death due to Staphylococcus aureus infection. The organisms produced a variant superantigen, cross-reactive with toxic shock syndrome toxin-1 (TSST-1 cross-reactive superantigen SE-like X), which we purport to be the causative agent for this syndrome.

Validating Interactions of Pathogenic Proteins of Staphylococcus aureus and E. coli with Phytochemicals of Ziziphus jujube and Acacia nilotica.

This study focused on the assessment of the antimicrobial resistance of Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli) isolated from bovine mastitis milk samples and the revealing anti-mastitis potential of phytocompounds of Ziziphus jujube and Acacia nilotica through molecular docking analysis. The mastitis milk samples were collected from various dairy farms for the isolation of the bacteria (S. aureus and E. coli) and their response to antibiotics. Ethanolic extracts of both plants were prepared. Their antibacterial activity was evaluated, and they were processed for phytochemical analysis after which, molecular docking analysis with pathogenic proteins of the bacteria was carried out. Parametric and non-parametric statistical analyses were performed to reach the conclusions of this study. The findings of the study revealed a higher drug resistance (≥40%) of E. coli against ampicillin, amikacin, and vancomycin, while S. aureus exhibited the highest resistance to ampicillin, erythromycin, and ciprofloxacin. The ethanolic extracts of the Ziziphus jujube and Acacia nilotica plants produced a ZOI between 18 and 23 mm against multidrug-resistant S. aureus and E. coli. Gas chromatography-mass spectrophotometry (GC-MS) was used to explore 15 phytocompounds from Ziziphus jujube and 18 phytocompounds from Acacia nilotica. The molecular docking analysis of 2cyclopenten-1-one,3,4,4 trimethyl and Bis (2ethylhexyl) phthalate of Ziziphus jujube showed a binding affinity of -4.8 kcal/mol and -5.3 kcal/mol and -5.9 kcal/mol and -7.1 kcal/mol against the DNA Gyrase and toxic shock syndrome toxin-1 proteins of S. aureus and E. coli, respectively. The suberic acid monomethyl ester of Acacia nilotica showed a binding affinity of -5.9 kcal/mol and -5 kcal/mol against the outer membrane protein A and Topoisomerase IV protein of E. coli and -5.1 kcal/mol and -5.8 kcal/mol against the toxic shock syndrome toxin-1 and Enterotoxin B proteins of S. aureus. Similarly, 2,2,4-trimethyl-1,3-pentanediol di-iso-butyrate showed a binding affinity of -6.5 kcal/mol and -5.3 kcal/mol against the outer membrane protein A and Topoisomerase IV of E. coli and -5.2 kcal/mol and -5.9 kcal/mol against the toxic shock syndrome toxin-1 and Enterotoxin B proteins of S. aureus, respectively. The study concluded that there was an increasing trend for the antimicrobial resistance of S. aureus and E. coli, while the Ziziphus jujube and Acacia nilotica plant extracts expressed significant affinity to tackle this resistance; hence, this calls for the development of novel evidence-based therapeutics.

Prevalence and Characteristics of Invasive Staphylococcus argenteus among Patients with Bacteremia in Hong Kong.

Staphylococcus argenteus is a novel Staphylococcus species derived from Staphylococcus aureus. Information on the prevalence and genetic characteristics of invasive S. argenteus in Asia is limited. In this study, 275 invasive S. aureus complex strains were retrieved from blood culture specimens in Hong Kong and re-analyzed using MALDI-TOF mass spectrometry and an in-house multiplex real-time PCR for S. argenteus. The prevalence of invasive S. argenteus in Hong Kong was found to be 4.0% (11/275). These strains were primarily susceptible to commonly used antibiotics, except penicillin. Whole-genome sequencing revealed the circulation of three S. argenteus genotypes (ST-2250, ST-1223, and ST-2854) in Hong Kong, with ST-2250 and ST-1223 being the predominant genotypes. The local ST-2250 and ST-1223 strains showed close phylogenetic relationships with isolates from mainland China. Antimicrobial-resistant genes (fosB, tet-38, mepA, blaI, blaZ) could be found in nearly all local S. argenteus strains. The ST-1223 and ST-2250 genotypes carried multiple staphylococcal enterotoxin genes that could cause food poisoning and toxic shock syndrome. The CRISPR/Cas locus was observed only in the ST-2250 strains. This study provides the first report on the molecular epidemiology of invasive S. argenteus in Hong Kong, and further analysis is needed to understand its transmission reservoir.

Accessory gene regulators and virulence genes associated with the pathogenicity of Staphylococcus aureus from clinical and community settings in Lagos, Nigeria

Staphylococcus aureus is a prominent pathogen that causes serious community and hospital-acquired infections globally. Its pathogenicity is attributed to a variety of secreted and cell surface associated proteins that are modulated by the quorum-sensing accessory gene regulator (agr) system. In this study, we investigated the presence of toxin genes and agr involved with S. aureus from clinical samples and apparently healthy individuals. Unequivocal identification of the isolates was obtained with the Vitek 2 system. We screened 70 clinical (CL) and 22 community (C) S. aureus strains for the methicillin resistance (mecA) gene, agr and superantigens (SAg) (enterotoxins and toxic shock syndrome toxin-1) using PCR techniques. A total of 12 clinical isolates were classified as methicillin-resistant S. aureus (MRSA); 89 isolates belonged to one of the four agr groups (agr1-4), and 3 isolates were non-typeable. Of the agr groups, agr1 was the most prominent and mostly consisted of isolates from pus/wounds. The methicillin-susceptible S. aureus (MSSA) isolates were distributed within the four agr groups while MRSA strains were restricted to agr1 and agr3. The most common enterotoxin gene, sei, was likewise more prevalent in MSSA strains than in MRSA strains, where sea predominated. The co-existence of two or more enterotoxins was confirmed in 40% of the isolates. sea occurred through all the agr groups except agr3 and sei was not found in agr1 and agr4. The toxic shock toxin (tst) gene was detected in six MSSA. These findings suggest that MSSA may cause more lethal infections than MRSA because of the increased frequency of toxic genotypes seen in MSSA strains. Significance: Isolates in the agr1,3 groups had more SAg toxin genes, whereas isolates in the agr4 groups possessed more tst genes. The MSSA isolates contained higher proportions of virulence genes than MRSA. The clinical implications of this discovery include that MSSA may cause more lethal infections than MRSA due to the greater number of toxigenic genotypes discovered.

Antimicrobial Resistance Profile of Airborne Aspergillus flavus and Methicillin-Resistant Staphylococcus aureus in Public Toilets within Port Harcourt, Nigeria

MRSA is a major contributor to skin infections, bloodstream infections, toxic shock syndrome, and joint inflammation. Aspergillus flavus can result in a range of health issues these problems include allergic reactions, aspergilloma, both invasive and non-invasive. infections are a matter of importance for public health. Aspergillus flavus and Methicillin-resistant Staphylococcus aureus (MRSA) resistance to both antibiotics and antifungal medications put the public at risk.This study therefore was carried out to investigate the antimicrobial susceptibility pattern of Aspergillus flavus and Methicillin resistant Staphylococcus aureus (MRSA) isolated from publicly used toilets in Port Harcourt, Rivers State Nigeria. Eighty (80) samples were collected for a period of two months from five public toilets using the sedimentation air sampling method. Samples were subjected to isolation and identification, antibiotics and antifungal susceptibility test using Kirby-Bauer disk diffusion method, plant extracts and molecular identification of bacterial isolates for analysis. The susceptibility profile showed that MRSA were resistant to Ofloxacin (61%), Ceftazidime (92.30%), Levoflaxcin (92.30%), Vancomycin (77 %), Gentamycin (61%), Azithromycin (46.2%) and cefotaxime (46.2%) and susceptible to Imipenem (100%), Meropenem (92.32%). Ketoconazole and nystatin both antifungals were both effective on the A. flavus. Methanol extract of Ocimum grastissimum was more effective followed by Psidium guajava and moringa oleifera on MRSA but also less effective in A. flavus. The MAR index ranged from 0.1 to 0.8 which showed that 60% of MRSA isolates had MAR index of 0.8, while 20% had MAR index of 0.4 and 0.5. The antimicrobial activity of the extracts is promising as the extracts could be used as a cheap antimicrobial for the treatment of infections cause by these test organisms. Conclusively, this study revealed both organisms present in toilet air, their vulnerability patterns was established, their resistance gene verified, and explore the potential use of natural plant compounds on them, would assist in mitigating public health.

Rapidly progressive streptococcal toxic shock syndrome epidemic in Kraków, 2023.

Rapidly progressive streptococcal toxic shock syndrome epidemic in Kraków, 2023.

Streptococcus pyogenes: Pathogenesis and the Current Status of Vaccines.

Streptococcus pyogenes (group A Streptococcus; GAS), a Gram-positive coccal bacterium, poses a significant global disease burden, especially in low- and middle-income countries. Its manifestations can range from pharyngitis and skin infection to severe and aggressive diseases, such as necrotizing fasciitis and streptococcal toxic shock syndrome. At present, although GAS is still sensitive to penicillin, there are cases of treatment failure for GAS pharyngitis, and antibiotic therapy does not universally prevent subsequent disease. In addition to strengthening global molecular epidemiological surveillance and monitoring of antibiotic resistance, developing a safe and effective licensed vaccine against GAS would be the most effective way to broadly address GAS-related diseases. Over the past decades, the development of GAS vaccines has been stalled, mainly because of the wide genetic heterogeneity of GAS and the diverse autoimmune responses to GAS. With outbreaks of scarlet fever in various countries in recent years, accelerating the development of a safe and effective vaccine remains a high priority. When developing a GAS vaccine, many factors need to be considered, including the selection of antigen epitopes, avoidance of self-response, and vaccine coverage. Given the challenges in GAS vaccine development, this review describes the important virulence factors that induce disease by GAS infection and how this has influenced the progression of vaccine development efforts, focusing on several candidate vaccines that are further along in development.