Lack of muco-cutaneous signs of toxic shock syndrome when T cells are absent: S.aureus shock in immunodeficient adults with multiple myeloma
| Autor: | Anna Yarilina, N. S. Kamel, A. Dosik, M. C. Banks, David N. Posnett, D. Ursea |
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| Jazyk: | angličtina |
| Rok vydání: | 2002 |
| Předmět: |
Adult
Male Staphylococcus aureus Myeloma protein medicine.medical_treatment T-Lymphocytes Immunology Opportunistic Infections medicine.disease_cause Lymphocyte Depletion Sepsis Diagnosis Differential Immunocompromised Host Superantigen Immunology and Allergy Medicine Humans Child Cells Cultured Skin Mucous Membrane Superantigens biology business.industry Toxic shock syndrome Original Articles Middle Aged Staphylococcal Infections medicine.disease Shock Septic Genes T-Cell Receptor Cytokine Shock (circulatory) Child Preschool biology.protein Female Antibody medicine.symptom business Multiple Myeloma |
| Popis: | SUMMARY Staphylococcal toxic shock syndrome (TSS) is an acute life threatening disease. The diagnosis can be made clinically based on diagnostic criteria. The clinical manifestations are caused in large part by the release of high levels of T-cell-derived cytokines as a result of potent toxins, also called superantigens (SAg), produced by Staphylococcus aureus, but it is not clear which clinical symptoms/signs are strictly T-cell dependent. Here, we report on three adults with multiple myeloma (MM) presenting with S. aureus sepsis/shock, and two patients with typical TSS. The MM patients had compromised humoral immunity because of depression of normal immunoglobulin (Ig) levels at the expense of the M protein. In addition, their T cells were absent due to high dose chemotherapy initiated for bone marrow transplantation. The MM cases lacked mucosal hyperemia, erythroderma and desquamation, but were otherwise indistinguishable from the TSS cases. All patients grew S. aureus and in each case, SAg genes were detected by PCR. In several cases, the plasma contained biological SAg activity resulting in Vβ specific proliferation of indicator T cells in vitro. The same specific activity was observed with the supernatant fluids of S. aureus broth cultures from the respective bacterial isolates. This confirms the presence of bio-active toxins in the plasma but did not lead to full blown TSS when T cells were lacking. Thus, S. aureus sepsis/shock can be clinically distinguished from typical TSS, and we suggest that muco-cutaneous manifestations of TSS are the most telling signs of massive T-cell-dependent cytokine release. |
| Databáze: | OpenAIRE |
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