title: Immunogenicity of toxins during Staphylococcus aureus infection.
abstract: BACKGROUND
  Toxins are important Staphylococcus aureus virulence factors, but little is known about their immunogenicity during infection. Here, additional insight is generated.
  
  
  METHODS
  Serum samples from 206 S. aureus-infected patients and 201 hospital-admitted control subjects were analyzed for immunoglobulin (Ig) G binding to 20 toxins, using flow-cytometry based technology. Antibody levels were associated with polymerase chain reaction-defined presence of toxin genes in homologous S. aureus isolates.
  
  
  RESULTS
  IgG levels directed to exfoliative toxin (ET) A, ETB, gamma hemolysin B (HlgB), leukocidin (Luk) D, LukE, LukS, staphylococcal enterotoxin (SE) A, SEE, SEH, SEI, and SElM were higher in S. aureus-infected patients than in control subjects (P < .05). Furthermore, in the S. aureus-infected patient group, IgG levels were higher if genes encoding ETA, ETB, SEA, SEC, SEH, SElQ, toxic shock syndrome toxin-1 (TSST-1), or Panton-Valentine leukocidin (PVL) were present in the infectious isolate (P< .05). Levels of anti-SEA IgG increased during infections with sea-positive (median fluorescence intensity from 11,555 to 12,388; P<.05) but not sea-negative strains. In addition, anti-LukS IgG levels increased during skin and soft-tissue infections with luk-PV-positive (median fluorescence intensity from 15,231 to 15,911; P<.05) but not luk-PV-negative strains. Bacteremia was associated with sea (odds ratio, 3.4; 95% confidence interval, 1.2-10.0) and tst (odds ratio, 5.7; 95% confidence interval, 1.6-20.8). Skin and soft-tissue infections and bone and joint infections were associated with luk-PV (odds ratio, 2.5; 95% confidence interval, 1.2-5.2).
  
  
  CONCLUSIONS
  Many toxins are expressed in vivo and recognized by the immune system during staphylococcal infections, suggesting their involvement in S. aureus pathogenesis.
authors: Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, the Netherlands. n.j.verkaik@erasmusmc.nl
authors: Nelianne J
authors: NJ
authors: Verkaik
authors: Olivier
authors: O
authors: Dauwalder
authors: Kenza
authors: K
authors: Antri
authors: Ilhem
authors: I
authors: Boubekri
authors: Corné P
authors: CP
authors: de Vogel
authors: Cédric
authors: C
authors: Badiou
authors: Michèle
authors: M
authors: Bes
authors: François
authors: F
authors: Vandenesch
authors: Mohamed
authors: M
authors: Tazir
authors: Herbert
authors: H
authors: Hooijkaas
authors: Henri A
authors: HA
authors: Verbrugh
authors: Alex
authors: A
authors: van Belkum
authors: Jerome
authors: J
authors: Etienne
authors: Gerard
authors: G
authors: Lina
authors: Nadjia
authors: N
authors: Ramdani-Bouguessa
authors: Willem J B
authors: WJ
authors: van Wamel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000276:immunology*; D001427:Bacterial Toxins / Q000235:genetics / Q000276:immunology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000235:genetics / Q000276:immunology / Q000472:pathogenicity*; D018709:Statistics, Nonparametric
chemical_list: D000907:Antibodies, Bacterial; D001427:Bacterial Toxins; D007074:Immunoglobulin G