Staphylococcus aureus (Staph), a common microbe found on human skin and mucus membranes, can become pathogenic under the right conditions, infecting the body and causing many diseases. Staphylococcal bacteria spread easily between people through direct contact, especially people with poor hygiene, or by touching contaminated objects such as clothing and bed sheets. Infants, children, the elderly, and the immunocompromised are especially susceptible to Staph infections due to their weaker immune systems.
Staph produces a variety of toxins and enzymes that make it a highly virulent pathogen. It can cause infection by entering the body through wounds, cuts, and surgical incisions, by entering around splinters, sutures and catheters, or even through ingestion of contaminated food. Once infection sets in, the patient will usually require antibiotics, and in more serious cases, hospitalization or even surgery. This common microbe can cause the following ten diseases.
Endocarditis is a disease that can be fatal if not treated immediately. It occurs when Staph enters the bloodstream and makes its way to the heart valves and then to the inner lining of the heart (the endocardium). Initial symptoms are flu-like, including fatigue, fever, coughing, and muscle pain, but the disease rapidly gets worse, leading to problems with cardiac output, septic embolism, and heart failure. Endocarditis is most common in people with a damaged or diseased heart valve, artificial heart valves, congenital heart defects, or illegal IV drug use. The outcome is poor unless the patient receives medical treatment immediately. Endocarditis has a mortality rate of almost 50%, and heart valve replacement can be necessary in extreme cases.
2 Staphylococcal Scalded Skin Syndrome (SSSS)
Most commonly seen in infants and children under age 5, SSSS usually starts off as redness, inflammation, and crusting on one area of the skin that spreads over the body within a few days. Fluid-filled blisters form which cause the skin to break easily. After that, the skin will peel and slough off, sometimes in large sheets. The affected areas will appear burned or scalded, which is how the disease gets its name. A toxin released by the bacteria causes this damage by breaking apart adjoining cells in the outer layer of the skin.
3 Staphylococcal Food Poisoning
Staphylococcal food poisoning occurs when Staph enters food left out at room temperature. The bacteria can pass into the food by a sneeze or an unwashed hand, or by contact with unpasteurized dairy products. Staph releases a heat-stable toxin into the food that can remain in the food even if it is reheated. Ham, salted or pulled pork, potato salad and ice cream are some of the most commonly contaminated foods.*
Symptoms will usually show about 30 minutes to four hours after eating, and will include vomiting, nausea, and diarrhea. Fortunately, this disease runs its course after about 24 hours, so symptoms should only last about 1 day.
A recent case of Staphylococcal Food Poisoning happened in Lake City, Florida where approximately 30 students at a science olympiad were hospitalized after eating contaminated pulled pork for lunch. Read the full article here.
Impetigo is a skin infection most often seen in infants and young children. It usually affects the mouth, nose, hands and feet. Starting off as a simple red bump, the infected area quickly fills with pus and ruptures easily. After it ruptures, a yellowish-brown scab-like crust will form over the sore. Impetigo is itchy and sometimes painful. It is highly contagious and easily passed between children at school and in other crowded conditions.
In 2014, the British Journal of Medicine reported a case of a newborn baby born with impetigo. The baby, delivered via C-section to a mother with gestational diabetes, was born with red, peeling, and painful skin, as well as difficulty breathing. Read the case report with pictures here.
Folliculitis occurs when Staph infects the hair follicles causing pain, irritation and itching. The follicle becomes inflamed, red, and filled with pus. When this happens at the base of the eyelid, it forms a sty. In severe cases, it can even lead to permanent hair loss and scarring.
A rare form of this disease called Tufted Hair Folliculitis causes multiple hairs to grow from the same follicle, in addition to hair loss and scarring. Read a personal account from a patient who suffers from this condition here.
6 Furuncles and Carbuncles
Like folliculitis, furuncles are large and painful nodules that contain necrotic tissue around a hair follicle. In 2010, the Journal of Medical Case Reports described an extreme case in which a furuncle led to penile lymphedema. The patient received a skin graft to correct the problem. Read the full article with pictures here.
When furuncles extend further into the skin, they become carbuncles. Carbuncles are usually found on the back and neck and are highly contagious. They grow very fast and fill with pus which can leak and crust. They can grow up to the size of a golf ball if not treated immediately.
7 Pneumonia and Empyema
Staphylococcal pneumonia affects the respiratory system either through inhalation of oral secretions containing the bacteria, or by spread of the bacteria to the lungs from another site in the body. X-rays will often show abscesses which form when the body is trying to fight off the infection.* If the infection spreads beyond the lungs, pus builds up in the chest and puts pressure on the lungs causing a condition called Empyema. This disease causes chest pain, coughing and shortness of breath. In extreme cases, the necessary treatment is to put a tube in the chest to drain the infected fluid out of the body.
Osteomyelitis commonly starts in the skin after an injury occurs, and the bacteria spreads into the bone. In children, it usually affects the long bones, such as the femur, while in adults, it usually affects the vertebrae, causing back pain and fever. It usually takes 2-3 weeks for it to show up on X-rays in the form of an abscess.
In 2014, a case occurred in a 5-year old boy who had pain and swelling in both legs. Exams showed that he had discharge coming from the tibial bones in his legs, as well as destruction of the outer bone layer, and edema in the bone marrow. Read the full case report here.
9 Septic Arthritis
Septic Arthritis usually occurs when Staph enters the shoulder, hip, knee, or elbow joint either after an infection spreading from another part of the body, or after an injection into the joint. The synovium surrounding the joints does not offer much protection from infection and injury, and can easily become inflamed and reduce blood flow to the area. The joint will become very painful, and will usually require aspiration to remove the infected fluid.
In 2016, oral surgeons in Korea reported a rare case of septic arthritis in the temporomandibular joint (TMJ). A 52-year old man complained of jaw pain, swelling, and difficulty opening his mouth and chewing. Surgeons performed arthrocentesis to clean the infection out of the joint. Read the case report here.
10 Toxic Shock Syndrome (TSS)
TSS was first seen in Australia in 1928 when twelve children died from a vaccine that had been contaminated with Staph.* It showed up again in 1980 when women contracted the disease while on their periods. The bacteria could multiply in highly absorbent tampons and release a heat-resistant toxin. Although the bacteria itself remained in the vagina, the toxin could spread through the body causing the body to go into shock and induce organ failure. Eventually the tampons were recalled, and incidence of the disease has decreased drastically since then.
Although incidence of tampon-associated TSS has decreased overall, cases still do occur. In 2015, a case occurred in Australia where a 15-year old girl was hospitalized for over a month after she had left a tampon in for 24 hours. Upon removal, the contaminated tampon was covered in green mucous and discharge. Read the case report here.
In addition to the genitals, TSS can manifest in other parts of the body as well. Another case happened in Kuwait in 2015. This time the patient was a 9-year old boy with an injury to his left ankle. Doctors at the hospital removed 12 milliliters of pus from the heel of his foot. Read the case report here.
* From: Murray, P. R., Rosenthal, K. S., & Pfaller, M. A. (2009). Staphylococcus and Related Gram-Positive Cocci. In Medical Microbiology, 6th ed. (211-220). Philadelphia, PA: Mosby-Elsevier.