Summary: Protein exotoxins from Staphylococcus aureus, phage type II, which cause epidermal necrolysis. They are proteins with a molecular weight of 26,000 to 32,000. They cause a condition variously called scaled skin, Lyell or Ritter syndrome, epidermal exfoliative disease, toxic epidermal necrolysis, etc.

Top Publications

  1. Fudaba Y, Nishifuji K, Andresen L, Yamaguchi T, Komatsuzawa H, Amagai M, et al. Staphylococcus hyicus exfoliative toxins selectively digest porcine desmoglein 1. Microb Pathog. 2005;39:171-6 pubmed
    ..These findings strongly suggest that Exhs cause blister formation of porcine skin by digesting porcine desmoglein 1 in a similar fashion to exfoliative toxins from S. aureus. ..
  2. Amagai M, Yamaguchi T, Hanakawa Y, Nishifuji K, Sugai M, Stanley J. Staphylococcal exfoliative toxin B specifically cleaves desmoglein 1. J Invest Dermatol. 2002;118:845-50 pubmed
    ..These findings demonstrate that exfoliative toxin A and exfoliative toxin B cause blister formation in staphylococcal scalded skin syndrome and bullous impetigo by identical molecular pathophysiologic mechanisms...
  3. Prevost G, Couppie P, Monteil H. Staphylococcal epidermolysins. Curr Opin Infect Dis. 2003;16:71-6 pubmed
    ..Even though cases of staphylococcal scalded skin syndrome in adults are rare, they raise further questions about the pathogenic features of the disease such as individual sensitivity and distribution of the toxins into the body. ..
  4. Ladhani S, Joannou C, Lochrie D, Evans R, Poston S. Clinical, microbial, and biochemical aspects of the exfoliative toxins causing staphylococcal scalded-skin syndrome. Clin Microbiol Rev. 1999;12:224-42 pubmed
  5. Futagawa Saito K, Ba Thein W, Higuchi T, Sakurai N, Fukuyasu T. Nationwide molecular surveillance of exfoliative toxigenic Staphylococcus hyicus on pig farms across Japan. Vet Microbiol. 2007;124:370-4 pubmed
    ..This study denotes high prevalence of toxigenic strains among S. hyicus circulating on pig farms in Japan. ..
  6. Yoon J, Lee G, Lee S, Park C, Yoo J, Park H. Prevalence of genes for enterotoxins, toxic shock syndrome toxin 1 and exfoliative toxin among clinical isolates of Staphylococcus pseudintermedius from canine origin. Vet Dermatol. 2010;21:484-9 pubmed publisher
    ..pseudintermedius such as pyoderma or chronic otitis. ..
  7. Nishifuji K, Sugai M, Amagai M. Staphylococcal exfoliative toxins: "molecular scissors" of bacteria that attack the cutaneous defense barrier in mammals. J Dermatol Sci. 2008;49:21-31 pubmed
    ..The species-specificity of staphylococcal exfoliative toxins to cleave Dsg1 in certain mammalian species is discussed...
  8. Kanbar T, Voytenko A, Alber J, Lammler C, Weiss R, Skvortzov V. Distribution of the putative virulence factor encoding gene sheta in Staphylococcus hyicus strains of various origins. J Vet Sci. 2008;9:327-9 pubmed
    ..hyicus strains in Russia and Germany. The toxigenic potential of this exotoxin, which does not have the classical structure of a staphylococcal exfoliative toxin, remains to be elucidated. ..
  9. Nakaminami H, Noguchi N, Ikeda M, Hasui M, Sato M, Yamamoto S, et al. Molecular epidemiology and antimicrobial susceptibilities of 273 exfoliative toxin-encoding-gene-positive Staphylococcus aureus isolates from patients with impetigo in Japan. J Med Microbiol. 2008;57:1251-8 pubmed publisher
    ..Additionally, the macrolide-resistance gene ermA or ermC was detected in 67.6% of MRSA and 71.4% of MSSA. Therefore, these results suggest that SCCmec types IV or V have spread, particularly in MSSA carrying etb in the community...

More Information


  1. Yamasaki O, Tristan A, Yamaguchi T, Sugai M, Lina G, Bes M, et al. Distribution of the exfoliative toxin D gene in clinical Staphylococcus aureus isolates in France. Clin Microbiol Infect. 2006;12:585-8 pubmed
    ..Most etd- and Panton-Valentine leukocidin-positive strains belonged to the clone of community-acquired methicillin-resistant S. aureus spreading currently throughout France...
  2. Lee C, Schmidt J, Johnson Winegar A, Spero L, Iandolo J. Sequence determination and comparison of the exfoliative toxin A and toxin B genes from Staphylococcus aureus. J Bacteriol. 1987;169:3904-9 pubmed
    ..The mature protein is 242 amino acids. The DNA sequence of the exfoliative toxin B gene was also determined. Corrections indicate that the amino acid sequence of exfoliative toxin B is in accord with chemical sequence data...
  3. Andresen L. Production of exfoliative toxin by isolates of Staphylococcus hyicus from different countries. Vet Rec. 2005;157:376-8 pubmed
    ..Of the 44 isolates from other animal species, only one isolate, from a hare from Belgium, produced ExhB, and one isolate, from a cow with mastitis from Japan, produced ExhA. ..
  4. Yamasaki O, Yamaguchi T, Sugai M, Chapuis Cellier C, Arnaud F, Vandenesch F, et al. Clinical manifestations of staphylococcal scalded-skin syndrome depend on serotypes of exfoliative toxins. J Clin Microbiol. 2005;43:1890-3 pubmed
    ..Thus, ETA is associated with bullous impetigo and ETB is associated with generalized SSSS, possibly owing to a lower titer of anti-ETB neutralizing antibodies in the general population...
  5. Andresen L, Ahrens P, Daugaard L, Bille Hansen V. Exudative epidermitis in pigs caused by toxigenic Staphylococcus chromogenes. Vet Microbiol. 2005;105:291-300 pubmed
    ..chromogenes. This confirmed that the disease-causing agent was the inoculated S. chromogenes strain VA654. The results of this study show that S. chromogenes may cause exudative epidermitis in pigs. ..
  6. Hanakawa Y, Selwood T, Woo D, Lin C, Schechter N, Stanley J. Calcium-dependent conformation of desmoglein 1 is required for its cleavage by exfoliative toxin. J Invest Dermatol. 2003;121:383-9 pubmed
    ..These data suggest that the specificity of exfoliative toxin cleavage of desmoglein 1 resides not only in simple amino acid sequences but also in its calcium-dependent conformation. ..
  7. Futagawa Saito K, Makino S, Sunaga F, Kato Y, Sakurai Komada N, Ba Thein W, et al. Identification of first exfoliative toxin in Staphylococcus pseudintermedius. FEMS Microbiol Lett. 2009;301:176-80 pubmed publisher
    ..The prevalence of exi assessed by dot-blot hybridization was 23.3% (10/43) in S. pseudintermedius isolates from canine pyoderma. The EXI reported herein is the first exfoliative toxin identified in S. pseudintermedius. ..
  8. Yamaguchi T, Nishifuji K, Sasaki M, Fudaba Y, Aepfelbacher M, Takata T, et al. Identification of the Staphylococcus aureus etd pathogenicity island which encodes a novel exfoliative toxin, ETD, and EDIN-B. Infect Immun. 2002;70:5835-45 pubmed
    ..This strongly suggests that ETD might play a pathogenic role in a broader spectrum of bacterial infections than previously considered. ..
  9. Hanakawa Y, Schechter N, Lin C, Garza L, Li H, Yamaguchi T, et al. Molecular mechanisms of blister formation in bullous impetigo and staphylococcal scalded skin syndrome. J Clin Invest. 2002;110:53-60 pubmed
    ..aureus to spread under the stratum corneum, the main barrier of the skin, explaining how, although they circulate through the entire body in SSSS, they cause pathology only in the superficial epidermis...
  10. Johnson W, Tyler S, Ewan E, Ashton F, Pollard D, Rozee K. Detection of genes for enterotoxins, exfoliative toxins, and toxic shock syndrome toxin 1 in Staphylococcus aureus by the polymerase chain reaction. J Clin Microbiol. 1991;29:426-30 pubmed
    ..aureus by the PCR offers a very specific, sensitive, relatively rapid, and inexpensive alternative to traditional immunological assays which depend on adequate gene expression for reliability and sensitivity. ..
  11. Plano L, Adkins B, Woischnik M, Ewing R, Collins C. Toxin levels in serum correlate with the development of staphylococcal scalded skin syndrome in a murine model. Infect Immun. 2001;69:5193-7 pubmed
    ..Thus, whereas the adaptive immune response is not needed for protection of adult mice from SSSS, efficient clearance of the toxin from the bloodstream is a critical factor...
  12. Andresen L. Differentiation and distribution of three types of exfoliative toxin produced by Staphylococcus hyicus from pigs with exudative epidermitis. FEMS Immunol Med Microbiol. 1998;20:301-10 pubmed
    ..In this study two new antigenically distinct exfoliative toxins were isolated and tools for in vitro detection of toxin producing S. hyicus isolates and for further studies on the exfoliative toxins from S. hyicus have been provided. ..
  13. Sato H, Watanabe T, Higuchi K, Teruya K, Ohtake A, Murata Y, et al. Chromosomal and extrachromosomal synthesis of exfoliative toxin from Staphylococcus hyicus. J Bacteriol. 2000;182:4096-100 pubmed
  14. Yamaguchi T, Hayashi T, Takami H, Ohnishi M, Murata T, Nakayama K, et al. Complete nucleotide sequence of a Staphylococcus aureus exfoliative toxin B plasmid and identification of a novel ADP-ribosyltransferase, EDIN-C. Infect Immun. 2001;69:7760-71 pubmed
    ..The size variation of the plasmid is mainly attributed to defined regions which may be hot spots for gene shuffling. ..
  15. Sila J, Sauer P, Kolar M. Comparison of the prevalence of genes coding for enterotoxins, exfoliatins, panton-valentine leukocidin and tsst-1 between methicillin-resistant and methicillin-susceptible isolates of Staphylococcus aureus at the university hospital in olomouc. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2009;153:215-8 pubmed
    ..05) in two cases (seg, sei). A higher prevalence of selected virulence genes was not confirmed in the methicillin-resistant S. aureus group. This indicates no further increase in their threat. ..
  16. Lautz S, Kanbar T, Alber J, Lammler C, Weiss R, Prenger Berninghoff E, et al. Dissemination of the gene encoding exfoliative toxin of Staphylococcus intermedius among strains isolated from dogs during routine microbiological diagnostics. J Vet Med B Infect Dis Vet Public Health. 2006;53:434-8 pubmed
    ..The presence of the exfoliative toxin gene could mainly be found among S. intermedius isolated from skin and wound infections and from otitis externa possibly indicating a role of this toxin for the clinical symptoms. ..
  17. Kanbar T, Voytenko A, Alber J, Lammler C, Weiss R, Zschock M, et al. Prevalence of genes encoding exfoliative toxins among Staphylococcus hyicus isolated in Russia and Germany. J Vet Med B Infect Dis Vet Public Health. 2006;53:429-33 pubmed
    ..However, comparable with the S. hyicus strains isolated in Germany which were investigated previously by Andresen (J. Vet. Rec., 157, 2005, 376), exhD seems to predominate in S. hyicus strains from Russia. ..
  18. Sato H, Watanabe T, Murata Y, Ohtake A, Nakamura M, Aizawa C, et al. New exfoliative toxin produced by a plasmid-carrying strain of Staphylococcus hyicus. Infect Immun. 1999;67:4014-8 pubmed
    ..It was thermolabile and lost its toxicity after being heated at 60 degrees C for 30 min. We propose that the new SHET be designated SHETB and that the SHET produced by the plasmidless strain be designated SHETA. ..
  19. Vath G, Earhart C, Monie D, Iandolo J, Schlievert P, Ohlendorf D. The crystal structure of exfoliative toxin B: a superantigen with enzymatic activity. Biochemistry. 1999;38:10239-46 pubmed publisher
  20. Papageorgiou A, Plano L, Collins C, Acharya K. Structural similarities and differences in Staphylococcus aureus exfoliative toxins A and B as revealed by their crystal structures. Protein Sci. 2000;9:610-8 pubmed publisher
    ..Finally, the crystal structure of ETs, together with biochemical data and mutagenesis studies, strongly confirms the classification of these molecules as "serine proteases" rather than "superantigens."..
  21. Jarraud S, Lyon G, Figueiredo A, Lina G, Gerard L, Vandenesch F, et al. Exfoliatin-producing strains define a fourth agr specificity group in Staphylococcus aureus. J Bacteriol. 2000;182:6517-22 pubmed
    ..This finding raises the question of the biological significance of the agr autoinduction threshold. ..
  22. Andresen L, Ahrens P. A multiplex PCR for detection of genes encoding exfoliative toxins from Staphylococcus hyicus. J Appl Microbiol. 2004;96:1265-70 pubmed
    ..hyicus elucidating the epidemiology of EE in pigs. The multiplex PCR is currently being used for selection of Staph. hyicus isolates for production of autogenous vaccine. ..
  23. Becker K, Friedrich A, Lubritz G, Weilert M, Peters G, von Eiff C. Prevalence of genes encoding pyrogenic toxin superantigens and exfoliative toxins among strains of Staphylococcus aureus isolated from blood and nasal specimens. J Clin Microbiol. 2003;41:1434-9 pubmed
    ..aureus. Moreover, mainly due to the fixed combinations of seg plus sei, as well as sed plus sej, the possession of multiple PTSAg genes (62.9%) is more frequent than assumed so far. ..
  24. Ladhani S. Recent developments in staphylococcal scalded skin syndrome. Clin Microbiol Infect. 2001;7:301-7 pubmed
    ..The recent developments in our understanding of the exfoliative toxins should lead to new and improved diagnostic and therapeutic strategies, including the use of specific antixoxins to prevent exfoliation...
  25. Terauchi R, Sato H, Hasegawa T, Yamaguchi T, Aizawa C, Maehara N. Isolation of exfoliative toxin from Staphylococcus intermedius and its local toxicity in dogs. Vet Microbiol. 2003;94:19-29 pubmed
    ..The molecular weight of the ETLT was estimated at 30 kDa by SDS-PAGE. In the present study, we propose the ETLT was a novel type of ET, S. intermedius exfoliative toxin (SIET). ..
  26. Ahrens P, Andresen L. Cloning and sequence analysis of genes encoding Staphylococcus hyicus exfoliative toxin types A, B, C, and D. J Bacteriol. 2004;186:1833-7 pubmed
    ..The recombinant toxins could be expressed in Escherichia coli, and three of the four toxins were recognized by monoclonal antibodies raised against native exfoliative toxins. ..
  27. Saiman L, Jakob K, Holmes K, Whittier S, Garzon M, Rago J, et al. Molecular epidemiology of staphylococcal scalded skin syndrome in premature infants. Pediatr Infect Dis J. 1998;17:329-34 pubmed
    ..We describe two cases of SSSS in very low birth weight infants in a neonatal intensive care unit (NICU) and the success of infection control strategies used to prevent an outbreak...
  28. Hallin M, Denis O, Deplano A, De Ryck R, Crèvecoeur S, Rottiers S, et al. Evolutionary relationships between sporadic and epidemic strains of healthcare-associated methicillin-resistant Staphylococcus aureus. Clin Microbiol Infect. 2008;14:659-69 pubmed publisher
    ..These findings suggest that the SCCmec type and insertion/deletion of other mobile genetic elements may be involved in modulating the epidemic behaviour of MRSA strains of similar genetic background, independently of fitness cost. ..
  29. Johnsen C, Jensen A, Ahrens P, Andresen L. The porcine skin associated T-cell homing chemokine CCL27: molecular cloning and mRNA expression in piglets infected experimentally with Staphylococcus hyicus. Vet Immunol Immunopathol. 2003;96:13-8 pubmed
  30. Gould I, Girvan E, Browning R, MacKenzie F, Edwards G. Report of a hospital neonatal unit outbreak of community-associated methicillin-resistant Staphylococcus aureus. Epidemiol Infect. 2009;137:1242-8 pubmed publisher
    ..Region-wide surveillance of over 6000 MRSA isolates collected from 1998 to 2004 showed that 95 (1.6%) were closely related to the outbreak strain although only 60 carried the ETA gene. The strain has not been seen elsewhere in Scotland. ..
  31. Terauchi R, Sato H, Endo Y, Aizawa C, Maehara N. Cloning of the gene coding for Staphylococcus intermedius exfoliative toxin and its expression in Escherichia coli. Vet Microbiol. 2003;94:31-8 pubmed
    ..intermedius and was expressed in Escherichia coli. The nucleotide sequence of the SIET gene consists of a coding region of 990 bp specifying a polypeptide of 330 amino acid residues, which included a putative 42-residue signal sequence. ..
  32. Aalfs A, Oktarina D, Diercks G, Jonkman M, Pas H. Staphylococcal scalded skin syndrome: loss of desmoglein 1 in patient skin. Eur J Dermatol. 2010;20:451-6 pubmed publisher
    ..This raises the question if other toxins and/or other bacteria than Staphylococcus aureus might also induce SSSS...
  33. Mertz P, Cardenas T, Snyder R, Kinney M, Davis S, Plano L. Staphylococcus aureus virulence factors associated with infected skin lesions: influence on the local immune response. Arch Dermatol. 2007;143:1259-63 pubmed
    ..Staphylococcus aureus virulence factors ETA, ETB, and PVL are associated with WBC counts from infected skin lesions. The exact role they play in affecting the WBC counts remains to be determined. ..
  34. Kawada Matsuo M, Shammi F, Oogai Y, Nakamura N, Sugai M, Komatsuzawa H. C55 bacteriocin produced by ETB-plasmid positive Staphylococcus aureus strains is a key factor for competition with S. aureus strains. Microbiol Immunol. 2016;60:139-47 pubmed publisher
    ..These results suggest that the C55 bacteriocin produced by pETB-positive strains affects the proportion of each strain when pETB-positive and -negative strains co-exist. ..
  35. Funakoshi T, Payne A. Cleavage isn't everything: potential novel mechanisms of exfoliative toxin-mediated blistering. Am J Pathol. 2010;177:2682-4 pubmed publisher
    ..This Commentary describes breakthroughs in understanding the interactions between desmoglein 1 and plakogloben in staphylococcal-mediated blistering skin diseases. ..
  36. Courjon J, Hubiche T, Phan A, Tristan A, Bes M, Vandenesch F, et al. Skin findings of Staphylococcus aureus toxin-mediated infection in relation to toxin encoding genes. Pediatr Infect Dis J. 2013;32:727-30 pubmed publisher
    Staphylococcal scalded skin syndrome and toxic shock syndrome are associated with exfoliatins and superantigens, respectively; and are easy to distinguish in their usual presentation...
  37. Machida K, Sakurai S, Kondo I, Ikawa S. Genetic control of immune response to staphylococcal exfoliative toxin A in mice. Infect Immun. 1987;55:2768-73 pubmed
    ..This result suggests that if the mother is a high responder to ETA and is effectively immunized with ETA, the maternal immunity makes it possible to neutralize this toxin in neonatal mice. ..
  38. Onuma K, Uoya Y, Koide T, Shibata A, Tanabe T, Sato H. Detection of Staphylococcus hyicus exfoliative toxin genes by dot blot hybridization and multiplex polymerase chain reaction. Microbiol Immunol. 2011;55:168-73 pubmed publisher
    ..This multiplex PCR system has high specificity among the well-known S. hyicus ET genes. Of the 69 known ET-producing S. hyicus strains, 38, 19, 10, 2 and 1 strains have exhB, exhD exhA, shetb and exhC genes, respectively. ..
  39. Onuma K, Tanabe T, Sato H. Development of a high-expression system for staphylococcal exfoliative toxin genes. J Vet Med Sci. 2011;73:1051-7 pubmed
    ..The yields of all rETs were high, and all of them showed exfoliative activity in susceptible animals. The antigenicities of rETs and ETs were not distinguishable from each other. ..
  40. Kato Z, Tsubouchi K, Kondo N. Molluscum contagiosum prevents progression of staphylococcal scalded skin syndrome. Eur J Pediatr. 2005;164:768-9 pubmed
    ..Prevention of progression of staphylococcal scalded skin syndrome by molluscum contagiosum indicated a possible interference by viral anti-cytokine molecule such as interleukin-18 binding protein. ..
  41. Gravet A, Couppie P, Meunier O, Clyti E, Moreau B, Pradinaud R, et al. Staphylococcus aureus isolated in cases of impetigo produces both epidermolysin A or B and LukE-LukD in 78% of 131 retrospective and prospective cases. J Clin Microbiol. 2001;39:4349-56 pubmed
    ..The new association of toxins with a clinical syndrome may reveal principles of the pathological process...
  42. Sayama K, Midorikawa K, Hanakawa Y, Sugai M, Hashimoto K. Superantigen production by Staphylococcus aureus in psoriasis. Dermatology. 1998;196:194-8 pubmed
    ..aureus. We believe that superantigens are not essential in sustaining disease activity but may, instead, be exacerbating or triggering factors for some psoriasis patients. ..
  43. Koning S, van Belkum A, Snijders S, van Leeuwen W, Verbrugh H, Nouwen J, et al. Severity of nonbullous Staphylococcus aureus impetigo in children is associated with strains harboring genetic markers for exfoliative toxin B, Panton-Valentine leukocidin, and the multidrug resistance plasmid pSK41. J Clin Microbiol. 2003;41:3017-21 pubmed
    ..The identification of these microbial genetic markers, which are predictive of the severity and the course of the disease, will facilitate guided individualized antimicrobial therapy in the future...
  44. Plano L. Staphylococcus aureus exfoliative toxins: how they cause disease. J Invest Dermatol. 2004;122:1070-7 pubmed
  45. Ito Y, Funabashi Yoh M, Toda K, Shimazaki M, Nakamura T, Morita E. Staphylococcal scalded-skin syndrome in an adult due to methicillin-resistant Staphylococcus aureus. J Infect Chemother. 2002;8:256-61 pubmed
    ..A. hydrophila is recognized as an opportunistic pathogen. SSSS should be considered in the differential diagnosis of immunocompromised adult patients with sudden onset of high fever and erythema. ..
  46. Li H, Li X, Lu Y, Wang X, Zheng S. Staphylococcus sciuri exfoliative toxin C is a dimer that modulates macrophage functions. Can J Microbiol. 2011;57:722-9 pubmed publisher
    ..7 cells. These results suggest that ExhC may play an important role in innate immune response against S. sciuri infection. ..
  47. Motoshima M, Yanagihara K, Morinaga Y, Matsuda J, Sugahara K, Yamada Y, et al. Genetic diagnosis of community-acquired MRSA: a multiplex real-time PCR method for Staphylococcal cassette chromosome mec typing and detecting toxin genes. Tohoku J Exp Med. 2010;220:165-70 pubmed
    ..No isolate was lukS/F-PV positive. The present study indicates the high rate of lukS/F-PV-negative SCCmec type IV in Nagasaki. Our PCR method is convenient for typing MRSA and detecting toxins in Japan. ..
  48. Endo Y, Yamada T, Matsunaga K, Hayakawa Y, Kaidoh T, Takeuchi S. Phage conversion of exfoliative toxin A in Staphylococcus aureus isolated from cows with mastitis. Vet Microbiol. 2003;96:81-90 pubmed
    ..aureus, and the lysogenized S. aureus isolates had the ability to produce ETA. These results suggest the possibility of horizontal transmission of the eta gene by temperate bacteriophages among bovine isolates of S. aureus. ..
  49. Brennan D, Hu Y, Kljuic A, Choi Y, Joubeh S, Bashkin M, et al. Differential structural properties and expression patterns suggest functional significance for multiple mouse desmoglein 1 isoforms. Differentiation. 2004;72:434-49 pubmed
    ..These results suggest that the developmental complexity of mouse tissues, including skin and hair, may play a significant role in the evolutionary driving force to maintain multiple Dsg1 genes in mouse. ..
  50. Ladhani S. Understanding the mechanism of action of the exfoliative toxins of Staphylococcus aureus. FEMS Immunol Med Microbiol. 2003;39:181-9 pubmed
    ..It is hoped that this knowledge will lead to development of rapid screening and diagnostic tests, and new antitoxin strategies for the treatment and prevention of the staphylococcal scalded skin syndrome in the near future. ..
  51. Ouchi T, Kubo A, Yokouchi M, Adachi T, Kobayashi T, Kitashima D, et al. Langerhans cell antigen capture through tight junctions confers preemptive immunity in experimental staphylococcal scalded skin syndrome. J Exp Med. 2011;208:2607-13 pubmed publisher
    ..Targeting this immunological process confers protection with minimal invasiveness and should have a marked impact on future strategies for development of percutaneous vaccines...
  52. Sonnevend A, Blair I, Alkaabi M, Jumaa P, Al Haj M, Ghazawi A, et al. Change in meticillin-resistant Staphylococcus aureus clones at a tertiary care hospital in the United Arab Emirates over a 5-year period. J Clin Pathol. 2012;65:178-82 pubmed publisher
    ..The emergence of CA-MRSA clones with subsequent entry to and spread within the hospital has contributed to the increasing incidence of MRSA observed in Tawam Hospital and probably also in other hospitals in the UAE. ..
  53. Youn J, Koo H, Ahn K, Lim S, Park Y. Determination of staphylococcal exotoxins, SCCmec types, and genetic relatedness of Staphylococcus intermedius group isolates from veterinary staff, companion animals, and hospital environments in Korea. J Vet Sci. 2011;12:221-6 pubmed
    ..Strains having the same band patterns were detected in S. pseudintermedius isolates collected at 13 and 18 months, suggesting possible colonization and/or expansion of a specific S. pseudintermedius strain in a veterinary hospital. ..
  54. Piechowicz L, Garbacz K, Wisniewska K, Dabrowska Szponar M. Screening of Staphylococcus aureus nasal strains isolated from medical students for toxin genes. Folia Microbiol (Praha). 2011;56:225-9 pubmed publisher
    ..aureus nasal carriage, nor the frequency of clinically important toxin gene presence, but it could have influenced the positive selection of toxigenic MRSA strains. ..
  55. Melter O, Aires de Sousa M, Laskafeldová K, Urbaskova P, Wünschová M, de Lencastre H. Delineation of the endemic and sporadic methicillin-resistant Staphylococcus aureus clones in a Czech hospital. Microb Drug Resist. 2004;10:218-23 pubmed
  56. Hanakawa Y, Li H, Lin C, Stanley J, Cotsarelis G. Desmogleins 1 and 3 in the companion layer anchor mouse anagen hair to the follicle. J Invest Dermatol. 2004;123:817-22 pubmed
    ..These findings demonstrate the importance of the companion layer, and particularly the Dsg1 and Dsg3 in this layer, in anchoring the anagen hair to the follicle. ..
  57. Ruzickova V, Voller J, Pantucek R, Petras P, Doskar J. Multiplex PCR for detection of three exfoliative toxin serotype genes in Staphylococcus aureus. Folia Microbiol (Praha). 2005;50:499-502 pubmed
    ..The PCR method using the multiplex and specific primer set was shown to be reliable in rapid identification of the exfoliative toxin producing S. aureus and can be used as a convenient tool for hospital epidermolytic infection control. ..
  58. Holochová P, Ruzickova V, Pantucek R, Petráš P, Janisch R, Doskar J. Genomic diversity of two lineages of exfoliative toxin A-converting phages predominating in Staphylococcus aureus strains in the Czech Republic. Res Microbiol. 2010;161:260-7 pubmed publisher
    ..This study highlights not only the conclusive genomic diversity of eta gene-positive phages, but also their virulence implications in impetigo S. aureus strains. ..
  59. Dakic I, Vukovic D, Stepanovic S, Hauschild T, Jezek P, Petráš P, et al. Survey of genes encoding staphylococcal enterotoxins, toxic shock syndrome toxin 1, and exfoliative toxins in members of the Staphylococcus sciuri group. J Clin Microbiol. 2005;43:4875-6 pubmed
    ..This strongly suggests that production of the staphylococcal exotoxins by these bacteria is highly unlikely. ..
  60. Zollner T, Nuber V, Duijvestijn A, Boehncke W, Kaufmann R. Superantigens but not mitogens are capable of inducing upregulation of E-selectin ligands on human T lymphocytes. Exp Dermatol. 1997;6:161-6 pubmed
    ..An additional adhesion pathway via E-selectin may thus be available to lymphocytes, comparable to granulocytes which constitutively express CD15s. ..
  61. Nishifuji K, Fudaba Y, Yamaguchi T, Iwasaki T, Sugai M, Amagai M. Cloning of swine desmoglein 1 and its direct proteolysis by Staphylococcus hyicus exfoliative toxins isolated from pigs with exudative epidermitis. Vet Dermatol. 2005;16:315-23 pubmed
    ..Recognition and digestion of calcium-stabilized structure on the extracellular domains of swine Dsg1 by Exhs indicated that EE shares similar molecular pathophysiological mechanisms of intra-epidermal splitting with SSSS in humans. ..
  62. Sillevis Smitt J. [Diagnostic image (202). A newborn with subfebrile temperature and skin lesions]. Ned Tijdschr Geneeskd. 2004;148:2150; author reply 2150 pubmed
  63. Iyori K, Futagawa Saito K, Hisatsune J, Yamamoto M, Sekiguchi M, Ide K, et al. Staphylococcus pseudintermedius exfoliative toxin EXI selectively digests canine desmoglein 1 and causes subcorneal clefts in canine epidermis. Vet Dermatol. 2011;22:319-26 pubmed publisher
    ..These findings indicate that EXI has a proteolytic activity that digests canine Dsg1, and this characteristic might be involved in the pathogenesis of intraepidermal splitting in canine impetigo. ..
  64. Unal N, Askar S, Macun H, Sakarya F, Altun B, Yildirim M. Panton-Valentine leukocidin and some exotoxins of Staphylococcus aureus and antimicrobial susceptibility profiles of staphylococci isolated from milks of small ruminants. Trop Anim Health Prod. 2012;44:573-9 pubmed publisher
    ..However, Panton-Valentine leukocidin produced by S. aureus could be an important virulence factor and contribute to subclinical mastitis pathogenicity. ..
  65. Franke G, Böckenholt A, Sugai M, Rohde H, Aepfelbacher M. Epidemiology, variable genetic organization and regulation of the EDIN-B toxin in Staphylococcus aureus from bacteraemic patients. Microbiology. 2010;156:860-72 pubmed publisher
    ..These data suggest that the EDIN-B toxin is produced during human infection, is part of a highly variable pathogenicity island and can be controlled by the sarA gene regulon and secreted bacterial proteases. ..
  66. Ladhani S, Robbie S, Garratt R, Chapple D, Joannou C, Evans R. Development and evaluation of detection systems for staphylococcal exfoliative toxin A responsible for scalded-skin syndrome. J Clin Microbiol. 2001;39:2050-4 pubmed
    ..This is the first detection system with the potential to confirm the diagnosis of staphylococcal scalded-skin syndrome from a routine blood test within 3 h of presentation...
  67. Jursa Kulesza J, Kordek A, Kopron K, Wojciuk B, Giedrys Kalemba S. Molecular studies of an impetigo bullosa epidemic in full-term infants. Neonatology. 2009;96:61-8 pubmed publisher
    ..aureus type. She was present at the birth of the first infected newborn. Today, molecular methods are essential for prompt recognition of an epidemic and implementation of appropriate infection control strategies. ..
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    ..The fascinating road leading to the discovery of ETs as the agents responsible for SSSS and the characterization of the molecular mechanism of their action, including recent advances in the field, are reviewed in this article. ..
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    ..Repeated courses of decontamination treatment failed to eradicate carriage. Nine months after the last case, another neonate developed a more severe form of bullous impetigo and the auxiliary nurse was reassigned to an adult ward...