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Influence on the Local Immune Response

Patricia M. Mertz, BA; Tatiana C. P. Cardenas, BS; Richard V. Snyder, PhD; Megan A. Kinney, BS; Stephen C. Davis, BS; Lisa R. W. Plano, MD, PhD

Arch Dermatol. 2007;143(10):1259-1263.

Objectives  To evaluate Staphylococcus aureus isolates from infected skin lesions for their potential to produce immune system–modulating toxins and to correlate these with white blood cell (WBC) counts associated with these lesions.

Design  Specimens were obtained for bacterial culture and gram staining from 105 infected skin lesions, and the number of WBCs per low-power field (LPF) was determined. Chromosomal DNA was prepared from 84 bacterial isolates and subjected to real-time polymerase chain reaction analysis to determine the presence of genes encoding potential immunomodulating toxins. Bacterial populations were divided into 2 groups: those associated with low WBC counts (0-5 WBCs/LPF) and those with high WBC counts (> 5 WBCs/LPF). We applied ² statistical analyses to compare the toxin gene profiles associated with WBC counts on initial swab for culture.

Patients  Samples were obtained from patients at a single geographic location.

Results  A higher than expected percentage of bacteria capable of producing the exfoliative toxins A and/or B (ETA and/or ETB) and Panton-Valentine leukocidin (PVL) was seen in all skin lesions infected with S aureus without regard to WBC count with initial cultures. Comparison of the toxins associated with the low WBC group vs the high WBC group showed that low WBC counts were associated with ETA and ETB, while high WBC counts were associated with PVL and toxic shock syndrome toxin. There were no differences in the clinical appearance of the lesions between groups.

Conclusions  Staphylococcus aureus virulence factors ETA, ETB, and PVL are associated with WBC counts from infected skin lesions. The exact role they play in affecting the WBC counts remains to be determined.

Author Affiliations: Miami Dermatology Research Institute (Ms Mertz), Miami, Florida; Departments of Pediatrics (Ms Cardenas and Drs Snyder and Plano), Dermatology (Mr Davis), and Microbiology and Immunology (Dr Plano), University of Miami, Leonard M. Miller School of Medicine, Miami; and Rosalind Franklin University of Medicine and Science, Chicago Medical School, North Chicago, Illinois (Ms Kinney).

RELATED LETTERS

Panton-Valentine Leukocidin, Exfoliative Toxins, and Skin Infections
François Durupt, Luc Thomas, and Jerome Etienne
Arch Dermatol. 2008;144(8):1069-1070.
EXTRACT | FULL TEXT  

Panton-Valentine Leukocidin, Exfoliative Toxins, and Skin Infections—Reply
Lisa R. W. Plano, Stephen C. Davis, and Patricia M. Mertz
Arch Dermatol. 2008;144(8):1070.
EXTRACT | FULL TEXT  

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