Staphylococcal enterotoxins G and I, a cause of severe but reversible neonatal enteropathy.

Abstract

BACKGROUND & AIMS:

Staphylococcus aureus is recognized to produce toxins A-E and toxic shock syndrome toxin-1 associated with food poisoning and toxic shock syndrome. Enterotoxins G and I co-exist in the same S aureus strains (staphylococcal enterotoxin G and staphylococcal enterotoxin I) and are implicated in scarlet fever and toxic shock. We report these enterotoxins as causative agents of 2 cases of neonatal intractable diarrhea with enteropathy.

METHODS:

We used a note review for this study. Stool culture, multiplex polymerase chain reaction for enterotoxin, duodenal biopsy specimens for H&E, periodic acid-Schiff staining, and electron microscopy were used.

RESULTS:

Infant 1 had diarrhea from age 2 weeks and was referred at age 5 weeks with weight less than the 0.4th percentile. Infant 2 was referred at age 7 weeks with 4 weeks' of diarrhea, weight less than the 0.4th percentile. Both infants were severely malnourished. Elemental feeds were not tolerated and total parenteral nutrition was required. S aureus producing staphylococcal enterotoxin G and staphylococcal enterotoxin I was isolated in stools from both infants. Clinical improvement occurred after intravenous flucloxacillin and parenteral nutrition. Histology showed subtotal villous atrophy (H&E) with abnormal brush border (periodic acid-Schiff). Electron microscopy showed severe microvilli destruction, dilated mitochondria, and lysosomes containing cellular debris. Repeat histology was normal in infant 2, age 3 months, off parenteral nutrition, showed return to normal. Currently, both infants are 2 years of age and are thriving on a normal diet.

CONCLUSIONS:

Staphylococcal enterotoxin G- and I-induced enteropathy is a life-threatening condition, causing reversible disruption of enterocyte ultrastructure that responds well to supportive treatment with flucloxacillin and parenteral nutrition This condition should be a differential diagnosis of neonatal early onset diarrhea.

• Authors: Sandhia Naik, Fabienne Smith, John Ho, Nicholas M Croft, Paola Domizio, Elisabeth Price, Ian R Sanderson, Nigel J Meadows
• Journal: Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association (Clin Gastroenterol Hepatol) Vol. 6 Issue 2 Pg. 251-4 (Feb 2008) ISSN: 1542-7714 [Electronic] United States
• PMID: 18063418 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Bacterial Agents
• DNA, Bacterial
• Enterotoxins
• Superantigens
• enterotoxin G, staphylococcal
• enterotoxin I, staphylococcal
• Floxacillin

Topics

• Anti-Bacterial Agents (therapeutic use)
• Biopsy
• Body Weight
• DNA, Bacterial (genetics)
• Diarrhea (drug therapy, microbiology)
• Enteritis (drug therapy, microbiology)
• Enterotoxins (genetics, toxicity)
• Feces (microbiology)
• Female
• Floxacillin (therapeutic use)
• Humans
• Infant Nutrition Disorders
• Infant, Newborn
• Intestinal Mucosa (pathology, ultrastructure)
• Microscopy, Electron, Transmission
• Parenteral Nutrition
• Polymerase Chain Reaction (methods)
• Staphylococcal Infections (diagnosis, drug therapy, microbiology, pathology)
• Staphylococcus aureus (genetics, isolation & purification, metabolism)
• Superantigens (genetics, toxicity)