Staphylococcal scalded skin syndrome
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Uma criança com Staphylococcal scalded skin syndrome
References
Staphylococcal Scalded Skin Syndrome é uma condição em que a pele se desprende devido a toxinas produzidas por certos tipos de bactérias Staphylococcus. É incomum em crianças com mais de seis anos. Também pode ocorrer em adultos com sistema imunológico enfraquecido ou problemas renais graves. A principal característica é a descamação extensa da pele após inflamação. A gravidade varia de algumas bolhas até perda generalizada de pele, o que pode causar quedas severas na temperatura corporal e instabilidade na pressão 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.
Um menino de 10 meses chegou com o nariz escorrendo e não se alimentando bem. Os médicos disseram que era uma infecção respiratória superior. Dois dias depois, ele voltou porque não estava melhorando e tinha novos problemas como rosto inchado e pele irritada ao redor da boca. Nos dois dias seguintes, o menino piorou. Seus braços e pernas incharam e sua pele começou a sair. De volta ao hospital, os médicos notaram uma erupção vermelha no rosto e nas dobras da pele, que empalidecia ao toque. Eles o diagnosticaram com staphylococcal scalded skin syndrome (SSSS) e começaram a tomar antibióticos através de uma veia.
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.
Uma menina de 2 anos apareceu com uma erupção cutânea em todo o corpo que se desenvolveu ao longo de 48 horas, após picadas de insetos no rosto no dia anterior. Durante o exame, ela apresentou uma erupção cutânea generalizada composta por pequenas protuberâncias que se fundiam e, quando esfregada levemente, sua pele apresentava sinais do sinal de Nikolsky. Não havia sinais de erupção cutânea afetando suas membranas mucosas. Os exames de sangue dela não mostraram sinais de infecção.
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.
A síndrome é induzida por exotoxinas epidermolíticas (esfoliatina) A e B, que são liberadas pelo S. aureus. O prognóstico da staphylococcal scalded skin syndrome em crianças é excelente, com resolução completa em 10 dias de tratamento e sem cicatrizes significativas. Contudo, a staphylococcal scalded skin syndrome deve ser cuidadosamente diferenciada da necrólise epidérmica tóxica, que acarreta um mau prognóstico.
○ Diagnóstico e Tratamento
O diagnóstico incorreto de lesões de eczema, como dermatite atópica, e a aplicação de pomada esteróide exacerbam as lesões. Procure atendimento médico o mais rápido possível ao aplicar a pomada antibiótica.
#Bacitracin
#First-generation cephalosporins (e.g. Cefradine)
#Bacterial culture
#Third-generation cephalosporins (e.g. Cefditoren Pivoxil)