Pathopysiology and treatment in emerging infectious disease, Neonatal TSS-like exanthematous disease, induced by exotoxin from MRSA

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1. According to replies to our questionnaires, neonates fulfilling the clinical criteria of NTED have been observed in 80.5% of major neonatal care units in Japan until 2000. Two hundred five NTED cases were observed in 44 units in 2000.2. Fifty-four among 60 MRSA strains isolated from NTED patients in major neonatal care units in retained TSST-1/SEC genes. One MRSA isolate retained SEB gene. Forty-nine MRSA isolates can be classified in MRSA Clone A of which coagulase type was II, while only one MRSA isolate is classified in Clone B having coagulase typeVII and SEB gene. These clone A MRSA isolates were collected from any area of Japan.3. The down regulation of Vβ2^+ T cells was consistently observed in the very early phase of NTED. We investigated Vβ2 expression in samples of NTED suspected cases from 9 NICUs in Japan. Eight of 9 cases can be estimated to be compatible for the change of Vβ2^+ T cells in NTED.4. The parallel use of the separation of MRSA carriers and MRSA-free neonates, the use of gloves in all cares of infants, and the use of closed tracheal suction system was effective to decrease of the number of MRSA carriers.5. The serum titers of anti-TSST-1 antibody were significantly positive in 65% of Japanese pregnant women and their infants' cord blood. The main subclasses of anti-TSST-1 antibody were IgG1 and IgG4.