Staphylococcal scalded skin syndrome caused by exfoliative toxin B-producing methicillin-resistantStaphylococcus aureus

Sir: Methicillin-resistant Staphylococcus aureus (MRSA) is pathogenic in immunocompromised patients, neonates and premature infants. The spread of MRSA in neonatal intensive care units (NICUs), and nursing homes results in serious health problems [2]. MRSA as well as methicillin-sensitive S. aureus produces several kinds of toxins, which may specify the capacity for invasiveness of each staphylococcal strain. We encountered a 6-month-old infant, suffering from staphylococcal scalded skin syndrome, whose mother used steroid ointment for the infant 's erythematous skin rash for 2 days. On the 3rd day, the infant was admitted to our hospital with fever (37.8 ~ C), erythema on his trunk and extremities, and flaccid blisters and erosions in his periorificial areas and neck. Nikolsky sign was positive. Blood cultures were negative, but S. aureus was isolated from his pharynx, inflammatory conjunctival lesions and exudates from other skin lesions. The biological characteristics of the isolates were coagulase type II, enterotoxin-nonproducing, TSST1-nonproducing, and protease pattern: D type (Martley 's method), plasmid profile; 780 kbp. Investigations for the exfoliative toxin (ET) were negative for ET-A but positive for ET-B, as proven by the polymerase chain reaction method using the primers established by Johnson et al. [1] (Fig. 1). The isolated strain of S. aureus was resistant to methicillin (MRSA), and was furFig. 1 Detection of the exfoliative toxin-B gene by polymerase chain reaction. Primers were selected as reported by Johnson et al. [1] (for sense: 5 ' -ACGGCTATATACATTCAATT-3 ' and for antisense: 5 ' -TCCATCGATAATATACCTAA-3'). Molecular weight markers are indicated on the left (lane 1, 100 bp DNA ladder, BRL, MD). Lane 2: LCDC* 888902 (exfoliative toxin-A gene positive