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Detection of circulating bacterial superantigen and lymphotoxin-a in patients with streptococcal toxic-shock syndrome

1996; Elsevier BV; Volume: 348; Issue: 9037 Linguagem: Inglês

10.1016/s0140-6736(05)65800-x

1474-547X

Shiranee Sriskandan, David L. Moyes, Jonathan Cohen,

Toxin Mechanisms and Immunotoxins

The emergence of a toxic-shock-like syndrome (TSLS) associated with group A streptococcal disease has renewed interest in the role of gram-positive bacterial toxins and lymphocyte-mediated inflammation. It is proposed that production of superantigenic exotoxins by group A streptococci underlies the pathogenesis of TSLS, 1 Schlievert PM Role of superantigens in disease. J Infect Dis. 1993; 167: 997-1002 Crossref PubMed Scopus (310) Google Scholar although there is currently no definite evidence. We have studied seven patients with severe group A streptococcal disease/TSLS, to discover whether streptococcal exotoxin can be detected in such patients, and to look for evidence of a superantigen effect. Patients with severe group A streptococcal disease or suspected streptococcal TSLS 2 Working Group on Severe Streptococcal Infections Defining the group A streptococcal toxic shock syndrome: rationale and consensus definition. JAMA. 1993; 269: 390-401 Crossref PubMed Scopus (680) Google Scholar were identified on admission to hospital. Bacterial isolates were tested for the spea gene which encodes streptococcal pyrogenic exotoxin A (SPEA) by polymerase chain reaction (PCR), and sera taken at the time of admission and on subsequent days were tested by enzyme-linked immunosorbent assay (ELISA) for SPEA. 3 Sriskandan S Moyes D Buttery LK et al. Streptococcal pyrogenic exotoxin A (SPEA) release, distribution and role in a murine model of fasciitis and multi-organ failure due to Streptococcus pyogenes. J Infect Dis. 1996; 173: 1399-1407 Crossref PubMed Scopus (51) Google Scholar Sera were also tested by ELISA for lymphotoxin-a (LT-a), a lymphokine produced by superantigen-stimulated T cells.