Which organism can cause toxic shock syndrome, often associated with foreign packing, and can cause scalded skin syndrome in children?

• A. Staphylococcus aureus
• B. Staphylococcus epidermidis
• C. Streptococcus pneumoniae
• D. Staphylococcus saprophyticus

Answer: (A)

Staphylococcus aureus can produce powerful toxins that drive both systemic and skin-directed disease. One toxin, TSST-1, acts as a superantigen that nudges a large portion of T cells to release a flood of cytokines, leading to fever, low blood pressure, rash, and potential organ involvement—this is toxic shock syndrome. This toxin exposure is classically linked to foreign packing, such as tampons or nasal packs, which concentrate toxin in the body.

Separately, S. aureus can make exfoliative toxins (A and B) that target the skin, causing staphylococcal scalded skin syndrome in children. These toxins cleave desmoglein-1 in the epidermis, leading to superficial bullae and widespread desquamation, with a positive Nikolsky sign.

Other organisms listed don’t produce these toxins or cause this toxin-driven skin/ systemic syndrome in the same way, which is why Staphylococcus aureus fits best.