Staphylococcal scalded skin syndrome - Stafylokokový Syndrom Opařené Kůže
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Dítě s Stafylokokový Syndrom Opařené Kůže (Staphylococcal scalded skin syndrome)
References
Staphylococcal Scalded Skin Syndrome je stav, kdy se kůže odlupuje kvůli toxinům produkovaným určitými typy bakterií Staphylococcus. U dětí starších šesti let je to neobvyklé. Může se také objevit u dospělých s oslabeným imunitním systémem nebo vážnými problémy s ledvinami. Hlavním rysem je rozsáhlé olupování kůže po zánětu. Závažnost se pohybuje od několika puchýřů až po rozsáhlé ztráty kůže, které mohou způsobit vážné poklesy tělesné teploty a nestabilitu krevního tlaku.
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.
Přišel 10měsíční chlapec s rýmou a špatně jedl. Lékaři řekli, že jde o infekci horních cest dýchacích. O dva dny později se vrátil, protože se nezlepšil a měl nové problémy, jako je oteklý obličej a podrážděná kůže kolem úst. Během následujících dvou dnů se chlapec zhoršil. Otekly mu ruce a nohy a začala se mu odlupovat kůže. V nemocnici si lékaři všimli červené vyrážky na jeho obličeji a v záhybech kůže, která při dotyku zbledla. Diagnostikovali mu staphylococcal scalded skin syndrome (SSSS) a nasadili mu antibiotika do žíly.
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.
Dvouletá dívka se objevila s vyrážkou po celém těle, která se vyvinula během 48 hodin po bodnutí hmyzem na její tváři den předtím. Při vyšetření měla rozsáhlou vyrážku tvořenou malými hrbolky, které splývaly a při lehkém roztírání její kůže vykazovala známky Nikolského znamení. Nebyly žádné známky toho, že by vyrážka postihovala její sliznice. Testy její krve neukázaly žádné známky infekce.
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.
Syndrom je vyvolán epidermolytickými exotoxiny (exfoliatin) A a B, které uvolňuje S. aureus. Prognóza stafylokokový syndrom opařené kůže (staphylococcal scalded skin syndrome) u dětí je vynikající, s úplným ústupem do 10 dnů léčby a bez výrazných jizev. Nicméně stafylokokový syndrom opařené kůže (staphylococcal scalded skin syndrome) musí být pečlivě odlišen od toxické epidermální nekrolýzy, která má špatnou prognózu.
○ Diagnostika a léčba
Špatná diagnóza jako ekzémové léze, jako je atopická dermatitida, a aplikace steroidní masti léze zhorší. Při aplikaci antibiotické masti vyhledejte co nejdříve lékařskou pomoc.
#Bacitracin
#First-generation cephalosporins (e.g. Cefradine)
#Bacterial culture
#Third-generation cephalosporins (e.g. Cefditoren Pivoxil)