Serious Complications from Staphylococcal aureus in Atopic Dermatitis

Abstract

Colonization with Staphylococcal aureus is markedly more frequent in individuals with atopic dermatitis (AD) than in unaffected individuals. Chronic scratching leads to worsening of an existing defect in the epidermal barrier, which can allow S. aureus invasion into the bloodstream and subsequent systemic infections. We report two unusual cases of systemic illness in individuals with AD. One developed infective endocarditis followed by a stroke and the other developed septic arthritis and osteomyelitis. We performed an extensive literature review of reported systemic complications caused by S. aureus in patients with AD. Although reports are rare, practitioners should be aware of these important, albeit unlikely, complications of staphylococcal superinfections in individuals with AD.

Systemic immune mechanisms in atopic dermatitis and psoriasis with implications for treatment

“…Patients with AD tend to be more susceptible to microbial infections at lesional sites, possibly because of reduced levels of IL‐17‐induced AMPs . Staphylococcus aureus is found in >90% of AD skin lesions, potentially positioning patients with AD at increased risk for methicillin‐resistant S. aureus infection.…”

Atopic dermatitis: the skin barrier and beyond

“…AD is also associated with a susceptibility to cutaneous infections, notably by bacteria such as Staphylococcus aureus , as well as certain viruses including herpes simplex . Furthermore, children with AD have a higher prevalence of extracutaneous infections, including streptococcal pharyngitis, respiratory infections, recurrent otitis and urinary tract infections, with recent reports even suggesting a relationship between AD and infective endocarditis …”

Methicillin-sensible Staphylococcus aureus causing endocarditis, with cerebral and orthopaedic complications, in a 17-month-old child with no risk factor

“…Indeed, S. aureus is one of the main neutrophil foe 10. It could be also secondary to atopic dermatitis lesion, as it is also known as a gateway for invasive S. aureus infection 11. Even though our patient did not show any risk factor, he will undergo whole exome sequencing of DNA in a Human Genetic Laboratory of Infectious Diseases in France, to look for a new immunodeficiency disease.…”