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Case Reports
. 2023 Mar 7;23(1):108.
doi: 10.1186/s12887-023-03914-5.

Probable enterotoxin-associated toxic shock syndrome caused by Staphylococcus epidermidis

William F Pomputius  1 , Samuel H Kilgore  2 , Patrick M Schlievert  3   4
Affiliations
Case Reports

Probable enterotoxin-associated toxic shock syndrome caused by Staphylococcus epidermidis

William F Pomputius et al. BMC Pediatr. .

Abstract

Background: We describe a case of a toxic shock-like syndrome in a child, which was associated with Staphylococcus epidermidis instead of Staphylococcus aureus or Streptococcus pyogenes, the usual causes of toxic shock syndrome.

Case presentation: The patient was an 8-year-old boy who developed a toxic shock syndrome-like illness, including fever, hypotension, and rash. The Staphylococcus epidermidis isolate was cultured from urine, but this organism was unavailable for toxin testing. Multiple blood cultures were negative. Instead, a highly novel assay was used on acute plasma from the patient which demonstrated the presence of the genes for superantigens, staphylococcal enterotoxins A, C, D, and E. Superantigens are the known causes of toxic shock syndrome.

Conclusions: Our study suggests strongly that Staphylococcus epidermidis was causing the TSS symptoms through the known Staphylococcus aureus superantigens. It is unknown how many other such patients exist; this should be explored. Of great importance is that PCR performed directly on blood plasma in the absence of microbial isolation could be used to demonstrate superantigen genes.

Keywords: Case report; Enterotoxin; Staphylococcus epidermidis; Toxic shock syndrome; Urinary tract infection.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PCR on (A) patient blood plasma and (B) S. aureus strain MN8 DNA for detection of staphylococcal superantigen genes encoding TSST-1 and staphylococcal enterotoxins (SEs) A, B, C, D, and E. Bands indicate the presence of PCR products for the indicated superantigen. Strain MN8 is known to have the genes for TSST-1 and SEA, but not SEB-SEE. MW = molecular weight standards. The gel shown has not been modified from its original appearance as photographed
See this image and copyright information in PMC

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