Fatal group a streptococcal toxic shock-like syndrome in a child with varicella: report of the first well documented case with detection of the genetic sequences that code for exotoxins SPE A and B, in Sao Paulo, Brazil

Crianca de sete anos, previamente higida, foi admitida na unidade de terapia intensiva por quadro de toxemia associado a varicela. Evoluiu rapidamente para choque e insuficiencia de multiplos orgaos e sistemas e, apesar do tratamento intensivo, morreu no quarto dia apos a admissao. A cultura de secrecao colhida por puncao profunda de partes moles em regiao toracica foi positiva para Streptococcus pyogenes, proteina-M nao tipavel e carreador dos genes codificadores da producao de exotoxinas pirogenicas estreptococicas A e B, preenchendo os criterios para definicao de Sindrome do choque toxico estreptococico. Os autores discutem aspectos clinicos e fisiopatologicos desta sindrome, bem como alguns aspectos incomuns relacionados a este caso

Channel-forming leucotoxins from Staphylococcus aureus cause severe inflammatory reactions in a rabbit eye model.

Panton-Valentine leucocidin arises from the combination of one S component (LukS-PV) with one F component (LukF-PV), whereas gamma-haemolysin comprises two S components (HlgA and HlgC) with one F component HlgB. The intravitreal injection of rabbit eye with the six combinations (S + F) of channel-forming leucotoxins produced by Staphylococcus aureus ATCC 49775 induced acute inflammatory reactions depending on time and doses of toxins. These reactions involved posterior chamber as well as anterior chamber and conjunctiva, eyelids and annexes. Histological examination confirmed the involvement of eye tissues and the disruption of the retinal barrier. The lesions began only 4 h after injections and persisted for at least 5 days. Clinical and biological effects of each leucotoxin were modulated by the speed of onset and intensity of inflammation and necrosis, leading to a functional classification according to the severity of the lesions (HlgA + LukF-PV > HlgA + HlgB > or = LukS-PV + HlgB > or = LukS-PV + LukF-PV > HlgC + HlgB > or = HlgC + LukF-PV). Moreover, N-acetyl beta-D glucosaminidase assays on crude extracts of vitreous revealed granules and granule secretions from polymorphonuclear cells with levels according the above classification. These results show that channel-forming leucotoxins have a very significant inflammatory activity. As most S. aureus strains produce two or even six leucotoxins depending on the production of Panton-Valentine leucocidin, these compounds could be considered to be virulence factors.