Naik, S.; Smith, F.; Ho, J.; Croft, N.M.; Domizio, P.; Price, E.; Sanderson, I.R.; Meadows, N.J.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA101
Academic Journal
Introduction: Staphylococcal aureus is well known to produce a variety of toxins (A, B, C1-C3, D, E, G, H, I, J, and TSST1), associated with food poisoning and toxic shock syndrome. Enterotoxins G and I coexist in the same S aureus strains (SEG + SEI) and have been implicated in toxic shock and scarlet fever. We report SEG and SEI as causative agents of intractable diarrhoea with enteropathy in 2 neonates presenting to our unit. Methods: Case note review and literature search. Results: Infant 1 had diarrhoea from week 2 of life and was referred at 5 weeks with weight <<0.4th centile. Infant 2 was referred at 7 weeks with one month's history of diarrhoea and failure to thrive, weight <<0.4th centile. Both infants were severely malnourished. Elemental feeds were not tolerated and total parenteral nutrition (TPN) was required. S aureus producing SEG and SEI was isolated in stools in both infants. After intravenous flucloxacillin was commenced there was marked clinical improvement. Follow up stool cultures were persistently negative. Histology showed subtotal villous atrophy (H and E) with abnormal brush border (PAS). Electron microscopy demonstrated severe destruction of microvilli, dilated mitochondria, and lysosomes with cellular debris. Repeat histology in infant 2, age 3 months, off TPN, showed a return to normal of microvillous architecture and brush border morphology. Conclusion: Staphylococcal enterotoxin G and J induced enteropathy is a life threatening condition causing disruption of enterocyte ultrastructure, which responds well to supportive treatment with parenteral nutrition and flucloxacillin. In any neonate presenting in the first few weeks of life with severe failure to thrive and diarrhoea, S aureus isolation in stools has to be specifically requested and if present, toxin analysis by PCR should be performed.


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