Summary and conclusionNeonatal toxic shock syndrome like exanthematous disease (NTED) is a new neonatal disease caused by toxic shock syndrome toxin-1 (TSST-1). It has the following clinical criteria (i) exanthema plus (ii) at least one of the following three signs: thrombocytopenia (low platellat count < 150.000/mm3), a low – positive serum CRP value (positive CRP > 1.0 mg/dL) and fever (rectal temperature of > 38oC)Since 1992; the number of hospitals in Japan in which this disease had been encountered increased from 25.7 % in 1995 to 70.8 % in 1998. subsequently, microbiological examination showed that most of the neonates with this illness were colonized by methicillin-resistant staph-aureus (MRSA) strains that produced TSST-1. also NTED appeared in France in 2002 and Netherlands in 2003. there the apprehension that NTED will become widespread throughout the world.To Study the prevalence of neonatal toxic shock syndrome like exanthematous disease (NTED) in our Neonatology Unit of Pediatric Department, Zagazig University Hospital, identification the causative organism of this disease and the preventation.This study was conducted from August 2002 to August 2004.The study included two groups :(1) Cases:This study included 30 neonates within the first week of life, from which 10 neonates with rash but other 20 neonates without rash. The cases were selected from Neonatology unit of pediatric Department, Zagazig university Hospital .(2) Controls group :Included 15 healthy neonate within The first week of life (except the recovery cases) selected from obstetric unit of obstetric and Gynecology Department, Zagagzig University and from neonates seeking medical Advice at The outpatient clinic of pediatrics, Zagazig university Hospital.Swabs and blood samples were collected from all cases and controls were tested by:• Nasal swabs, bacterial isolation and identification• Conventional blood culture• Mini vital automated system• Vitek• System identification MRSA BBL crystal• Measurement of anti-TSS-1 Ab?s by Elisa• PCRNasal swabs and blood samples were taken from all cases and controls and isolated on blood agar and mannitol salt plates identification of staph. aureus isolates was done by microscopically examination (catalase test, coagulase test and urease test). The results showed that (73.3%) of cases were positive to staph-aureus compared with (6.7%) of controls.Automated blood culture systems as vital system and the vitek system for easily and rapid identification of organism. We found that staph-aureus was the organism isolated from (63.3 % ) of cases but all control were staph-aureus negative.Identification of MRSA isolates was done by BBL crystal MRSA identification system; we found that all cases (63.3 %) of blood culture positive to staph-aureus were MRSA.Our study shown that (63.3 %) of the cases had MRSA from which (31.6 %) were manifested by NTED. measurement of anti-TSST-1Ab?s by ELISA shown that; The anti-TSST-1 IgG titer in NTED were less than (0.2 OD at 450 nm.) the anti-TSST-1 IgG titer in carriers between (0.18 to 0.3 OD at 450 nm.) and the anti-TSST-1 IgG titer in Controls more than (0.2 OD at 450 nm.).Also we found that; The anti-TSST-1 IgM titer was negligible (less than 0.01) soon after birth (4-7 days) in all NTED, carriers and controls, but at one month of life, the anti-TSST-1 IgM Ab titer had increased in recovery neonates (from 0.01 - 0.03)the extracted DNA were amplified by PCR analysis of the amplified product by a garose gel electrophoresis for detection the mec A gene MRSA. We found that mec A gene was presented in (53.3 %) neonates had MRSA.Conclusion- NTED was found in Neonatology Unit of Pediatrics Department, Zagazig University Hospital. It represented (31.6 %) from all cases of MRSA (63.3 %) from August 2002 – August 2004.- MRSA was the causative organism of NTED.- Mec A gene was present in most cases had MRSA positive carriers; so Mec A gene was the cause of high level resistance to methicillin.- Anti-TSST-1 Ab?s transferred placentally from the pregnant women to her baby play a role in protecting neonates from developing NTED.Summary and conclusionNeonatal toxic shock syndrome like exanthematous disease (NTED) is a new neonatal disease caused by toxic shock syndrome toxin-1 (TSST-1). It has the following clinical criteria (i) exanthema plus (ii) at least one of the following three signs: thrombocytopenia (low platellat count < 150.000/mm3), a low – positive serum CRP value (positive CRP > 1.0 mg/dL) and fever (rectal temperature of > 38oC)Since 1992; the number of hospitals in Japan in which this disease had been encountered increased from 25.7 % in 1995 to 70.8 % in 1998. subsequently, microbiological examination showed that most of the neonates with this illness were colonized by methicillin-resistant staph-aureus (MRSA) strains that produced TSST-1. also NTED appeared in France in 2002 and Netherlands in 2003. there the apprehension that NTED will become widespread throughout the world.To Study the prevalence of neonatal toxic shock syndrome like exanthematous disease (NTED) in our Neonatology Unit of Pediatric Department, Zagazig University Hospital, identification the causative organism of this disease and the preventation.This study was conducted from August 2002 to August 2004.The study included two groups :(1) Cases:This study included 30 neonates within the first week of life, from which 10 neonates with rash but other 20 neonates without rash. The cases were selected from Neonatology unit of pediatric Department, Zagazig university Hospital .(2) Controls group :Included 15 healthy neonate within The first week of life (except the recovery cases) selected from obstetric unit of obstetric and Gynecology Department, Zagagzig University and from neonates seeking medical Advice at The outpatient clinic of pediatrics, Zagazig university Hospital.Swabs and blood samples were collected from all cases and controls were tested by:• Nasal swabs, bacterial isolation and identification• Conventional blood culture• Mini vital automated system• Vitek• System identification MRSA BBL crystal• Measurement of anti-TSS-1 Ab?s by Elisa• PCRNasal swabs and blood samples were taken from all cases and controls and isolated on blood agar and mannitol salt plates identification of staph. aureus isolates was done by microscopically examination (catalase test, coagulase test and urease test). The results showed that (73.3%) of cases were positive to staph-aureus compared with (6.7%) of controls.Automated blood culture systems as vital system and the vitek system for easily and rapid identification of organism. We found that staph-aureus was the organism isolated from (63.3 % ) of cases but all control were staph-aureus negative.Identification of MRSA isolates was done by BBL crystal MRSA identification system; we found that all cases (63.3 %) of blood culture positive to staph-aureus were MRSA.Our study shown that (63.3 %) of the cases had MRSA from which (31.6 %) were manifested by NTED. measurement of anti-TSST-1Ab?s by ELISA shown that; The anti-TSST-1 IgG titer in NTED were less than (0.2 OD at 450 nm.) the anti-TSST-1 IgG titer in carriers between (0.18 to 0.3 OD at 450 nm.) and the anti-TSST-1 IgG titer in Controls more than (0.2 OD at 450 nm.).Also we found that; The anti-TSST-1 IgM titer was negligible (less than 0.01) soon after birth (4-7 days) in all NTED, carriers and controls, but at one month of life, the anti-TSST-1 IgM Ab titer had increased in recovery neonates (from 0.01 - 0.03)the extracted DNA were amplified by PCR analysis of the amplified product by a garose gel electrophoresis for detection the mec A gene MRSA. We found that mec A gene was presented in (53.3 %) neonates had MRSA.Conclusion- NTED was found in Neonatology Unit of Pediatrics Department, Zagazig University Hospital. It represented (31.6 %) from all cases of MRSA (63.3 %) from August 2002 – August 2004.- MRSA was the causative organism of NTED.- Mec A gene was present in most cases had MRSA positive carriers; so Mec A gene was the cause of high level resistance to methicillin.- Anti-TSST-1 Ab?s transferred placentally from the pregnant women to her baby play a role in protecting neonates from developing NTED.Summary and conclusionNeonatal toxic shock syndrome like exanthematous disease (NTED) is a new neonatal disease caused by toxic shock syndrome toxin-1 (TSST-1). It has the following clinical criteria (i) exanthema plus (ii) at least one of the following three signs: thrombocytopenia (low platellat count < 150.000/mm3), a low – positive serum CRP value (positive CRP > 1.0 mg/dL) and fever (rectal temperature of > 38oC)Since 1992; the number of hospitals in Japan in which this disease had been encountered increased from 25.7 % in 1995 to 70.8 % in 1998. subsequently, microbiological examination showed that most of the neonates with this illness were colonized by methicillin-resistant staph-aureus (MRSA) strains that produced TSST-1. also NTED appeared in France in 2002 and Netherlands in 2003. there the apprehension that NTED will become widespread throughout the world.To Study the prevalence of neonatal toxic shock syndrome like exanthematous disease (NTED) in our Neonatology Unit of Pediatric Department, Zagazig University Hospital, identification the causative organism of this disease and the preventation.This study was conducted from August 2002 to August 2004.The study included two groups :(1) Cases:This study included 30 neonates within the first week of life, from which 10 neonates with rash but other 20 neonates without rash. The cases were selected from Neonatology unit of pediatric Department, Zagazig university Hospital .(2) Controls group :Included 15 healthy neonate within The first week of life (except the recovery cases) selected from obstetric unit of obstetric and Gynecology Department, Zagagzig University and from neonates seeking medical Advice at The outpatient clinic of pediatrics, Zagazig university Hospital.Swabs and blood samples were collected from all cases and controls were tested by:• Nasal swabs, bacterial isolation and identification• Conventional blood culture• Mini vital automated system• Vitek• System identification MRSA BBL crystal• Measurement of anti-TSS-1 Ab?s by Elisa• PCRNasal swabs and blood samples were taken from all cases and controls and isolated on blood agar and mannitol salt plates identification of staph. aureus isolates was done by microscopically examination (catalase test, coagulase test and urease test). The results showed that (73.3%) of cases were positive to staph-aureus compared with (6.7%) of controls.Automated blood culture systems as vital system and the vitek system for easily and rapid identification of organism. We found that staph-aureus was the organism isolated from (63.3 % ) of cases but all control were staph-aureus negative.Identification of MRSA isolates was done by BBL crystal MRSA identification system; we found that all cases (63.3 %) of blood culture positive to staph-aureus were MRSA.Our study shown that (63.3 %) of the cases had MRSA from which (31.6 %) were manifested by NTED. measurement of anti-TSST-1Ab?s by ELISA shown that; The anti-TSST-1 IgG titer in NTED were less than (0.2 OD at 450 nm.) the anti-TSST-1 IgG titer in carriers between (0.18 to 0.3 OD at 450 nm.) and the anti-TSST-1 IgG titer in Controls more than (0.2 OD at 450 nm.).Also we found that; The anti-TSST-1 IgM titer was negligible (less than 0.01) soon after birth (4-7 days) in all NTED, carriers and controls, but at one month of life, the anti-TSST-1 IgM Ab titer had increased in recovery neonates (from 0.01 - 0.03)the extracted DNA were amplified by PCR analysis of the amplified product by a garose gel electrophoresis for detection the mec A gene MRSA. We found that mec A gene was presented in (53.3 %) neonates had MRSA.Conclusion- NTED was found in Neonatology Unit of Pediatrics Department, Zagazig University Hospital. It represented (31.6 %) from all cases of MRSA (63.3 %) from August 2002 – August 2004.- MRSA was the causative organism of NTED.- Mec A gene was present in most cases had MRSA positive carriers; so Mec A gene was the cause of high level resistance to methicillin.- Anti-TSST-1 Ab?s transferred placentally from the pregnant women to her baby play a role in protecting neonates from developing NTED.Summary and conclusionNeonatal toxic shock syndrome like exanthematous disease (NTED) is a new neonatal disease caused by toxic shock syndrome toxin-1 (TSST-1). It has the following clinical criteria (i) exanthema plus (ii) at least one of the following three signs: thrombocytopenia (low platellat count < 150.000/mm3), a low – positive serum CRP value (positive CRP > 1.0 mg/dL) and fever (rectal temperature of > 38oC)Since 1992; the number of hospitals in Japan in which this disease had been encountered increased from 25.7 % in 1995 to 70.8 % in 1998. subsequently, microbiological examination showed that most of the neonates with this illness were colonized by methicillin-resistant staph-aureus (MRSA) strains that produced TSST-1. also NTED appeared in France in 2002 and Netherlands in 2003. there the apprehension that NTED will become widespread throughout the world.To Study the prevalence of neonatal toxic shock syndrome like exanthematous disease (NTED) in our Neonatology Unit of Pediatric Department, Zagazig University Hospital, identification the causative organism of this disease and the preventation.This study was conducted from August 2002 to August 2004.The study included two groups :(1) Cases:This study included 30 neonates within the first week of life, from which 10 neonates with rash but other 20 neonates without rash. The cases were selected from Neonatology unit of pediatric Department, Zagazig university Hospital .(2) Controls group :Included 15 healthy neonate within The first week of life (except the recovery cases) selected from obstetric unit of obstetric and Gynecology Department, Zagagzig University and from neonates seeking medical Advice at The outpatient clinic of pediatrics, Zagazig university Hospital.Swabs and blood samples were collected from all cases and controls were tested by:• Nasal swabs, bacterial isolation and identification• Conventional blood culture• Mini vital automated system• Vitek• System identification MRSA BBL crystal• Measurement of anti-TSS-1 Ab?s by Elisa• PCRNasal swabs and blood samples were taken from all cases and controls and isolated on blood agar and mannitol salt plates identification of staph. aureus isolates was done by microscopically examination (catalase test, coagulase test and urease test). The results showed that (73.3%) of cases were positive to staph-aureus compared with (6.7%) of controls.Automated blood culture systems as vital system and the vitek system for easily and rapid identification of organism. We found that staph-aureus was the organism isolated from (63.3 % ) of cases but all control were staph-aureus negative.Identification of MRSA isolates was done by BBL crystal MRSA identification system; we found that all cases (63.3 %) of blood culture positive to staph-aureus were MRSA.Our study shown that (63.3 %) of the cases had MRSA from which (31.6 %) were manifested by NTED. measurement of anti-TSST-1Ab?s by ELISA shown that; The anti-TSST-1 IgG titer in NTED were less than (0.2 OD at 450 nm.) the anti-TSST-1 IgG titer in carriers between (0.18 to 0.3 OD at 450 nm.) and the anti-TSST-1 IgG titer in Controls more than (0.2 OD at 450 nm.).Also we found that; The anti-TSST-1 IgM titer was negligible (less than 0.01) soon after birth (4-7 days) in all NTED, carriers and controls, but at one month of life, the anti-TSST-1 IgM Ab titer had increased in recovery neonates (from 0.01 - 0.03)the extracted DNA were amplified by PCR analysis of the amplified product by a garose gel electrophoresis for detection the mec A gene MRSA. We found that mec A gene was presented in (53.3 %) neonates had MRSA.Conclusion- NTED was found in Neonatology Unit of Pediatrics Department, Zagazig University Hospital. It represented (31.6 %) from all cases of MRSA (63.3 %) from August 2002 – August 2004.- MRSA was the causative organism of NTED.- Mec A gene was present in most cases had MRSA positive carriers; so Mec A gene was the cause of high level resistance to methicillin.- Anti-TSST-1 Ab?s transferred placentally from the pregnant women to her baby play a role in protecting neonates from developing NTED.Summary and conclusionNeonatal toxic shock syndrome like exanthematous disease (NTED) is a new neonatal disease caused by toxic shock syndrome toxin-1 (TSST-1). It has the following clinical criteria (i) exanthema plus (ii) at least one of the following three signs: thrombocytopenia (low platellat count < 150.000/mm3), a low – positive serum CRP value (positive CRP > 1.0 mg/dL) and fever (rectal temperature of > 38oC)Since 1992; the number of hospitals in Japan in which this disease had been encountered increased from 25.7 % in 1995 to 70.8 % in 1998. subsequently, microbiological examination showed that most of the neonates with this illness were colonized by methicillin-resistant staph-aureus (MRSA) strains that produced TSST-1. also NTED appeared in France in 2002 and Netherlands in 2003. there the apprehension that NTED will become widespread throughout the world.To Study the prevalence of neonatal toxic shock syndrome like exanthematous disease (NTED) in our Neonatology Unit of Pediatric Department, Zagazig University Hospital, identification the causative organism of this disease and the preventation.This study was conducted from August 2002 to August 2004.The study included two groups :(1) Cases:This study included 30 neonates within the first week of life, from which 10 neonates with rash but other 20 neonates without rash. The cases were selected from Neonatology unit of pediatric Department, Zagazig university Hospital .(2) Controls group :Included 15 healthy neonate within The first week of life (except the recovery cases) selected from obstetric unit of obstetric and Gynecology Department, Zagagzig University and from neonates seeking medical Advice at The outpatient clinic of pediatrics, Zagazig university Hospital.Swabs and blood samples were collected from all cases and controls were tested by:• Nasal swabs, bacterial isolation and identification• Conventional blood culture• Mini vital automated system• Vitek• System identification MRSA BBL crystal• Measurement of anti-TSS-1 Ab?s by Elisa• PCRNasal swabs and blood samples were taken from all cases and controls and isolated on blood agar and mannitol salt plates identification of staph. aureus isolates was done by microscopically examination (catalase test, coagulase test and urease test). The results showed that (73.3%) of cases were positive to staph-aureus compared with (6.7%) of controls.Automated blood culture systems as vital system and the vitek system for easily and rapid identification of organism. We found that staph-aureus was the organism isolated from (63.3 % ) of cases but all control were staph-aureus negative.Identification of MRSA isolates was done by BBL crystal MRSA identification system; we found that all cases (63.3 %) of blood culture positive to staph-aureus were MRSA.Our study shown that (63.3 %) of the cases had MRSA from which (31.6 %) were manifested by NTED. measurement of anti-TSST-1Ab?s by ELISA shown that; The anti-TSST-1 IgG titer in NTED were less than (0.2 OD at 450 nm.) the anti-TSST-1 IgG titer in carriers between (0.18 to 0.3 OD at 450 nm.) and the anti-TSST-1 IgG titer in Controls more than (0.2 OD at 450 nm.).Also we found that; The anti-TSST-1 IgM titer was negligible (less than 0.01) soon after birth (4-7 days) in all NTED, carriers and controls, but at one month of life, the anti-TSST-1 IgM Ab titer had increased in recovery neonates (from 0.01 - 0.03)the extracted DNA were amplified by PCR analysis of the amplified product by a garose gel electrophoresis for detection the mec A gene MRSA. We found that mec A gene was presented in (53.3 %) neonates had MRSA.