title: Clinical features of neonatal toxic shock syndrome-like exanthematous disease emerging in Japan.
abstract: OBJECTIVE
  An epidemic of neonatal toxic shock syndrome (TSS)-like exanthematous disease (NTED) has emerged in Japan. NTED is caused by TSS toxin-1 produced predominantly by methicillin-resistant Staphylococcus aureus (MRSA). Using a large-scale investigation, the present study aimed to elucidate the overall clinical picture of NTED in Japan.
  
  
  METHODS
  We performed nationwide surveys regarding NTED in Japanese neonatal intensive care units (NICUs) in 2000, 2002 and 2005, and summarized the clinical findings of 540 patients. We also performed a case-control study to identify the relationship between patients' clinical findings and NTED.
  
  
  RESULTS
  The frequency of NTED in Japanese NICUs in 2000 was 52.2% and declined to 28.3% in 2005. The number of NTED patients in 2000 was 240 and decreased to 139 in 2005. In 2005, the isolation of methicillin-sensitive S. aureus (MSSA) increased to 20.0% in term patients. Although no term infants suffered shock or death, preterm patients sometimes developed severe symptoms.
  
  
  CONCLUSIONS
  The number of NTED patients decreased over the 5-year period from 2000 to 2005, even though more than 100 patients contracted NTED in Japanese NICUs in 2005. MSSA as well as MRSA can cause NTED, and NTED is more severe in preterm infants than in term infants.
authors.affiliation: Department of Pediatrics, Jichi Medical University School of Medicine, Tochigi, Japan. naoto-t@jichi.ac.jp
authors.forename: Naoto
authors.initials: N
authors.lastname: Takahashi
authors.forename: Ritei
authors.initials: R
authors.lastname: Uehara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nishida
authors.forename: Izumi
authors.initials: I
authors.lastname: Sakuma
authors.forename: Chika
authors.initials: C
authors.lastname: Yamasaki
authors.forename: Kayo
authors.initials: K
authors.lastname: Takahashi
authors.forename: Yoko
authors.initials: Y
authors.lastname: Honma
authors.forename: Mariko Y
authors.initials: MY
authors.lastname: Momoi
authors.forename: Takehiko
authors.initials: T
authors.lastname: Uchiyama
mesh_terms: D005076:Exanthema / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007564:Japan / Q000453:epidemiology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification / Q000472:pathogenicity; D012772:Shock, Septic / Q000150:complications