1887

Abstract

A young female with no identifiable risk factors developed rapid, overwhelming endocarditis. Despite rapid sterilization of the blood and the mitral valve with optimal antimicrobials, she had persistent septic shock. In order to investigate this, the toxin-producing capacity of the infecting strain and the patient's ability to produce antibodies were determined. The strain produced high levels of both α-toxin and staphylococcal enterotoxin A (SEA), whilst the patient responded with modestly high levels of antibodies to α-toxin and lownormal levels to SEA. The patient was most probably susceptible to the actions of SEA and developed a toxic-shock-syndrome-like disease that further aggravated her valvular dysfunction. This case illustrates that optimal antimicrobial therapy alone is not sufficient treatment in patients with persistent toxic shock and that there is a need to evaluate immunomodulatory strategies in such patients.

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2003-02-01
2024-04-19
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References

  1. Cassada D. C, Moniz M, Stevens S. L, Freeman M. B, Goldman M. H, Schuchmann G. S. 1999; Factors affecting the surgical management of infective endocarditis. Am Surg 65:307–310
    [Google Scholar]
  2. Colque-Navarro P, Söderquist B, Holmberg H, Blomqvist L, Olcen P, Möllby R. 1998; Antibody response in Staphylococcus aureus septicaemia –a prospective study. J Med Microbiol 47:217–225 [CrossRef]
    [Google Scholar]
  3. Colque-Navarro P, Palma M, Söderquist B, Flock J.-I, Möllby R. 2000; Antibody responses in patients with staphylococcal septicemia against two Staphylococcus aureus fibrinogen binding proteins: clumping factor and an extracellular fibrinogen binding protein. Clin Diagn Lab Immunol 7:14–20
    [Google Scholar]
  4. Dinges M. M, Orwin P. M, Schlievert P. M. 2000; Exotoxins of Staphylococcus aureus . Clin Microbiol Rev 13:16–34 [CrossRef]
    [Google Scholar]
  5. Fowler V. G Jr, Li J., Corey G. R. 8 other authors 1997; Role of echocardiography in evaluation of patients with Staphylococcus aureus bacteremia: experience in 103 patients. J Am Coll Cardiol 30:1072–1078 [CrossRef]
    [Google Scholar]
  6. Gentry C. A, Rodvold K. A, Novak R. M, Hershow R. C, Naderer O. J. 1997; Retrospective evaluation of therapies for Staphylococcus aureus endocarditis. Pharmacotherapy 17:990–997
    [Google Scholar]
  7. Kanclerski K, Söderquist B, Kjellgren M, Holmberg H, Möllby R. 1996; Serum antibody response to Staphylococcus aureus enterotoxins and TSST-1 in patients with septicaemia. J Med Microbiol 44:171–177 [CrossRef]
    [Google Scholar]
  8. Kaul R, McGreer A, Norrby-Teglund A, Kotb M, Schwartz B, O'Rourke K, Talbot J, Low D. E. 1999; Intravenous immunoglobulin therapy for streptococcal toxic shock syndrome –a comparative observational study. The Canadian Streptococcal Study Group. . Clin Infect Dis 28:800–807 [CrossRef]
    [Google Scholar]
  9. LeClaire R. D, Bavari S. 2001; Human antibodies to bacterial superantigens and their ability to inhibit T-cell activation and lethality. Antimicrob Agents Chemother 45:460–463 [CrossRef]
    [Google Scholar]
  10. Möllby R. 1983; Isolation and properties of membrane damaging toxins. In Staphylococci and Staphylococcal Infections vol. 2 pp 628–630 Edited by Easmon C. S. F., Adams C. London: Academic Press;
    [Google Scholar]
  11. Monday S. R, Bohach G. A. 1999; Properties of Staphylococcus aureus enterotoxins and toxic shock syndrome toxin-1. In The Comprehensive Sourcebook of Bacterial Toxins . , 2nd edn. pp 589–609 Edited by Alouf J. E., Freer J. H. London: Academic Press;
  12. Norrby-Teglund A, Basma H, Andersson J, McGreer A, Low D. E, Kotb M. 1998; Varying titers of neutralizing antibodies to streptococcal superantigens in different preparations of normal polyspecific immunoglobulin G: implications for therapeutic efficacy. Clin Infect Dis 26:631–638 [CrossRef]
    [Google Scholar]
  13. Roder B. L, Wandall D. A, Frimodt-Moller N, Espersen F, Skinhoj P, Rosdahl V. T. 1999; Clinical features of Staphylococcus aureus endocarditis. a 10-year experience in Denmark. Arch Intern Med 159:462–469 [CrossRef]
    [Google Scholar]
  14. Watanakunakorn C. 1994; Staphylococcus aureus endocarditis at a community teaching hospital, 1980 to; 1991; An analysis of 106 cases. Arch Intern Med 154:2330–2335 [CrossRef]
    [Google Scholar]
  15. Working Party of the British Society for Antimicrobial Chemotherapy; 1998; Antibiotic treatment of streptococcal, enterococcal, and staphylococcal endocarditis. Heart 79:207–210 [CrossRef]
    [Google Scholar]
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