{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:21:40Z","timestamp":1790727700729,"version":"4.1.0"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,8,18]],"date-time":"2021-08-18T00:00:00Z","timestamp":1629244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K22 AI141582"],"award-info":[{"award-number":["K22 AI141582"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:p>\n                    Staphylococci producing exfoliative toxins are the causative agents of staphylococcal scalded skin syndrome (SSSS). Exfoliative toxin A (ETA) is encoded by\n                    <jats:italic>eta<\/jats:italic>\n                    , which is harbored on a temperate bacteriophage \u03a6ETA. A recent increase in the incidence of SSSS in North America has been observed; yet it is largely unknown whether this is the result of host range expansion of \u03a6ETA or migration and emergence of established lineages. Here, we detail an outbreak investigation of SSSS in a neonatal intensive care unit, for which we applied whole-genome sequencing (WGS) and phylogenetic analysis of\n                    <jats:italic>Staphylococcus aureus<\/jats:italic>\n                    isolates collected from cases and screening of healthcare workers. We identified the causative strain as a methicillin-susceptible\n                    <jats:italic>S. aureus<\/jats:italic>\n                    (MSSA) sequence type 582 (ST582) possessing \u03a6ETA. To then elucidate the global distribution of \u03a6ETA among staphylococci, we used a recently developed tool to query extant bacterial WGS data for biosamples containing\n                    <jats:italic>eta<\/jats:italic>\n                    , which yielded 436 genomes collected between 1994 and 2019 from 32 countries. Applying population genomic analysis, we resolved the global distribution of\n                    <jats:italic>S. aureus<\/jats:italic>\n                    with lysogenized \u03a6ETA and assessed antibiotic resistance determinants as well as the diversity of \u03a6ETA. The population is highly structured with eight dominant sequence clusters (SCs) that generally aligned with\n                    <jats:italic>S. aureus<\/jats:italic>\n                    ST clonal complexes. The most prevalent STs included ST109 (24.3%), ST15 (13.1%), ST121 (10.1%), and ST582 (7.1%). Among strains with available data, there was an even distribution of isolates from carriage and disease. Only the SC containing ST121 had significantly more isolates collected from disease (69%,\n                    <jats:italic>n<\/jats:italic>\n                    = 46) than carriage (31%,\n                    <jats:italic>n<\/jats:italic>\n                    = 21). Further, we identified 10.6% (46\/436) of strains as methicillin-resistant\n                    <jats:italic>S. aureus<\/jats:italic>\n                    (MRSA) based on the presence of\n                    <jats:italic>mecA<\/jats:italic>\n                    and the SCC\n                    <jats:italic>mec<\/jats:italic>\n                    element. Assessment of \u03a6ETA diversity based on nucleotide identity revealed 27 phylogroups, and prophage gene content further resolved 62 clusters. \u03a6ETA was relatively stable within lineages, yet prophage variation is geographically structured. This suggests that the reported increase in incidence is associated with migration and expansion of existing lineages, not the movement of \u03a6ETA to new genomic backgrounds. This revised global view reveals that \u03a6ETA is diverse and is widely distributed on multiple genomic backgrounds whose distribution varies geographically.\n                  <\/jats:p>","DOI":"10.3389\/fmicb.2021.663831","type":"journal-article","created":{"date-parts":[[2021,8,18]],"date-time":"2021-08-18T07:41:11Z","timestamp":1629272471000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":23,"title":["Genomic Epidemiology and Global Population Structure of Exfoliative Toxin A-Producing Staphylococcus aureus Strains Associated With Staphylococcal Scalded Skin Syndrome"],"prefix":"10.3389","volume":"12","author":[{"given":"Taj","family":"Azarian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora","family":"Cella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah L.","family":"Baines","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margot J.","family":"Shumaker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Samel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Jubair","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Pegues","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Z.","family":"David","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,8,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"70","DOI":"10.3390\/v9040070","article-title":"How to name and classify your phage: an informal guide.","volume":"9","author":"Adriaenssens","year":"2017","journal-title":"Viruses"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e00054-15","DOI":"10.1128\/mBio.00054-15","article-title":"Transmission and microevolution of USA300 MRSA in U.S. households: evidence from whole-genome sequencing.","volume":"6","author":"Alam","year":"2015","journal-title":"mBio"},{"key":"B3","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1001\/archpedi.1972.02110130043006","article-title":"Nursery outbreak of staphylococcal scalded skin syndrome: rapid identification of the epidemic bacterial strain.","volume":"124","author":"Anthony","year":"1972","journal-title":"Am. 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