To the Editor.—
In their recent report of a possible case of Kawasaki disease, Schlossberg et al1 discuss the possibility that a staphylococcal exotoxin, found in the patient's vaginal discharge, may have been responsible for her symptoms. The pyrogenic exotoxin that they isolated, however, lacked exfoliative activity in the rabbit and mouse.In 1978, Todd et al2 observed seven children who had "toxic-shock syndrome associated with group I staphylococcal infections." Like the case reported by Schlossberg et al, the infections were usually mucosal. Fever, headache, diarrhea, conjunctival infection, and a scarlatiniform and exfoliative dermatitis developed in these patients. Renal failure, hepatic dysfunction, disseminated intravascular coagulation, and shock often developed also. The staphylococci isolated from these patients produced an exotoxin that had exfoliative activity in the newborn mouse and was biochemically and immunologically distinct from the group II exfoliation producing the staphylococcal scalded skin syndrome.Schlossberg et al
Person JR. Kawasaki Disease and Staphylococcal Exotoxins. Arch Dermatol. 1980;116(9):986. doi:10.1001/archderm.1980.01640330024002
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