title: Staphylococcal enterotoxin B toxic shock syndrome induced by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA).
abstract: We herein report a case of toxic shock syndrome (TSS) associated with the 2009 pandemic H1N1 (pH1N1) influenza virus and a community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection in a 16-year-old Vietnamese girl. Staphylococcal enterotoxin B (SEB) was detected in the patient's serum, and the level of anti-SEB antibodies was found to be elevated. A flow cytometric analysis showed evidence of activated SEB-reactive Vβ3+ and Vβ12+ T cells. These data suggest that the CA-MRSA-induced activation of SEB-reactive T cells may cause TSS in patients with pH1N1 virus infection. Moreover, this is the first report describing immunological confirmation of SEB contributing directly to TSS in a patient fulfilling the diagnostic criteria of TSS.
authors.affiliation: Internal Medicine, Department of Pulmonary Medicine/Infection and Oncology, Nippon Medical School, Japan. s9024@nms.ac.jp
authors.forename: Takeru
authors.initials: T
authors.lastname: Kashiwada
authors.forename: Ken
authors.initials: K
authors.lastname: Kikuchi
authors.forename: Shinji
authors.initials: S
authors.lastname: Abe
authors.forename: Hidehito
authors.initials: H
authors.lastname: Kato
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hayashi
authors.forename: Taisuke
authors.initials: T
authors.lastname: Morimoto
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kamio
authors.forename: Jiro
authors.initials: J
authors.lastname: Usuki
authors.forename: Shinhiro
authors.initials: S
authors.lastname: Takeda
authors.forename: Keiji
authors.initials: K
authors.lastname: Tanaka
authors.forename: Ken'ichi
authors.initials: K
authors.lastname: Imanishi
authors.forename: Junji
authors.initials: J
authors.lastname: Yagi
authors.forename: Arata
authors.initials: A
authors.lastname: Azuma
authors.forename: Akihiko
authors.initials: A
authors.lastname: Gemma
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D004768:Enterotoxins / Q000633:toxicity*; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications; D055624:Methicillin-Resistant Staphylococcus aureus; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D012772:Shock, Septic / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D004768:Enterotoxins; C031818:enterotoxin B, staphylococcal