Staphylococcal scalded skin syndrome - Síndrome De Pell Escaldada Estafilocòcica
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Un nadó amb Síndrome De Pell Escaldada Estafilocòcica (Staphylococcal scalded skin syndrome)
References
Staphylococcal Scalded Skin Syndrome és una condició on la pell es desprèn a causa de les toxines produïdes per certs tipus de bacteris estafilococs. És poc freqüent en nens de més de sis anys. També pot ocórrer en adults amb sistemes immunològics debilitats o problemes renals greus. La característica principal és la descamació extensa de la pell després de la inflamació. La gravetat oscil·la des d'unes poques butllofes fins a una pèrdua generalitzada de la pell, que pot provocar caigudes greus de la temperatura corporal i inestabilitat de la pressió arterial.
Staphylococcal Scalded Skin Syndrome is a disease characterized by denudation of the skin caused by exotoxin producing strains of the Staphylococcus species, typically from a distant site. It usually presents 48 hours after birth and is rare in children older than six years. It may also present in immunocompromised adults or those with severe renal disease. The disorder is characterized by significant exfoliation of skin following cellulitis. The severity may vary from a few blisters to system exfoliation leading to marked hypothermia and hemodynamic instability.
Staphylococcal Scalded Skin Syndrome is a disease characterized by denudation of the skin caused by exotoxin producing strains of the Staphylococcus species, typically from a distant site. It usually presents 48 hours after birth and is rare in children older than six years. It may also present in immunocompromised adults or those with severe renal disease. The disorder is characterized by significant exfoliation of skin following cellulitis. The severity may vary from a few blisters to system exfoliation leading to marked hypothermia and hemodynamic instability.
Staphylococcal scalded skin syndrome (SSSS) and bullous impetigo are infections caused by Staphylococcus aureus. Bullous impetigo is due to the local release of these toxins and thus, often presents with localized skin findings, whereas SSSS is from the systemic spread of these toxins, resulting in a more generalized rash and severe presentation. Both conditions are treated with antibiotics that target S. aureus. These conditions can sometimes be confused with other conditions that result in superficial blistering.
Va entrar un nen de 10 mesos amb secreció nasal i no menjava bé. Els metges van dir que era una infecció respiratòria superior. Dos dies després, va tornar perquè no millorava i tenia nous problemes com la cara inflada i la pell irritada al voltant de la boca. Durant els dos dies següents, el nen va empitjorar. Els seus braços i cames es van inflar i se li va començar a desprendre la pell. De tornada a l'hospital, els metges van notar una erupció vermella a la cara i als plecs de la seva pell, que es va blanquejar quan es va tocar. Li van diagnosticar staphylococcal scalded skin syndrome (SSSS) i li van començar amb antibiòtics per vena.
A 10-month-old male presented with rhinorrhea and decreased oral intake and was diagnosed with an upper respiratory infection. Two days later, he returned to the clinic due to a lack of improvement and the onset of new symptoms, including facial edema and perioral skin irritation. That evening, he became febrile at 100.4 °F and went to the emergency department at the local children's hospital. No further workup was done and the parents were instructed to continue with the current treatment regimen. Over the next 48 hours, the patient's symptoms worsened with the new onset of bilateral extremity edema and desquamation. The patient was returned to the emergency department. A physical exam was notable for a blanching, desquamating, erythematous rash on the face and creases of the arms, legs, and groin. A positive Nikolsky sign was reported. A clinical diagnosis of staphylococcal scalded skin syndrome (SSSS) was made, and the patient was started on intravenous clindamycin. This case illustrates a severe presentation of SSSS in a pediatric patient, demonstrating the challenges it poses to diagnosis and treatment.
A 10-month-old male presented with rhinorrhea and decreased oral intake and was diagnosed with an upper respiratory infection. Two days later, he returned to the clinic due to a lack of improvement and the onset of new symptoms, including facial edema and perioral skin irritation. That evening, he became febrile at 100.4 °F and went to the emergency department at the local children's hospital. No further workup was done and the parents were instructed to continue with the current treatment regimen. Over the next 48 hours, the patient's symptoms worsened with the new onset of bilateral extremity edema and desquamation. The patient was returned to the emergency department. A physical exam was notable for a blanching, desquamating, erythematous rash on the face and creases of the arms, legs, and groin. A positive Nikolsky sign was reported. A clinical diagnosis of staphylococcal scalded skin syndrome (SSSS) was made, and the patient was started on intravenous clindamycin. This case illustrates a severe presentation of SSSS in a pediatric patient, demonstrating the challenges it poses to diagnosis and treatment.
Una nena de 2 anys va aparèixer amb una erupció a tot el cos que s'havia desenvolupat durant 48 hores, després de picades d'insectes a la cara el dia anterior. Durant l'examen, va tenir una erupció generalitzada formada per petites protuberàncies que es van fusionar i, quan es va fregar lleugerament, la seva pell mostrava signes del signe de Nikolsky. No hi havia signes de l'erupció que afectés les seves mucoses. Les proves a la seva sang no van mostrar cap signe d'infecció.
A 2-year-old girl presented a generalised rash with 48 h of evolution, in the context of insect bites on the face on the day before. At observation, she had a generalised micropapular rash with confluent areas and Nikolsky sign. There was no mucosal area affected. Blood cultures were negative.
A 2-year-old girl presented a generalised rash with 48 h of evolution, in the context of insect bites on the face on the day before. At observation, she had a generalised micropapular rash with confluent areas and Nikolsky sign. There was no mucosal area affected. Blood cultures were negative.
La síndrome és induïda per les exotoxines epidermolíticas (exfoliatina) A i B, que són alliberades per S. aureus. El pronòstic de la síndrome de pell escaldada estafilocòcica (staphylococcal scalded skin syndrome) en nens és excel·lent, amb resolució completa als 10 dies de tractament i sense cicatrius importants. Tanmateix, la síndrome de pell escaldada estafilocòcica (staphylococcal scalded skin syndrome) s'ha de diferenciar amb cura de la necròlisi epidèrmica tòxica, que té un pronòstic dolent.
○ Diagnòstic i tractament
El diagnòstic errònia com lesions d'èczema com la dermatitis atòpica i l'aplicació d'ungüents esteroides agreugen les lesions. Busqueu atenció mèdica tan aviat com sigui possible mentre apliqueu pomada antibiòtica.
#Bacitracin
#First-generation cephalosporins (e.g. Cefradine)
#Bacterial culture
#Third-generation cephalosporins (e.g. Cefditoren Pivoxil)