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Nursery outbreak of scalded-skin syndrome. Scarlatiniform rash due to phage group I Staphylococcus aureus.

From Aug 6 to 14, 1973, scariatiniform eruptions that were considered to be mild forms of the staphylococcal scalded-skin syndrome developed in four neonates. One infant had mild epidermal peeling. All had generalized, finely papular erythema that cleared rapidly after treatment with antibiotics. Cultures from the umbilical stumps or anterior nares of three of the infants yielded colonies of group I Staphylococcus aureus, phage type 29/52/79/86/D11/81, that were able to produce epidermal exfoliation in suckling mice. These data indicate that the nursery outbreak was caused by phage group I staphylococci rather than group II organisms previously associated with staphylococcal scalded-skin syndrome. The demonstration that a group I Staphylococcus can produce exfoliative toxin suggests that the same mechanism for toxin production may exist for phage groups I and II staphylococci.

Cross Infection

A comprehensive reference catalog of human skin DNA virome reveals novel viral diversity and microenvironmental influences.

UNLABELLED: Human skin serves as a dynamic habitat for a diverse microbiome, including a complex array of viruses whose diversity and roles are not fully understood. A total of 2,760 skin metagenomes from 6 published skin studies were collected. A skin virome catalog was constructed using standard methods in the viromics field. Viral characteristics were identified through cross-cohort meta-analysis and used to characterize viral features across different skin environments. We identified 20,927 viral sequences, which clustered into 2,873 viral operational taxonomic units (vOTUs), uncovering a substantial breadth of viral diversity on human skin. The results also highlight significant differences in viral communities that are associated with varying skin microenvironments. The oily skin is enriched in Papillomaviridae, the dry skin area is enriched in Autographiviridae and Inoviridae, and the moist skin is enriched in Herelleviridae. We also investigated the relationship between bacteriophages and bacteria on the skin surface. We found that skin bacteria such as Pseudomonas, Klebsiella, and Staphylococcus are predicted to be infected by phages from the class Caudoviricetes. This comprehensive skin DNA viral catalog significantly advances our understanding of the virome's role within the skin ecosystem. IMPORTANCE: This study presents a comprehensive reference catalog of the human skin DNA virome, constructed from 2,760 metagenomic datasets collected globally. It identified 20,927 viral sequences, with 90.85% representing previously unknown viruses, greatly expanding our understanding of skin viral diversity. The findings reveal significant differences in viral communities between distinct skin microenvironments (oily, dry, and moist) and highlight close interactions between bacteriophages and their bacterial hosts, suggesting a potential role for the virome in maintaining microbial balance and skin health. This extensive skin viral catalog constitutes a crucial resource for future epidemiological and therapeutic research, potentially facilitating the development of novel phage therapies and diagnostic markers for skin disorders.

Humans

Detachable dissolving microneedles loaded with Silviavirus phage Pelagios enhance antibacterial efficacy against methicillin resistant Staphylococcus aureus in ex vivo porcine skin.

Methicillin-resistant Staphylococcus aureus (MRSA) wound infections remain a major clinical challenge due to antibiotic resistance and biofilm persistence. Although phage therapy has re-emerged as a promising alternative, its efficacy is limited by poor stratum corneum penetration following conventional topical application. Here, we isolated and characterized a lytic MRSA phage, Pelagios, and evaluated its transdermal delivery using detachable dissolvable microneedles (DDMNs). Genomic analyses classified Pelagios within the genus Silviavirus of the family Herelleviridae and indicated that it may represent a novel species. The phage displayed rapid adsorption (∼15 min), a short latent period (∼20 min), a burst size of ∼102 PFU/cell, and stability across physiologically relevant temperature (4 °C -45 °C) and pH conditions (pH 4-10). Whole-genome sequencing confirmed the absence of toxin genes, virulence factors, antimicrobial resistance determinants, and lysogeny-associated genes, supporting its genomic safety. Pelagios exhibited broad lytic activity against multiple clinical MRSA isolates and significantly reduced planktonic bacterial populations both in vitro and in ex vivo porcine skin models in a dose-independent manner. It also effectively inhibited MRSA biofilm formation, although eradication of established biofilms was limited. Phage-loaded DDMNs fabricated from hyaluronic acid and gelatin achieved efficient skin penetration, rapid dissolution, complete needle detachment, and markedly improved phage stability at 4 °C. In ex vivo infection models, DDMN-mediated delivery significantly enhanced antibacterial and biofilm-eradicating efficacy compared with free phage suspension. These findings demonstrate that Pelagios delivered via DDMNs constitutes a safe and effective strategy for treating MRSA-associated wound and biofilm infections.

Staphylococcus aureus

Comparison of "invasive" and "non-invasive" strains of Staphylococcus epidermidis by phage typing.

Seventy strains of coagulase-negative staphylococci isolated from blood of patients together with 41 strains of these bacteria isolated from the skin were typed by three different phage sets. Different percentages of phage typability by compared phage sets were found. Blood culture strains showed phage pattern Ph10/U14/U16 while other strains were of different phage patterns.

Bacteriophage Typing

[Bacteriophage typing of Staphylococcus aureus strains isolated from patients in the microbiology department].

78 Staphylococci isolated from mouth, throat, nose, ear passages and skin lesions were typed with 22 basic phage types. 68 of 78 staphylococci were typed. 45 of these (66%) could be typed with RTD, and 23 (33.8%) with 1000 X RTD. When phage grouping is considered, 14 out of 68 strains were from Group III and 12 out of 52 strains isolated from nose were from Group I phage.

Bacteriophage Typing

Use of a phage set for the ecological typing of coagulase-negative staphylococci.

The staphylococcal flora of skin and acne lesions of 98 patients was analysed by the use of phage typing and biotyping methods. It appeared that in some individuals a relatively stable staphylococcal flora was present while others harboured 7 or more different strains. The same S. epidermidis strains were found on different skin sites and in acne lesions of a given individual. Examples of different carriage patterns were given.

Acne Vulgaris

Colonization and infection of newborn infants caused by bacteriophage-group II Staphylococcus aureus strains.

A staphylococcal strain which exhibited weak lytic reaction with group II phages was isolated from a newborn infant with a skin infection. Subsequent investigations established that this weakly reacting strain was responsible for an endemic level of infection and colonization within the hospital nursery. The use of consistently appearing weak lytic reactions in the evaluation of this episode is described.

Bacteriophage Typing

Staphylococcal scalded-skin syndrome: development of a primary binding assay for human antibody to the exfoliative toxin.

Exfoliative toxin (ET) from a phage group II Staphylococcus aureus strain causing staphylococcal scalded-skin syndrome was purified by electrofocusing. Ampholytes and salts were removed from the final product by column chromatography on G-50 Sephadex. Sodium dodecyl sulfate-polyacrylamide gels of the final product yielded a single band upon gel electrophoresis, even when 60 mug of protein was placed in the gels. Radiolabeling of the purified toxin with 125I yielded a product that still caused exfoliation of suckling mice, indicating that the toxin was still biologically active. A radioimmunobinding assay was developed and used to test rabbit and human sera for antibodies to exfoliative toxin. Although the maximum percentage of binding was not as high as expected (approximately 40%), it was postulated that either iodination had not been sufficiently vigorous or the toxin had sustained immunological damage. The assay was reproducible and more sensitive than the existing neutralization method and readily applicable to the testing of human sera for exfoliative toxin antibodies.

Animals

Evaluation of a new bacteriophage set for typing of Staphylococcus epidermidis strains.

A new set of typing phages was evaluated for typing 821 Staphylococcus epidermidis strains isolated from normal human skin and from acne lesions. This method was compared with two different systems for biochemical differentiation of S. epidermidis. Distinct subgroups of cocci, which differed in phage susceptibility as well as in biochemical properties, were found. A tentative subdivision of S. epidermidis strains by use of 16 phages arranged into four groups is proposed, together with additional biochemical differentiation of non-typable strains.

Acne Vulgaris

Bullous impetigo. Occurrence of localized scalded skin syndrome in an adult.

The localized form of staphylococcal scalded skin syndrome, bullous impetigo, occurs commonly in children but rarely in adults. We will describe a case of bullous impetigo in an adult which developed while the patient was receiving short-term therapy with orally administered corticosteriods. Scalded skin syndrome in this case was characterized by isolation of phage group 2 staphylococci from intact bullae and by the presence of an intraepidermal, subgranular cleavage plane in histological sections. Features that differentiate the localized form of scalded skin syndrome from generalized forms include the presence of dermal infiltrate and the absence of cutaneous erythema and tenderness. On the basis of available experimental evidence, the rarity of both localized and generalized scalded skin syndrome in adults can be attributed to immunologic competence or enhanced capacity of adults to metabolize the staphylococcal exfoliatin.

Diagnosis, Differential

Phage typing and biotyping of coagulase-negative staphylococci.

A total of 211 strains of coagulase-negative staphylococci isolated from clinical materials were tested by use of 16 phages of PULVERER's set and biochemical methods proposed by KLOOS and SCHLEIFER. It appeared that 75% of tested strains was typable by used phages and ninety different phage patterns were observed. Most strains were classified as Staphylococcus epidermidis and the rest as S. warneri, S. simulans, S. hominis, Single strains represented species: S. capitis, S. haemolyticus and S. cohnii. No segregation of different phage patterns into particular species was found.

Bacteriological Techniques

Studies of the mechanism of epidermal injury by a Staphylococcal epidermolytic toxin.

Experimental animal models of the two forms of toxic epidermal necrolysis have been reviewed: a murine model of staphylococcal-induced epidermolysis and a hamster model of graft-versus-host disease. In the former, a protein exotoxin, epidermolysin, has been purified and characterized. The exotoxin has a molecular weight of approximately 30,000 and causes a split beneath the granular layer. It is effective at 3 times 10(-12) moles. Epidermolysin does not require an intact complement system for its action since B10D2 mice deficient in C5 or mice injected with the decomplementing agent in cobra venom factor were susceptible to its epidermolytic effects. Neither are immunocompetent thymocytes required for the action of the toxin since hairless, athymic adult (nu/nu) mice are susceptible. A few reports of epidermolysis due to an exotoxin of group I Staphylococcus aureus have appeared. This toxin is antigenically different from the exotoxin of group II organisms. A model of drug-induced toxic epidermal necrolysis has been described in hamsters, but the toxic principle released from sensitized lymphoid cells has not yet been characterized.

Animals

Staphylococcus aureus infections of captive dolphins (Tursiops truncatus) and oceanarium personnel.

Samples from blowhole and pharynx of 1 dolphin ill with a respiratory tract infection and 31 healthy dolphins at 2 oceanariums were examined by bacteriologic cultural technique. During the same period, nasal and volar forearm skin samples were collected from 32 healthy personnel and from a furuncle on the forearm of 1 attendant. Coagulase-positive staphylococci were isolated from 8 dolphins (including the ill dolphin) and from 14 persons. Antibiotic sensitivity patterns (8 drugs were tested) differed markedly for the staphylococcal isolates recovered from dolphins, as compared with those from persons. Staphylocci from the dolphins were totally or partially sensitive to every antibiotic, whereas almost all of the isolates from persons were resistant to penicillin and ampicillin, as well as to certain other antibiotics. Staphylococcus bacteriophage typing revealed that only 1 isolate from a dolphin could be typed (type D11). Six of the isolates from persons were typable, but no isolate was sensitive to only type D11. It was concluded that, although Staphylococcus aureus could be isolated commonly from captive dolphins, there was no evidence of cross infection between the dolphins and the oceanarium personnel.

Animals

A novel phage vB_VhaM_HVS-1 inhibits host cell associated Vibrio harveyi.

INTRODUCTION: Vibrio harveyi is a major pathogen causing skin ulceration syndrome and mass mortality in sea cucumber Apostichopus japonicus aquaculture. METHODS: In this study, a pathogenic strain NB-3 was isolated from diseased A. japonicus and identified as V. harveyi based on morphological, physiological, and genomic analyses. A novel lytic phage vB_VhaM_HVS-1 belonging to the family Straboviridae (class Caudoviricetes) was isolated from A. japonicus breeding pond silt. RESULTS: The phage exhibited a latent period of 50 min and a burst size of approximately 168 PFU/cell, and its genome lacked lysogeny-related genes, suggesting a lytic nature. Phage treatment significantly reduced the number of cell-associated bacteria, decreasing the association rate from 2.3% to nearly 0. Flow cytometry revealed that phage infection protected coelomocytes from V. harveyi-induced damage, increasing the proportion of viable cells from 78.17% to 88.54%. CONCLUSION: These findings demonstrate that phage vB_VhaM_HVS-1 effectively reduces V. harveyi association with coelomocytes and alleviates host cell apoptosis. The phage shows strong potential as an alternative biocontrol agent against V. harveyi infection in sea cucumber aquaculture.

aquaculture disease

Microbial flora of atopic dermatitis.

The microbial flora of dermatitic skin, uninvolved skin, and the anterior nares of subjects with atopic eczema were investigated. The carriage rate of Staphylococcus aureus was 79% for the anterior nares, 76% for the uninvolved skin (normal skin), and 93% for lesions. The counts of S aureus were 7.5 X 10(4)/sq cm in lesions and 7.1 X 10(3)/sq cm on adjacent normal skin. Staphylococcus aureus was the predominant organism in the lesions and constituted 91% of the total aerobic bacterial flora. The coagulase-negative staphylococci were the second predominant organisms (9%). On normal skin, coagulase-negative staphylococci were the predominant organisms, constituting 63% of the total flora, followed by S aureus (30% of the bacterial flora). The micrococci counts were lower in the lesions (1.6 X 10(2)/sq cm) and higher on normal skin (9.5 X 10(2)/sq cm). Lipophilic diphtheroids were fewer on normal skin (6.7 X 10/sq cm), and there were none in the lesions. Fifty-eight percent of the strains belonged to group 3, and 38% were nontypeable. Staphylococcus aureus strains belonging to phage groups 2 and 4 were not detected.

Adolescent

Toxic-shock syndrome associated with phage-group-I Staphylococci.

Seven children (aged 8--17 years) presented with a high fever, headache, confusion, conjunctival hyperaemia, a scarlatiniform rash, subcutaneous oedema, vomiting, watery diarrhoea, oliguria, and a propensity to acute renal failure, hepatic abnormalities, disseminated intravascular coagulation, and severe prolonged shock. One patient died, one had gangrene of the toes, and all have had fine desquamation of affected skin and peeling of palms and soles during convalescence. Five patients were studied prospectively. Staphylococcus aureus related to phage-group I was isolated from mucosal (nasopharyngeal, vaginal, tracheal), or sequestered (empyema, abscess) sites, but not from blood. This organism produces an exotoxin which causes a positive Nikolsky sign in the newborn mouse and which is biochemically, pathologically, and immunologically distinct from phage-group-II stapphylococcal exfoliatin.

Acute Disease