Methicillin-resistenta Staphylococcus aureus (MRSA) som bär på genen mecA, har förekommit och spridit sig över hela världen, främst i sjukhusmiljö, och orsakat utbrott av vårdrelaterade (så kallade nosokomiala) infektioner. Dessa infektioner kan inte behandlas med stafylokock-penicilliner och MRSA-bakterierna är ofta resistenta även mot flera andra grupper av antibiotika vilket medför att infektionerna ofta är påtagligt svårbehandlade. Under senare år har emellertid allt fler fall beskrivits av samhällsförvärvad MRSA infektion, det vill säga uppträdande av MRSA hos personer som tidigare ej har haft kontakt med sjukhusvård eller behandlats med antibiotika. Det har länge varit oklart om de samhällsförvärvade MRSA [community-acquired (CA-MRSA)] representerar spridning av bakterier från sjukhusmiljön ut till samhället eller om dessa MRSA är spontant uppträdande. Många av dessa stammar har dessutom visat sig bära på sjukdomsrelaterade gener som vanligen inte återfinns hos S. aureus, t.ex. Panton Valentine leukocidin (PVL) som associeras med hudinfektioner och allvarlig lunginflammation med hög dödlighet hos unga och annars friska individer. Denna avhandling beskriver den molekylära epidemiologin hos MRSA med fokus på samhällsförvärvade MRSA som utgjorde mer än hälften av samtliga fall av MRSA i Örebro län och som dessutom ofta producerade PVL toxinet, vars funktion vidare analyserades i detalj. Undersökning av ursprung och släktskap hos samtliga MRSA som isolerats i Örebro län, samt karaktärisering av det genetiskt element som kallas staphylococcal cassette chromosome mec (SCCmec) vilket innehåller genen mecA och ibland även andra resistensgener, visade att CA-MRSA inte är relaterade till de nosokomiala MRSA, och att dessa har uppstått oberoende av varandra. Flertalet MRSA visade sig dessutom bära på SCCmec, och resistensmekanismer, som tidigare inte beskrivits. Troligen har dessa MRSA uppstått genom ett genetiskt utbyte av SCCmec mellan methicillin-resistenta koagulas-negativa stafylokocker (MR-KNS), som utgör huvudparten av normalfloran på huden, och methicillin-känsliga S. aureus som därvid erhåller genen mecA och resistensmekanismer mot samtliga stafylokockantibiotika. I den här avhandlingen framläggs bevis för att ett sådant genetiskt utbyte har skett på Barnkliniken på Universitetssjukhuset i Örebro i slutet på 1990-talet, vilket resulterade i uppkomsten av en ny klon av MRSA som därefter orsakade ett allvarligt utbrott. Kartläggning av DNA-sekvensen hos flertalet unika SCCmec från svenska MRSA gav dessutom en bättre förståelse för hur resistens uppkommer och sprider sig, samt mekanismerna bakom detta. Dessa nya kunskaper kan bidra till en förbättrad diagnostik av MRSA. Detta är framför allt av stor betydelse eftersom nya effektiva kloner av MRSA verkar kunna uppstå ute i samhället med potential att orsaka svårbehandlade infektioner men även att sprida sig bland den friska befolkningen. / Material and methods - During a period of 14 years, around 2000 patients with head injuries were admitted to the emergency ward at Lindesberg County Hospital and Örebro Medical Centre Hospital. Six hundred subjects suffered from skull fracture and/or brain contusion and diagnosis was established using a computed tomography scan (CT). The degree of initial brain injury was estimated using the Swedish Reaction Level Scale (RLS). Sixty-six subjects were investigated with pure tone audiometry in close proximity to the trauma, and this gave an opportunity to study the issue of progress. The investigation took place two to 14 years after trauma, and the results were compared to matched control groups. A battery of different audiological methods was used to investigate peripheral and central auditory function, and a specially designed acoustic environmental room was also utilized. Cognition was investigated using a computer-based test-battery, text information process system (TIPS). Self-assessed hearing, cognition and quality of life were explored using different questionnaires. Results - A high percentage of peripheral and central auditory impairments and also cognitive shortcomings were demonstrated. Progress of SNHL was a common finding, and fracture, high age at trauma and large initial hearing loss predicted progress. Antibody-mediated autoimmunity as a mechanism behind posttraumatic progress of SNHL or clear evidence for sympathetic cochleolabyrinthitis could not be demonstrated. Binaural auditory deficits could be demonstrated when tested in a realistic acoustic environment. Tinnitus, vertigo and memory shortcomings proved to be common sequelae, even in a long-term perspectiveCognitive shortcomings were found in several of these well-rehabilitated subjects.On a group level, there was a good correlation between self-assessments and audiometric results, even if some individuals had a tendency to over- or underestimate their abilities. Conclusion - Auditory and cognitive long-term sequelae of CHI are a common finding even in well-rehabilitated and socially well-functioning subjects, as are vertigo and tinnitus. Vertigo and tinnitus are also common sequelae after CHI, therefore a basic audiovestibular investigation after CHI is recommended, at least in selected cases.Early awareness of the risk for hearing and cognitive sequelae after CHI could lead to measurements taken to prevent tension-related symptoms.Early detection of HI offers an opportunity to try immunosuppressive treatment in cases with a large initial SNHL.

Made available in DSpace on 2016-08-15T20:31:33Z (GMT). No. of bitstreams: 1 GermanaGR_DISSERT.pdf: 1130619 bytes, checksum: 8a9b56b38e3290f0902f54c5111e97b8 (MD5) Previous issue date: 2015-09-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The aim of this study was to investigate the presence of enterotoxigenic and methicillin-resistant genes in Staphylococcus aureus isolated from goat milk obtained from Rio Grande do Norte state producers. To achieve such goal, 49 samples of goat milk and searched for S. aureus. The colonies were isolated in Petrifilm plates, Staph Express 3M model and biochemically identified. Afterwards, the isolated strains underwent an assessment to evaluate their antibiotic resistance profile, through the use of disk diffusion technique on Mueller-Hinton agar. Following we carried out a polymerase chain reaction (PCR) to search for the following selected genes: 16S rRNA (for molecular identification of S. aureus), mecA (characterizes the methicillin-resistant S.aureus) and enterotoxigenic genes (sea, seb-sec, sec, sed, see, seg, seh, sei, sej and tsst-1). Results from morphological and biochemical analyses revealed that all isolated strains belonged to the Staphylococcus aureus species. We also observed, through the antibiogram, high percentage of resistance to the antibiotics penicillin G (87.75%) and oxacillin (75.51%). Multidrug resistance was detected in 73.46% of the isolated strains. Analyzing the PCR, we confirmed that 100% of the isolated strains were S. aureus because of the amplification of the 16S rRNA gene. The mecA gene was found in 4.08% of the samples. In samples confirmed as S. aureus, concerning the research for staphylococcal enterotoxins (SE), there was amplification of the sej gene fragments in 79.5% of the samples, followed by the sei gene in 48.9%, sed gene in 22.4%, sea gene in 12, 2%, seh and sec genes in 8.1%, and sec gene in 2% for the samples. We did not observe any amplification for the seb-sec, see and tsst-1 genes. The strains of S. aureus isolated from goat milk have shown the presence of genes responsible for the production of toxins, a fact that requires greater care when processing this milk in the dairy industry. In addition, to antibiotic resistance and detection of mecA gene also leads to concern, can pose risks to consumer health / O objetivo do presente trabalho foi investigar a presença de genes enterotoxigênicos e de resistência à meticilina em Staphylococcus aureus isolados de leite caprino obtido de produtores do estado do Rio Grande do Norte. Para a realização do estudo, realizou-se a pesquisa de S.aureus em 49 amostras de leite caprino. O isolamento foi realizado em placas Petrifilm , modelo Staph Express 3M e identificadas bioquimicamente. Em seguida, os isolados foram submetidos a avaliação quanto ao perfil de resistência a antibióticos, utilizando a técnica de difusão em discos em Agar Mueller-Hinton. Seguiu-se com a realização da reação em cadeia pela polimerase (PCR) para pesquisa dos seguintes genes selecionados: 16S rRNA (para identificação molecular dos S. aureus), mecA (que caracteriza S. aureus resistente à meticilina) e genes enterotoxigênicos (sea, seb-sec, sec, sed, see, seg, seh, sei, sej e tsst-1). Os resultados das análises morfológicas e bioquímicas revelaram que todos os isolados pertenciam a espécie Staphylococcus aureus. Observou-se através do antibiograma realizado um maior percentual de resistência para os antimicrobianos penicilina G (87,75%) e oxacilina (75,51%). Multirresistência foi verificada em 73,46% dos isolados. Com a análise da PCR, confirmou-se que 100% dos isolados eram S. aureus, pela amplificação do gene 16S rRNA. O gene mecA foi detectado em 4,08% das amostras. Na pesquisa de enterotoxinas estafilocócicas (SE), nas amostras confirmadas para S. aureus, houve amplificação em 79,5 % dos fragmentos do gene sej, seguido de 48,9% do gene sei, 22,4% do gene sed, 12,2% para o gene sea, 8,1% para os genes seh e seg e 2% para o gene sec. Não foi observada nenhuma amplificação para os genes seb-sec, see e Tsst-1. As amostras de S. aureus isoladas a partir do leite caprino demostraram presença de genes responsáveis pela produção de toxinas, fato que exige um maior cuidado no tratamento deste leite pela indústria de alimentos. Além disso a resistência aos antibióticos e detecção do gene mecA também leva a preocupação, podendo representar riscos à saúde do consumidor

Thesis (MTech (Biomedical Sciences))--Cape Peninsula University of Technology, 2015. / BACKGROUND AND OBJECTIVES: Group B Streptococci (GBS) can asymptomatically colonise the vagina and rectum of women. Studies have shown that this bacterium is the leading cause of septicemia, meningitis and pneumonia in neonates. In Namibia no known studies have investigated GBS colonisation and the antibiotic resistance profile of GBS isolates in pregnant women. This study accessed the GBS colonisation rate amongst the pregnant women who attended the Windhoek Central Hospital Antenatal Clinic (Khomas region), in Namibia for a period of 13 months. Furthermore, using the VITEK 2 system, the GBS isolates were tested against the following antimicrobial substances; benzylpenicillin, ampicillin, clindamycin, erythromycin, tetracycline, vancomycin, cefotaxime, ceftriaxone, linezolid and trimethoprim/sulfamethoxazole. Penicillin G is the drug of choice in the majority of studies, and seems to be the most effective drug for intrapartum antibiotic prophylaxis (IAP). All the GBS isolates found in this study were also analysed for the presence of selected genes known to be associated with resistance to key antibiotics using specific primers within a polymerase chain reaction (PCR).

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No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Jessica_Silveira_Vitoria.pdf: 6777460 bytes, checksum: a576eea96dc73d5ae068edefa155b085 (MD5) Previous issue date: 2017-07-31 / Sem bolsa / A alimentação escolar deve ofertar alimentos seguros quanto à sua condição higienicossanitária buscando a proteção e promoção da saúde dos escolares. O objetivo deste estudo foi avaliar as condições higienicossanitárias de escolas municipais da cidade de Pelotas - RS por meio da aplicação de uma lista de verificação e de análises microbiológicas do ar ambiental, da superfície de manipulação de alimentos, da água, de preparações alimentícias e das mãos de manipuladores de alimentos. Além disso verificou-se a presença de genes produtores de enterotoxinas estafilocócicas clássicas (A, B, C, D e E) nos isolados de Staphylococcus spp. Foram realizadas visitas em 15 escolas municipais com aplicação da lista de verificação e coleta das amostras para as análises microbiológicas. Realizaram-se contagens de bactérias aeróbias mesófilas e bolores e leveduras nas amostras de ar ambiental, contagens de coliformes termotolerantes e bactérias aeróbias mesófilas em amostras de superfícies de manipulação e contagem de coliformes totais e Escherichia coli em amostras de água. Nas mãos dos manipuladores foram realizadas análises de coliformes termotolerantes e Staphylococcus spp. Nas preparações alimentícias foram realizadas análises de coliformes termotolerantes, Bacillus cereus, Staphylococcus spp. e Salmonella spp. Os isolados de Staphylococcus spp. foram submetidos à técnica de reação em cadeia da polimerase multiplex a fim de verificar a presença dos genes codificadores de enterotoxinas estafilocócicas clássicas. Os resultados obtidos a partir da lista de verificação apontaram alto percentual de não conformidades, sendo que duas das 15 escolas apresentaram "grau de risco sanitário alto" e todas as outras foram classificadas como “situação de risco sanitário regular”. Em relação às análises microbiológicas, a qualidade do ar ambiental foi satisfatória em todas as escolas avaliadas. Entretanto, foram encontradas contagens acima do permitido para bactérias aeróbias mesófilas em superfícies de manipulação de alimentos e coliformes totais e Escherichia coli em amostras de água. As mãos dos manipuladores e as preparações alimentícias apresentaram contagens acima do recomendado para Estafilococos coagulase positiva e coliformes termotolerantes. Em três isolados de Staphylococcus spp. verificou-se a presença de genes codificadores de enterotoxina estafilocócica B. Pode-se concluir que as escolas que fizeram parte da pesquisa não apresentam padrões higienicossanitários adequados, pois foram encontradas inadequações tanto na avaliação pela lista de verificação como nos resultados das análises microbiológicas. / School feeding should provide safe food for their hygienic and sanitary conditions, seeking to protect and promote the health of students. The aim of this study was to evaluate the sanitary conditions of municipal schools in the city of Pelotas - RS, through the application of a checklist and microbiological analyses of air, food handling surface, water, food preparations and hands of food handlers. In addition, the presence of classical EE genes (A, B, C, D and E) in Staphylococcus spp. was verified. Visits were carried out in 15 municipal schools with application of the checklist and sample collection for microbiological analyses. Counts of mesophilic aerobic bacteria and molds and yeasts in the air samples, counts of thermotolerant coliforms and aerobic mesophilic bacteria in samples of manipulation surfaces and counting of coliforms and Escherichia coli in water samples were carried out. In the food handlers’ hands were counts of thermotolerant coliforms and Staphylococcus spp. In the food preparations, counts of thermotolerant coliforms, Bacillus cereus, Staphylococcus spp. and Salmonella spp. were realized. Isolates from Staphylococcus spp. were submitted to the multiplex polymerase chain reaction technique in order to verify the presence of genes coding for classical staphylococcal enterotoxins. The results obtained from the checklist indicated a high percentage of nonconformities, and two of the 15 schools presented a "high sanitary risk situation" and all others were classified as "regular sanitary risk situation". Regarding the microbiological analyses, the air quality was satisfactory in all schools evaluated. However, counts above that allowed for counting of mesophilic aerobic bacteria in food and total coliform surfaces and Escherichia coli in water samples were found. Food handlers’ hands and the food preparations presented counts above the recommended for Staphylococcus coagulase positive and thermotolerant coliforms. In three isolates of Staphylococcus spp. the presence of staphylococcal enterotoxin B encoding genes was verified. It can be concluded that the schools that were part of the research did not present adequate hygienic and sanitary standards, since inadequacies were found both in the evaluation by the checklist and in the results of the microbiological analyses.

As condições de produção de queijos frescos são favoráveis à ocorrência e à produção de enterotoxinas produzidas por estafilococos, sendo estes os principais micro-organismos relacionados aos casos de intoxicação alimentar no mundo, tornando-se necessários estudos sobre a rastreabilidade das fontes de contaminação durante a fabricação, identificação genotípica e habilidade de cepas em produzir enterotoxinas. Este trabalho teve como objetivo isolar e identificar estafilococos positivos para o teste de coagulase, potencialmente produtores de enterotoxinas em laticínios do estado de São Paulo, desde o leite recebido até o produto final. A técnica da mPCR foi utilizada para identificar três espécies de Staphylococcus coagulase-positiva (S. aureus, S. hyicus e S. intermedius) entre os isolados obtidos de diferentes pontos de processamento em laticínios do Estado de São Paulo. O perfil genético das cepas foi avaliado através da comparação de bandas pela técnica Enterobacteria Repetitive Intergenic Consensus (ERIC-PCR) e graficamente demonstrados por um dendrograma. O DNA de 102 cepas isoladas, de amostras de leite cru, leite pasteurizado, coágulo, manipulador, superfícies de equipamentos de laticínios do Estado de São Paulo e queijos foi extraído e submetido à reação em cadeia da polimerase (PCR), utilizando-se primers específicos para a detecção de fragmentos dos genes envolvidos na síntese das toxinas (SE) do tipo A, B, C, D, E, G, H, I e J. Das 102 cepas avaliadas, 5 apresentaram amplificação do fragmento do gene responsável pela codificação da toxina A, 3 para toxina C, 56 para toxina G, 59 para toxina H, 9 para toxina I, e nenhuma para toxinas B, D, E e J. Amostras de leite cru, leite pasteurizado e queijos produzidos nos laticínios e dos isolados de Staphylococcus spp. coagulase positiva que apresentaram ao menos algum dos genes relacionados à produção de toxinas clássicas (A, B, C, D e E) foram submetidos a um teste de detecção de enterotoxinas pelo sistema VIDAS® Staph Enterotoxin (SET2). Os dados obtidos para a identificação molecular das cepas, da ocorrência de cepas portadoras dos genes relacionados à produção de enterotoxinas e da produção fenotípica das enterotoxinas foram submetidos ao teste qui-quadrado. O presente trabalhou confirmou que o risco de intoxicação estafilocócica é real, pois foi encontrada enterotoxina em amostras de leite pasteurizado e queijos. / The production conditions of fresh cheese are favorable to the occurrence and production of enterotoxin produced by Staphylococci, which are the main microorganisms related to food poisoning cases in the world, requiring studies to trace the sources of contamination during manufacturing and genotypic identification ability of strains to produce enterotoxin. This study aimed to isolate and identify staphylococci positive for coagulase test, potentially producing enterotoxins in dairy products in the state of São Paulo, from milk receiving to final product. In three dairy producers of Minas fresh cheese, samples were collected from various points in the manufacturing process. the technique of mPCR was used to identify three coagulase-positive species (S. aureus, S. hyicus and S. intermedius) between isolates from different points of a processing dairy in the state of São Paulo. The genetic profile of the strains were evaluated by comparing the bands through the technique Enterobacteria Repetitive Intergenic Consensus (ERIC-PCR) and were graphically displayed by a dendrogram. The DNA of 102 strains isolated from samples of raw milk , pasteurized milk , curd, handler and equipment surface from dairies in São Paulo State and cheese were subjected to the polymerase chain reaction (PCR), using primers for the detection of specific fragments of the genes involved in the synthesis of toxins (SE) of type A, B , C , D, E, G , H, I and J. Of the 102 strains tested, five showed amplification of the gene fragment encoding toxin A, three for toxin C , 56 to toxin G, 59 to toxin H, 9 to toxin I, and none for toxins B D, E and J. For confirmation, each isolated strain carrying at least some of the genes related to the production of classical enterotoxinas, cheese and milk samples was subjected to detection by enterotoxigenic VIDAS® Staph Enterotoxin II (VIDAS SET2) bioMérieux. This identification reinforces the need to adopt proper hygiene practices in the dairy, avoiding thus the spread of these microorganisms and the possible production of enterotoxin . The data obtained for the molecular identification of the strains, the occurrence of strains carrying the genes related to the production of enterotoxin production and phenotypic enterotoxins were subjected to the Chi-squared test. This work confirmed that the risk of staphylococcal food poisoning is real, because enterotoxin was found in samples of pasteurized milk and cheeses.

Aggregation of microtubule-associated protein tau is involved in the pathology of several neurodegenerative diseases, including Alzheimer’s disease. The affibody TP4 has been shown to inhibit this aggregation process, and its target-binding positions were previously grafted onto a dimeric affibody scaffold, creating the sequestrin seqTP4. This project constitutes a part of the affinity maturation process of seqTP4, using two different bacterial display methods. An error-prone PCR library was first expressed on Staphylococcus carnosus cells for selection of variants with improved tau-binding properties, resulting in a library of 1.4×107 transformants. Flow cytometric tests indicated difficulties in the setup due to nonspecific interactions, and whereas several different approaches to alleviate the problems were investigated, two cell sorting attempts were ultimately unsuccessful. Subcloning of seqTP4 and the library to an Escherichia coli surface display vector resulted in functional surface expression of seqTP4 on E. coli JK321 and BL21 cells, and a BL21 library size of 1.6×109 transformants. An initial flow cytometric test of this library indicates the presence of improved tau-binding variants, paving the way for future cell sorting. / Aggregering av mikrotubuli-associerat protein tau är involverad i patologin av flera neurodegenerativa sjukdomar, däribland Alzheimers sjukdom. Affibodymolekylen TP4 har visat sig inhibera denna aggregeringsprocess, och överföring av dess målbindande positioner till ett dimeriskt affibodyprotein har tidigare gett upphov till seqTP4, en så kallad sequestrin. Detta projekt utgör ett led i processen att affinitetsmaturera seqTP4, med hjälp av två olika metoder för presentation av proteiner på ytan av bakterieceller. Ett error-prone PCR-bibliotek uttrycktes först på ytan av Staphylococcus carnosus-celler för selektion av varianter med ökad affinitet för tau, vilket resulterade i ett bibliotek av 1.4×107 transformanter. Flödescytometriska tester tydde på svårigheter i detta upplägg på grund av ospecifika interaktioner, och emedan flera olika angreppssätt för att förmildra dessa problem undersöktes, misslyckades slutligen två cellsorteringsförsök. Omkloning av seqTP4 och biblioteket till en vektor för ytpresentation på Escherichia coli resulterade i funktionellt ytuttryck av seqTP4 på E. coli JK321- och BL21-celler, och ett BL21-bibliotek bestående av 1.6×109 transformanter. Ett första flödescytometriskt test av detta bibliotek tyder på närvaron av varianter med förbättrad förmåga att binda tau, och vägen ligger nu relativt öppen för cellsortering.

Objectives: To assess the expression of the symptoms of jaw muscle pain and its association with alterations in biochemistry, other symptoms and the carriage of staphylococci. Methods: Three different study populations were assessed. The first was selected and examined by the author and consisted of 43 pain and 41 age and sex matched controls. The second was a study of CFS patients who were blinded to the author and the author subsequently examined the associations between jaw muscle symptom reporting and the standardised biochemistry measures. The third study was also blinded to the author but included an investigation of staphylococci and certain cytokine and biochemistry measures. Results: The three studies clearly establish an association between the carriage of toxicogenic coagulase negative staphylococci and the expression of jaw muscle pain in both males and females. These associations were homogeneous and were found whether the patients were selected on the basis of having jaw muscle pain or selected from within a population of patients selected on the basis of having Chronic Fatigue Syndrome. The studies associated the changes with variations in biochemistry and these were in turn associated with symptom expression within the jaw muscle pain patients. These biochemical alterations included the dysregulation of immune cell counts, cytokines, electrolyte and protein metabolism. These symptoms and biochemical changes were associated with pain severity and illness duration and staphylococcal toxin production. From the data a model was developed which shows the mechanisms involved in the development of chronic pain in the jaw muscles. Conclusions: The carriage of toxicogenic coagulase-negative staphylococci were found to be associated with the expression of jaw muscle pain and the alterations in biochemistry associated with these symptoms.

Objectives: To assess the expression of the symptoms of jaw muscle pain and its association with alterations in biochemistry, other symptoms and the carriage of staphylococci. Methods: Three different study populations were assessed. The first was selected and examined by the author and consisted of 43 pain and 41 age and sex matched controls. The second was a study of CFS patients who were blinded to the author and the author subsequently examined the associations between jaw muscle symptom reporting and the standardised biochemistry measures. The third study was also blinded to the author but included an investigation of staphylococci and certain cytokine and biochemistry measures. Results: The three studies clearly establish an association between the carriage of toxicogenic coagulase negative staphylococci and the expression of jaw muscle pain in both males and females. These associations were homogeneous and were found whether the patients were selected on the basis of having jaw muscle pain or selected from within a population of patients selected on the basis of having Chronic Fatigue Syndrome. The studies associated the changes with variations in biochemistry and these were in turn associated with symptom expression within the jaw muscle pain patients. These biochemical alterations included the dysregulation of immune cell counts, cytokines, electrolyte and protein metabolism. These symptoms and biochemical changes were associated with pain severity and illness duration and staphylococcal toxin production. From the data a model was developed which shows the mechanisms involved in the development of chronic pain in the jaw muscles. Conclusions: The carriage of toxicogenic coagulase-negative staphylococci were found to be associated with the expression of jaw muscle pain and the alterations in biochemistry associated with these symptoms.

L’invasion des ostéoblastes par Staphylococcus aureus (SA) est considérée comme responsable, au moins partiellement, de l’évolution chronique ou récurrente des infections osseuses (IO). Nous avons émis l’hypothèse que des différences d’interactions SA-ostéoblastes pouvaient être associées aux différences de présentation clinique des IO. Nous avons d’abord développé un modèle ex vivo d’infection intracellulaire d’ostéoblastes humains permettant de quantifier l’adhésion, l’invasion, la survie intracellulaire de SA et les dommages subis par les cellules infectées. Grâce ce modèle, nous avons montré que les SA communautaires résistants à la méticilline (CA-MRSA), un groupe polyphylétique de souches hypervirulentes associées à des formes aiguës et sévères d’IO, induisent une cytotoxicité supérieure à celle des MRSA hospitaliers (HA-MRSA) associés à des IO plus souvent chroniques. A l’aide de mutants isogéniques, nous avons pu démontrer que cette cytotoxicité était indépendante de la toxine de Panton-Valentine et l’alphahémolysine mais associée à la surexpression des phenol-soluble modulins (PSM) par les CA-MRSA. Ces résultats ont permis d’identifier un nouveau mécanisme de virulence des CA-MRSA basé sur l’invasion des ostéoblastes et l’activité intracellulaire des PSM. Parallèlement, nous avons montré que certains antibiotiques modifient le niveau de transcription et d’expression des protéines staphylococciques impliquées dans l’invasion des ostéoblastes, sans que nous ne puissions montrer une modification de la capacité d’invasion de S. aureus dans ce même modèle ex vivo. Nos travaux ouvrent de nouvelles perspectives dans la compréhension et la prise en charge des IO due à SA / Osteoblast invasion by Staphylococcus aureus (SA) is currently considered a putative explanatory mechanism for the chronic or recurrent nature of osteomyelitis. We raised the hypothesis that inter-strain differences in the interactions between S. aureus and osteoblasts at the cellular level could correlate with differences in the clinical presentation of osteomyelitis. We first developed an ex vivo model of intracellular bacterial challenge of human osteoblasts to quantify SA adhesion, invasion and intracellular survival as well as SA-induced damage to infected cells. By means of this model, we have demonstrated that community-acquired methicillinresistant SA (CA-MRSA) strains, which belong to a polyphyletic group endowed with high virulence and are associated with severe and acute forms of osteomyelitis, induce more cytotoxicity in osteoblasts as compared to hospital MRSA strains, which in turn are more frequently involved in chronic forms of osteomyelitis. Using isogenic CA-MRSA mutants, we determined that SA-induced osteoblast damage was independent of the production of Panton-Valentin leukocidin and alpha-toxin, but was associated with the overexpression of phenol-soluble modulins (PSMs) by CAMRSA. These findings elucidate a novel virulence strategy of CA-MRSA based on the invasion and PSM-related killing of osteoblasts. In parallel to this research, we demonstrated that several antibiotics alter the transcription and expression levels of SA adhesins involved in osteoblast invasion. However, antibiotics did not induce changes in SA invasiveness in our ex vivo infection model. Collectively, our findings provide new insights into the pathogenesis of SA osteomyelitis

Ziel der hier vorgelegten Untersuchung war es, die Bedeutung von S. aureus-Exotoxinen/Superantigenen als Pathogenitätsfaktor bei der AD zu analysieren, da kausalpathogenetisch ausgerichtete Experimentalansätze sowie systematische klinische Untersuchungen zu dieser Thematik bei Patienten mit AD ausstanden. In einer Querschnittsstudie war eine Assoziation zwischen dem Grad der S. aureus-Besiedlung und dem Schweregrad der AD nachzuweisen. Von 74 Kindern mit AD waren 60 (81%) mit S. aureus kolonisiert. S. aureus Exotoxin-sezernie-rende Stämme wurden bei 40 Patienten (53%) von der Haut isoliert. Am häufigsten wurden SEA- und SEC-sezernierende Stämme nachgewiesen, gefolgt von SEB, TSST-1 und SED. Der ausgeprägteste Schweregrad der AD wurde in der mit Exotoxin-sezernierenden S. aureus-kolonisierten Gruppe beobachtet. Für die Schwere der Erkrankung, gemessen am SCORAD-Score wurde eine Varianzaufklärung von 30% für die Exotoxine und 50% für die S. aureus-Infektion errechnet. In einer Subgruppe von Patienten wurde der Einfluß von S. aureus-Exotoxinen auf intradermale T-Zell-Rezeptor-Vß-Repertoir-Veränderungen untersucht. Bei den Patienten mit chronischer AD, die mit SEB-sezernierendem S. aureus besiedelt waren, war mittels immunhistologischer Untersuchung in der Haut nachzuweisen, dass zwischen 25% und 65% der intradermalen T-Zellen das zugehörige Superantigen-reaktive Vß-T-Zell-Repertoire gegenüber 5% bis 17% der T-Zellen im Blut exprimieren. Weder in der Haut noch im Blut war eine Akkumulation nicht-superantigenreaktiver T-Zell-Subpopulationen nachzuweisen. Auch fand sich keine selektive Akkumulation von Vß-T-Zell-Subpopulationen bei Kindern mit S. aureus-Kolonisierung ohne Exotoxinnachweis. Die Ergebnisse belegen, dass bei Kindern mit AD und positivem S. aureus-Exotoxinnachweis auf ekzematöser Haut ein Grossteil der dermal akkumulierten T-Zellen auf diese S. aureus-Exotoxine/Superantigene reagieren können und wesentlich an der Pathogenese der AD beteiligt sind. In einer Teilpopulation bei 58 Kindern mit AD wurden Prävalenz und Rolle von Serum-IgE-Antikörpern gegen die S. aureus-Exotoxine SEA und SEB untersucht. Bei 34% der Kinder mit AD (20/58) konnten wir spezifische IgE-Antikörper gegen SEA und/oder SEB nachweisen (45% zu SEB, 10% zu SEA und 45% zu SEA und SEB). Alle gegen SEA und SEB sensibilisierten Kindern waren mit S. aureus kolonisiert gegenüber 71% (27/38) der nicht-sensibilisierten Kinder. Der Grad der S. aureus-Besiedlung, die Prävalenz von SEB-sezernierendem S. aureus auf der Haut, sowie die Prävalenz von S. aureus-Hautinfektionen war in der sensibilisierten Gruppe höher. Die höchste Varianzaufklärung von 37% wurde zwischen dem Vorliegen von S. aureus-Hautinfektionen und dem Nachweis spezifischer SEA/SEB-IgE-Antikörper ermittelt; diese stellen somit einen Risikofaktor für eine Sensibilisierung gegen S. aureus-Exotoxine dar. Die SEA/SEB-sensibilisierte Gruppe zeigte einen höheren Schweregrad der AD, höhere Serum-Gesamt-Spiegel und eine polyvalente Sensibilisierung gegen Inhalations- und Nahrungsmittelallergene. Insgesamt belegen unsere klinischen, immunologischen und statistischen Ergebnisse, dass die S. aureus-Exotoxine einen wesentlichen Einfluss auf die Immunpathogenese der AD haben. Eine orale Therapie mit CyA kann bei S. aureus-kolonisierten Kindern die S. aureus-Besiedlungsdichte reduzieren. In der S. aureus-infizierten Gruppe war die Prävalenz von Exotoxin-produzierendem S. aureus und die Krankheitsaktivität höher, wobei eine Verminderung der Besiedlung nicht beobachtet wurde. Die Ergebnisse dieser Arbeit erlauben den Schluss, dass S. aureus-Exotoxine als Triggerfaktor die Exazerbation der AD im Kindesalter wesentlich unterstützen. Deswegen sollte in ein therapeutisches Konzept eine konsequente Prävention bzw. eine Behandlung von S. aureus-Infektionen einbezogen werden. Kinder mit bereits schwerer AD profitieren von einer immunmodulatorischen Therapie. / Background: The skin of patients suffering from atopic dermatitis (AD) exhibits a striking susceptibility to colonization with S. aureus. Some strains of S. aureus secrete exotoxins with T cell superantigen activity (toxigenic strains) and abnormal T cell functions are known to play a critical role in AD. Objective: The aim of this study was to determine the impact of exotoxin production by skin-colonizing S. aureus on disease severity and the presence of T-cell subsets in lesional skin. Furthermore, we investigated the effect of oral cyclosporin A in severe pediatric atopic dermatitis on disease severity and S. aureus colonization density. Methods: In a cross sectional study of 74 children with atopic dermatitis, the presence and density of toxigenic and non-toxigenic strains of S. aureus was correlated with disease severity. In a subgroup of patients the T cell receptor (TCR) Vß repertoire of peripheral blood and lesional T cells was investigated and correlated with individual superantigen activity of skin colonizing S. aureus. Furthermore, in a subgroup of patients, the presence of IgE antibodies to SEA and SEB was correlated with severity of the disease and the total and other unrelated allergen-specific IgE titers and density of colonization with S. aureus strains on atopic skin and episodes of superficial S. aureus skin infections. Eleven children with severe AD (SCORAD score > 50) were treated for eight weeks with 2.5 to 5 mg/kg CyA. In five children the skin was only colonized with S. aureus whereas the remaining six patients had clinically relevant skin infections with requirement for systemic antibiotic therapy. The isolates from the latter patients were sensitive for the selected antibiotics. Clinical and microbiological investigations were performed before and after CyA therapy. Results: 53% of children with AD were colonized with toxigenic strains of S. aureus producing SEC, SEA, TSST-1, SEB and SED in decreasing frequency. Children colonized with toxigenic S. aureus strains presented with higher disease severity as compared to the non-toxigenic and S. aureus negative groups. The influence of exotoxin production on the SCORAD score was determined as R2 = 0.3 (ie, 30% of the SCORAD score is explained by exotoxin production), whereas infection with S. aureus revealed R2 = 0.5. Patients colonized with toxigenic S. aureus exhibited shifts in the intradermal TCR Vß repertoire which correspond to the respective superantigen-responsive T cell subsets. In a subgroup of patients, twenty of 58 children (34%) were sensitized to superantigens (45% to SEB, 10% to SEA, 45% to SEA and SEB). In this group, severity of AD and levels of specific IgE to food and air allergens were higher. The degree of disease severity correlated to a higher extent with the presence of SEA/SEB-specific antibodies than with total serum IgE levels. Density of colonization with superantigen-secreting S. aureus strains was higher in the superantigen IgE-positive group. Sixty-three of these children experienced repeated episodes of superficial S aureus skin infections. The influence of S. aureus skin infection on the presence of SEA/SEB-specific antibodies was determined as R2 = 0.37 (ie, 37% of the the presence of SEA/SEB-specific antibodies is explained by S. aureus superficial skin infection). In the group of patients, who were treated with CyA, clinical signs and symptoms of AD improved in all patients (mean SCORAD score reduction from 74 to 29). However, disease severity was more supressed by CyA in the "colonized" patients compared with the patients with clinical S. aureus infections. Furthermore, there was a significant decrease in S. aureus density on atopic skin after CyA treatment in "colonized" patients but not in "infected" patients. The prevalence of exotoxin producing strains was higher in the "infected" group. Conclusion: The data demonstrate that S. aureus released exotoxins can modulate disease severity and dermal T cell infiltration. Patients, suffering from AD may take profit from both consequent prevention or treatment of S. aureus skin infection as well as immunmodulating approaches.