A Recalcitrant, Erythematous, Desquamating Disorder Associatedwith Toxin-Producing Staphylococci in Patients with AIDS

Abstract

Although staphylococcal infections are common in patients with AIDS, staphylococcal toxin-related disorders have rarely been described. Five cases of a staphylococcal toxin-associated syndrome characterized by prolonged erythema, extensive cutaneous desquamation, hypotension, tachycardia, and multiple organ involvement are described in patients with AIDS. These illnesses were recurrent and recalcitrant with a mean duration of 50 days. Toxic shock syndrome toxin-1-producing staphylococci were isolated from three and staphylococcal enterotoxins B and A from one patient each. Sources of organisms were blood, one patient, and soft tissues and nasal accessory sinuses, two patients each. Three of the five patients died of renal failure and central nervous system abnormalities. One survivor required intubation for respiratory failure. All individuals manifested a marked diminution of CD4+ cells. Other laboratory abnormalities included azotemia and prolongation of partial thromboplastin time. Oliguria occurred in three patients. Thus, this recalcitrant erythematous desquamative disorder appears to be a variant of staphylococcal toxic shock syndrome in certain subsets of immunocompromised individuals.

Exotoxins of Staphylococcus aureus

“…It has also been proposed that these cases of TSS result from processes similar to those described for tampon-associated TSS, but the exact mechanism of disease induction remains unclear. There are also important nonmenstrual subsets of TSS, including (i) influenza-associated cases, in which S. aureus superinfects tracheal lesions causes by influenza virus (104); (ii) recalcitrant erythematous desquamating syndrome (41), in which patients with AIDS develop an unrelenting course of TSS for 70 days or more; (iii) postsurgical TSS, in which S. aureus induces TSS from a wound site but infection is not detected because the organisms typically fail to induce visible signs of inflammation; (iv) atopic dermatitis-like illnesses; and (v) scalded skin syndrome-like illnesses.…”

The relationship between HIV infection and atopic dermatitis

“…It would be useful in future studies to use more precise criteria to delineate these entities more accurately. Differential diagnosis of HIVassociated atopic dermatitis includes lichen simplex chronicus, prurigo nodularis, eczema associated with hyper-IgE syndrome, or a chronic desquamating disorder associated with staphylococcal infection [18].…”

“…Superantigen-induced disorders such as toxic shock syndrome, staph scalded skin syndrome and adult Kawasaki disease have been described in HIVinfected patients. In addition, a chronic desquamating disorder without shock induced by staphylococcal toxins has also been described [18]. It is not unreasonable, then, to think that staphylococcal superantigens may play a role in HIV-associated atopic dermatitis.…”

Reemergence of Staphylococcal Toxic Shock Syndrome in Minneapolis-St. Paul, Minnesota, during the 2000-2003 Surveillance Period

“…Nonmenstrual TSS may be caused by any of the 15 described SAgs but is most often associated with S. aureus strains that make TSST-1, SEB, or SEC (7). There are many subsets of nonmenstrual TSS, including those associated with routine skin infections (such as boils and minor wounds), recalcitrant erythematous desquamating syndrome of AIDS patients, and postsurgical and postrespiratory viral infections (1,4).…”