title: Exfoliative toxin A staphylococcal scalded skin syndrome in preterm infants.
abstract: Staphylococcal scalded skin syndrome (SSSS) demonstrates dermal symptoms due to exfoliative toxin (ET) A or ETB produced by Staphylococcus aureus. We examined the association between anti-ETA antibodies and SSSS onset in neonates. Three preterm infants carried an ETA-producing strain of S. aureus, manifesting as either SSSS or bullous impetigo; a full-term infant carrying the same strain was asymptomatic. The infants (n=106) were categorized into three groups according to their gestational age (GA) as follows: <30 weeks, 30-37 weeks, and >37 weeks. The measured levels of anti-ETA antibody in the three infants displaying SSSS were low before the onset of dermal symptoms; only the asymptomatic full-term infant displayed a high antibody level. Anti-ETA antibody levels in the preterm group with a GA of <30 weeks were statistically lower than those in the term infant group; the prevalences of anti-ETA antibodies above a cutoff value in the three groups of neonates were 55 % (18/33) among preterm infants with a GA <30 weeks, 73 % (25/34) among those with a GA of 30-37 weeks, and 90 % (35/39) among infants with a GA >37 weeks.
  
  
  CONCLUSIONS
  The presence of anti-ETA antibodies below a particular cutoff level might be associated with SSSS onset in preterm infants.
authors.affiliation: Department of Pediatrics Shinshu, University School of Medicine, 3-1-1 Asahi, Matsumoto, 390-8621, Japan, kensai524@gmail.com.
authors.forename: Ken
authors.initials: K
authors.lastname: Saida
authors.forename: Kenji
authors.initials: K
authors.lastname: Kawasaki
authors.forename: Kanae
authors.initials: K
authors.lastname: Hirabayashi
authors.forename: Yohei
authors.initials: Y
authors.lastname: Akazawa
authors.forename: Seiko
authors.initials: S
authors.lastname: Kubota
authors.forename: Eriko
authors.initials: E
authors.lastname: Kasuga
authors.forename: Mai
authors.initials: M
authors.lastname: Kusakari
authors.forename: Takefumi
authors.initials: T
authors.lastname: Ishida
authors.forename: Masatomo
authors.initials: M
authors.lastname: Kitamura
authors.forename: Atsushi
authors.initials: A
authors.lastname: Baba
authors.forename: Kenichi
authors.initials: K
authors.lastname: Koike
mesh_terms: D004797:Enzyme-Linked Immunosorbent Assay; D005083:Exfoliatins / Q000276:immunology*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000276:immunology; D013206:Staphylococcal Scalded Skin Syndrome / Q000175:diagnosis* / Q000276:immunology; D013211:Staphylococcus aureus / Q000276:immunology*
chemical_list: D005083:Exfoliatins