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Searching the Staphylococcal Toxic Shock Syndrome Toxin -1 in Septic Children with negative Cultures: A Comparative Study in Tehran, Iran

[ Vol. 21 , Issue. 2 ]


Samileh Noorbakhsh*, Ali Asghar Rabiei, Ali Akbar Rahbarimanesh, Morteza Haghighi and Sarvenaz Ashouri   Pages 187 - 192 ( 6 )


Background: Bacteria induced sepsis is common in infants and children. Staphylococcus aureus produces numerous exotoxins, like staphylococcal Toxic shock syndrome toxin (TSST- 1), which stimulate the immune system by T cell activation and inflammation in various organs. Recent studies suggest that staphylococcal toxins, generally named super antigens (SAgs), may also have a significant role in the pathogenesis of some pediatric disorders especially in the clinical presentation of sepsis and septic shock. This study was carried out in order to compare staphylococcal TSST- 1 (SAgs) in children with sepsis symptoms (and septic shock) with negative blood culture versus a control group.

Materials and Methods: This cross-sectional study was conducted during 2 years (2014 -2016) in two referral hospitals (Rasoul Akram and Bahrami hospitals) in Tehran, Iran. We selected 44 children) mean age of 4 years) who were admitted in pediatrics and PICUs wards with sepsis symptoms- /+septic shock. Forty-five children (mean age of 3.9 years) were selected as a control group. All cases with blood samples were examined for TSST-1 (SAgs) by polymerase chain reaction (PCR) method in both case and control groups and results were compared. Data were analyzed by SPSS-16software. Chi-square or Fisher test was used to compare the variables. P-value < 0.05 was considered as a valuable tool.

Results: Positive blood cultures with other bacteria, Streptococcus pneumonia, Haemophilus influenzae, Pseudomonas aeruginosa, Escherichia coli, were detected in 5 cases with negative TSST-1 in blood samples. S.aureus isolated from blood culture was detected in 2 cases with positive TSST- 1.Positive TSST-1 (SAgs) was detected in 6 cases (14%) with negative blood culture for S.aureus; it was significantly higher in cases (14% vs. 2%; P value = 0.05).

Conclusion: This study indicates the probable role of TSST-1(SAgs) in the progression of sepsis (and septic shock) in toxic children with negative blood culture for S.aureus. Anti-staphylococcal treatment is immediately required, especially in toxic children with related clinical presentations, even in cases with negative blood cultures. Indeed, the clinical use against SAgs suppressants of downstream cell-destructive events might be helpful.


Staphylococcus aureus, super antigens (SAgs), TSST-1, PCR, sepsis, septic shock, children.


Department of Pediatric Infectious Diseases, Iran University of Medical Sciences, Tehran, Pediatric Infectious Disease; Pediatrics Department, Shahre kord University of Medical Sciences, Shahre kord, Pediatric Infectious Disease; Pediatric Infectious Diseases Department, Tehran University of Medical Sciences, Tehran, Research Center and Department, The Five Senses Institute, Iran university of medical sciences, Tehran, Research Center and Department, The Five Senses Institute, Iran university of medical sciences, Tehran

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