Staphylococcal scalded skin syndrome - ブドウ球菌性熱傷皮膚症候群
References
Staphylococcal Scalded Skin Syndrome は、特定の種類のブドウ球菌によって生成される毒素によって皮膚が剥がれる状態です。 6歳以上の子供ではまれです。また、免疫力が低下していたり、腎臓に重篤な問題がある成人でも発生する可能性があります。主な特徴は、炎症後の皮膚の広範囲の剥離です。重症度は、数個の水疱から広範囲にわたる皮膚の喪失まで多岐にわたります。これにより、体温の大幅な低下や血圧の不安定が引き起こされることがあります。
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.
生後10か月の男の子が、鼻水を垂らし、食事もうまくいっていない状態で来院しました。医師らは上気道感染症だと述べた。 2日後、彼は症状が改善せず、顔の腫れや口の周りの皮膚の炎症などの新たな問題を抱えて戻ってきた。次の 2 日間で、少年の状態は悪化しました。腕と足が腫れ上がり、皮膚が剥がれ始めました。病院に戻った医師たちは、彼の顔と皮膚のひだに赤い発疹があり、触れると青くなっていることに気づきました。彼らは彼を staphylococcal scalded skin syndrome (SSSS) と診断し、抗生物質の静脈投与を開始しました。
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.
2歳の女の子は、前日に顔を虫に刺されてから48時間以上かけて全身に発疹ができて現れた。検査中、彼女には小さな隆起が合体してできた広範囲の発疹があり、軽くこすると、彼女の皮膚にニコルスキー徴候の兆候が現れました。彼女の粘膜に影響を与える発疹の兆候はありませんでした。彼女の血液検査では感染の兆候は見られませんでした。
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.
この症候群は、黄色ブドウ球菌によって放出される表皮溶解性外毒素 (エクスフォリアチン)A および B によって誘発されます。小児における ブドウ球菌性熱傷皮膚症候群 (staphylococcal scalded skin syndrome) の予後は良好で、治療後 10 日以内に完全に治癒し、重大な瘢痕は残りません。しかし、 ブドウ球菌性熱傷皮膚症候群 (staphylococcal scalded skin syndrome) は、予後不良の中毒性表皮壊死融解症とは注意深く区別する必要があります。
○ 診断と治療
アトピー性皮膚炎などの湿疹病変と誤診され、ステロイド軟膏を塗ると病変が悪化します。抗生物質の軟膏を塗りながら、できるだけ早く医師の診察を受けてください。
#Bacitracin
#First-generation cephalosporins (e.g. Cefradine)
#Bacterial culture
#Third-generation cephalosporins (e.g. Cefditoren Pivoxil)