Molecular investigation of Tsst, Eta, and Etb Genes in Staphylococcus aureus isolated from impetigo patients among children in Al-Diwaniyah city, Iraq

Document Type : Research Paper

Authors

1 Department of Pathological Analysis, College of Science, University of Al-Qadisiyah, Iraq

2 Department of Biology, College of Education, University of Al-Qadisiyah, Iraq

10.22103/jab.2025.25015.1682

Abstract

Objective
Staphylococcus aureus is a versatile and opportunistic pathogen responsible for a broad spectrum of human diseases ranging from superficial skin infections to life-threatening systemic situations. Among its many clinical manifestations, impetigo a contagious skin infection primarily affecting children is commonly related with S. aureus as a principal causative agent. The prevalence of S. aureus in skin and soft tissue infections has become a growing public health concern, especially in pediatric populations and in regions with restricted access to advanced healthcare resources. The current investigation aimed to investigate the molecular presence of the tsst, eta, and etb genes in S. aureus isolates achieved from children diagnosed with impetigo in Al-Diwaniyah City,. By combining 16S rRNA gene amplification with virulence gene profiling, this research contributes to a deeper understanding of the molecular epidemiology and pathogenic traits of S. aureus in a vulnerable patient population.

Materials and methods
This investigation was managed on clinical isolates achieved from children diagnosed with impetigo and attending dermatology clinics in Al-Diwaniyah City, Iraq. Totally 21 swab samples were gathered from infected skin lesions applying sterile cotton swabs. Genomic DNA was extracted from affirmed S. aureus isolates. To affirm the identity of the isolates, PCR was carried out targeting the 16S rRNA gene. The presence of tsst, eta, and etb genes was identified by conventional PCR applying gene-specific primers.
Results
All Staphylococcus aureus isolates demonstrated a distinct 1,500 bp band upon PCR amplification of the 16S rRNA gene, affirming successful amplification of the target gene. This result also indicated the high quality of the extracted bacterial DNA and the specificity of the primers applied. The conserved nature of the 16S rRNA gene reinforces its reliability as a molecular marker for bacterial identification. In addition, the presence of exfoliative toxin genes (eta, etb, and tsst-1) was evaluated applying PCR. Each gene generated a distinct amplification pattern. Among the 21 clinical isolates, 11 were positive for the tsst-1 gene. The eta and etb genes were also detected but in varying frequencies, suggesting differential distribution of these virulence factors among the isolates.

Conclusions
This investigation highlights the molecular presence of key virulence genes (tsst-1, eta, and etb) in Staphylococcus aureus isolates from impetigo cases in children. The detection of these toxin genes, particularly the high prevalence of tsst-1, underscores the pathogenic potential of circulating strains and reinforces the importance of molecular screening in clinical diagnostics and infection control strategies.

Keywords


Ahmad-Mansour, N., Loubet, P., Pouget, C., Dunyach-Remy, C., Sotto, A., Lavigne, J. P., & Molle, V. (2021). Staphylococcus aureus toxins: an update on their pathogenic properties and potential treatments. Toxins13(10), 677. https://doi.org/10.3390/toxins13100677 
Al-Bukhalifa, M. A., & Al-Tameemi, H. M. (2024). First whole genome sequencing of Staphylococcus aureus isolates from Iraq: Insights into zoonotic relations and biofilm-related genes. Open Veterinary Journal 14(12), 3269-3288. https://doi.org/10.5455/OVJ.2024.v14.i12.12.
Alfeky, A. E., Tawfick, M. M., Ashour, M. S., & El-Moghazy, A. A. (2022). High prevalence of multi-drug resistant methicillin-resistant Staphylococcus aureus in tertiary Egyptian hospitals. Journal of Infection and Public Health, 16(5), 795-806. https://doi.org/10.3855/jidc.15833 
Al-Kahfaji, M. H. A. M. (2022). Human skin infection: A review study. Biomedicine and Chemical Sciences, 1(4), 254-258. https://doi.org/10.48112/bcs.v1i4.259
AlMosawi, R., Jasim, H. A., & Haddad, A. (2024). Identification of S. aureus by specific 16S rRNA and detection of mecA gene from clinical samples in patients of Basrah governorate in Iraq. Access Microbiology, 000848-v1. https://doi.org/10.1099/acmi.0.000848.v1
Alsanie, W. F., Felemban, E. M., Farid, M. A., Hassan, M. M., Sabry, A., & Gaber, A. (2018). Molecular identification and phylogenetic analysis of multidrug-resistant bacteria applying 16S rDNA sequencing. Journal of Pure and Applied Microbiology, 12(2), 489–496. https://doi.org/10.22207/JPAM.12.2.07
Bazghandi, S. A., Arzanlou, M., Peeridogaheh, H., Vaez, H., Sahebkar, A., & Khademi, F. (2021). Prevalence of virulence genes and drug resistance profiles of Pseudomonas aeruginosa isolated from clinical specimens. Jundishapur Journal of Microbiology, 14(8), e118452. https://doi.org/10.5812/jjm.118452
Becker, K., Roth, R., & Peters, G. (1998). Rapid and specific detection of toxigenic Staphylococcus aureus: Applying two multiplex PCR enzyme immunoassays for amplification and hybridization of staphylococcal enterotoxin genes, exfoliative toxin genes, and toxic shock syndrome toxin 1 gene. Journal of Clinical Microbiology, 36(9), 2548-2553. https://doi.org/10.1128/JCM.36.9.2548-2553.1998
Brazel, M., Desai, A., Are, A., & Motaparthi, K. (2021). Staphylococcal scalded skin syndrome and bullous impetigo. Medicina (Kaunas), 57(11), 1157. https://doi.org/10.3390/medicina57111157
Brosnahan, A. J., & Schlievert, P. M. (2011). Gram-positive bacterial superantigen outside-in signaling causes toxic shock syndrome. FEBS Journal, 278(23), 4649–4667. https://doi.org/10.1111/j.1742-4658.2011.08151.x
Camaione, S. (2025). Biochemical characterization of a novel staphylococcal protein A (SpA) interaction with human fibronectin (Fn) and its role in Fn-dependent bacterial adhesion to host cells. IRIS Institutional Research Information System - AIR Institutional Research Archive. https://hdl.handle.net/11571/1518016
Chen, H., Zhang, J., He, Y., Lv, Z., Liang, Z., Chen, J., Li, P., Liu, J., Yang, H., Tao, A., & Liu, X. (2022). Exploring the role of Staphylococcus aureus in inflammatory diseases. Toxins (Basel), 14(7), 464. https://doi.org/10.3390/toxins14070464
Del Barrio-Tofiño, E., López-Causapé, C., & Oliver, A. (2020). Pseudomonas aeruginosa epidemic high-risk clones and their association with horizontally-acquired β-lactamases: 2020 update. International Journal of Antimicrobial Agents, 56(6), 106196. https://doi.org/10.1016/j.ijantimicag.2020.106196 
Díaz-Formoso, L., Silva, V., Contente, D., Feito, J., Hernández, P. E., Borrero, J., Igrejas, G., Del Campo, R., Muñoz-Atienza, E., Poeta, P., & Cintas, L. M. (2023). Antibiotic resistance genes, virulence factors, and biofilm formation in coagulase-negative Staphylococcus spp. isolates from European hakes (Merluccius merluccius, L.) caught in the Northeast Atlantic Ocean. Pathogens, 12(12), 1447. https://doi.org/10.3390/pathogens12121447
Gumaa, M. A., Idris, A. B., Bilal, N. E., & Hassan, M. A. (2021). First insights into molecular basis identification of 16S ribosomal RNA gene of Staphylococcus aureus isolated from Sudan. BMC Research Notes, 14(1), 240. https://doi.org/10.1186/s13104-021-05569-w 
Hajalizadeh, Z., Dayani, O., Khezri, A., Tahmasbi, R., Mohammadabadi, M., Solodka, T., Kalashnyk, O., Afanasenko, V., & Babenko, O. (2021). Expression of calpastatin gene in Kermani sheep using real-time PCR. Journal of Livestock Science and Technologies, 9(2), 51-57. https://doi.org/10.22103/jlst.2021.18165.1381
Kadhum, H. H., & Abood, Z. H. (2022). Staphylococcus aureus incidence in some patients with atopic dermatitis in Baghdad City. Iraqi Journal of Biotechnology, 21(2), 13–20. https://jige.uobaghdad.edu.iq/index.php/IJB/article/view/472
Kot, B., Piechota, M., Jakubczak, A., Gryzińska, M., Witeska, M., Grużewska, A., Baran, K., & Denkiewicz, P. (2022). The prevalence of virulence determinants in methicillin-resistant Staphylococcus aureus isolated from different infections in hospitalized patients in Poland. Scientific Reports12(1), 5477. https://doi.org/10.1038/s41598-022-09517-x
Medugu, N., Imran, J., Musa-Booth, T. O., Makun, B., & Adegboro, B. (2023). A review of staphylococcal scalded skin syndrome. African Journal of Clinical and Experimental Microbiology, 24(3), 235–242. https://doi.org/10.4314/ajcem.v24i3.2
Mehrotra, M., Wang, G., & Johnson, W. M. (2000). Multiplex PCR for detection of genes for Staphylococcus aureus enterotoxins, exfoliative toxins, toxic shock syndrome toxin 1, and methicillin resistance. Journal of Clinical Microbiology, 38(3), 1032–1035. https://doi.org/10.1128/JCM.38.3.1032-1035.2000
Merriman, J. A., Mueller, E. A., Cahill, M. P., Beck, L. A., Paller, A. S., Hanifin, J. M., Ong, P. Y., Schneider, L., Babineau, D. C., David, G., Lockhart, A., Artis, K., Leung, D. Y., & Schlievert, P. M. (2016). Temporal and racial differences associated with atopic dermatitis Staphylococcus aureus and encoded virulence factors. mSphere, 1(6), e00295-16. https://doi.org/10.1128/mSphere.00295-16 
Mohammadabadi, M. (2016). Inter-simple sequence repeat loci associations with predicted breeding values of body weight in kermani sheep. Genetics in the Third Millennium, 14(4), 4386-4393. https://sciexplore.ir/Documents/Details/472-591-539-924
Mohammadabadi, M., & Asadollahpour Nanaei, H. (2021). Leptin gene expression in Raini Cashmere goat using Real Time PCR. Agricultural Biotechnology Journal, 13(1), 197-214. https://doi.org/10.22103/jab.2021.17334.1305
Mohammadabadi, M., Akhtarpoor, A., Khezri, A., Babenko, O., Stavetska, R. V., Tytarenko, I., Ievstafiieva, Y., Buchkovska, V., Slynko, V., & Afanasenko, V. (2024a). The role and diverse applications of machine learning in genetics, breeding, and biotechnology of livestock and poultry. Agricultural Biotechnology Journal, 16(4), 413-442. https://doi.org/10.22103/jab.2025.24662.1644 
Mohammadabadi, M., Babenko Ivanivna, O., Borshch, O., Kalashnyk, O., Ievstafiieva, Y., & Buchkovska, V. (2024c). Measuring the relative expression pattern of the UCP2 gene in different tissues of the Raini Cashmere goat. Agricultural Biotechnology Journal, 16(3), 317-332. https://doi.org/10.22103/jab.2024.24337.1627
Mohammadabadi, M., Kheyrodin, H., Afanasenko, V., Babenko Ivanivna, O., Klopenko, N., Kalashnyk, O., Ievstafiieva, Y., & Buchkovska, V. (2024b). The role of artificial intelligence in genomics. Agricultural Biotechnology Journal, 16(2), 195-279. https://doi.org/10.22103/jab.2024.23558.1575
Mohammadinejad, F., Mohammadabadi, M., Roudbari, Z., & Sadkowski, T. (2022). Identification of Key Genes and Biological Pathways Associated with Skeletal Muscle Maturation and Hypertrophy in Bos taurus, Ovis aries, and Sus scrofa. Animals, 12(24), 3471. https://doi.org/10.3390/ani12243471
Mohseni, M., Rafiei, F., & Ghaemi, E. A. (2018). High frequency of exfoliative toxin genes among Staphylococcus aureus isolated from clinical specimens in the north of Iran: Alarm for the health of individuals under risk. Iranian Journal of Microbiology, 10(3), 158–165. https://pubmed.ncbi.nlm.nih.gov/30112153/ 
Mousavizadeh, A., Mohammad Abadi, M., Torabi, A., Nassiry, M. R., Ghiasi, H., & Esmailizadeh Koshkoieh, A. (2009). Genetic Polymorphism at the Growth Hormone Locus in Iranian Talli Goats by Polymerase Chain Reaction-Single Strand Conformation Polymorphism (PCR-SSCP). Iranian Journal of Biotechnology, 7(1), 51-53. https://www.ijbiotech.com/article_7064.html
Muhammad, J. A., Alzubaidi, A. F. A., Idris, K. A. H. M., & Kehail, M. A. (2024). S. aureus Colonization in Atopic Dermatitis Raises Global Concern. Academia Open, 9(2), 10-21070. https://doi.org/10.21070/acopen.9.2024.9150
Neamah, M. M. (2024). Prevalence of Exfoliative Toxin Genes (eta and etb) in Staphylococcus aureus Isolates from Tonsillitis, Wound, and Urinary Tract Infections in Iraq. Journal of Current Medical Research and Opinion, 7(11), 3724-3728. https://doi.org/10.52845/CMRO/2024/7-11-4
Omar, N. N., & Mohammed, R. K. (2021). A molecular study of toxic shock syndrome toxin gene (tsst-1) in β-lactam resistant Staphylococcus aureus clinical isolates. Iraqi Journal of Science, 62(3), 825–837. https://doi.org/10.24996/ijs.2021.62.3.13
Schmitt, T., Huber, J., Pircher, J., Schmidt, E., & Waschke, J. (2025). The impact of signaling pathways on the desmosome ultrastructure in pemphigus. Frontiers in Immunology, 15, 1497241. https://doi.org/10.3389/fimmu.2024.1497241
Shahsavari, M., Mohammadabadi, M., Khezri, A., Asadi Fozi, M., Babenko, O., Kalashnyk, O., Oleshko, V., & Tkachenko, S. (2023). Correlation between insulin-like growth factor 1 gene expression and fennel (Foeniculum vulgare) seed powder consumption in muscle of sheep. Animal Biotechnology, 34(4), 882–892. https://doi.org/10.1080/10495398.2021.2000997
Srivastava, S., Singh, V., Kumar, V., Verma, P. C., Srivastava, R., Basu, V., Gupta, V., & Rawat, A. K. (2008). Identification of regulatory elements in 16S rRNA gene of Acinetobacter species isolated from water sample. Bioinformation, 3(4), 173–176. https://doi.org/10.6026/97320630003173 
Sulimova, G. E., Azari, M. A., Rostamzadeh, J., Mohammad Abadi M.R., & Lazebny O.E. (2007). κ-casein gene (CSN3) allelic polymorphism in Russian cattle breeds and its information value as a genetic marker. Russian Journal of Genetics 43, 73–79. https://doi.org/10.1134/S1022795407010115
Taher, F. S., & Othman, H. E. (2024). Molecular identification and genotyping of methicillin-resistant staphylococcus aureus (mrsa) in different clinical samples. Science Journal of University of Zakho12(2), 159-168. https://doi.org/10.25271/sjuoz.2024.12.2.1276
Tam, K., & Torres, V. J. (2019). Staphylococcus aureus secreted toxins and extracellular enzymes. Microbiology Spectrum, 7(2), eGPP3-0039-2018. https://doi.org/10.1128/microbiolspec.GPP3-0039-2018
Yassin, H. Y., Melconian, A. K., & Mahmood, S. S. (2022). Prevalence of exfoliative toxin genes among clinical isolates of Staphylococcus aureus in Iraq. Iraqi Journal of Agricultural Sciences, 53(2), 465–470. https://doi.org/10.36103/ijas.v53i2.1554
Zhao, H., Xu, S., Yang, H., He, C., Xu, X., Hu, F., Shu, W., Gong, F., Zhang, C., & Liu, Q. (2019). Molecular typing and variations in amount of tst gene expression of TSST-1-producing clinical Staphylococcus aureus isolates. Frontiers in Microbiology, 10, 1388. https://doi.org/10.3389/fmicb.2019.01388