Staphylococcal scalded skin syndrome - Stafylokokový Syndróm Obarenej Kože
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Dieťa s Stafylokokový Syndróm Obarenej Kože (Staphylococcal scalded skin syndrome)
References
Staphylococcal Scalded Skin Syndrome je stav, pri ktorom sa koža odlupuje v dôsledku toxínov produkovaných určitými typmi baktérií Staphylococcus. U detí starších ako šesť rokov je to nezvyčajné. Môže sa vyskytnúť aj u dospelých s oslabeným imunitným systémom alebo vážnymi problémami s obličkami. Hlavným znakom je rozsiahle olupovanie kože po zápale. Závažnosť sa pohybuje od niekoľkých pľuzgierov až po rozsiahlu stratu kože, ktorá môže spôsobiť vážne poklesy telesnej teploty a nestabilitu krvného 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.
10-mesačný chlapček prišiel s nádchou a zle sa najedol. Podľa lekárov ide o zápal horných dýchacích ciest. O dva dni neskôr sa vrátil, pretože sa nezlepšoval a mal nové problémy, ako je opuchnutá tvár a podráždená pokožka okolo úst. Počas nasledujúcich dvoch dní sa chlapec zhoršil. Ruky a nohy mu opuchli a koža sa mu začala sťahovať. Ešte v nemocnici si lekári všimli červenú vyrážku na tvári a v záhyboch kože, ktorá pri dotyku zbledla. Diagnostikovali mu staphylococcal scalded skin syndrome (SSSS) a nasadili mu antibiotiká cez žilu.
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-ročné dievčatko sa objavilo s vyrážkou po celom tele, ktorá sa vyvinula počas 48 hodín po bodnutí hmyzom na jej tvári deň predtým. Počas vyšetrenia mala rozsiahlu vyrážku zloženú z malých hrbolčekov, ktoré spolu splývali a pri jemnom trení jej koža vykazovala znaky Nikolského znamienka. Nevyskytli sa žiadne známky toho, že by jej vyrážka postihla sliznice. Testy jej krvi nepreukázali žiadne známky infekcie.
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.
Syndróm je vyvolaný epidermolytickými exotoxínmi (exfoliatín) A a B, ktoré uvoľňuje S. aureus. Prognóza stafylokokový syndróm obarenej kože (staphylococcal scalded skin syndrome) u detí je výborná, s úplným vymiznutím do 10 dní od liečby a bez výrazných jaziev. Avšak stafylokokový syndróm obarenej kože (staphylococcal scalded skin syndrome) sa musí starostlivo odlíšiť od toxickej epidermálnej nekrolýzy, ktorá má zlú prognózu.
○ Diagnostika a liečba
Nesprávna diagnóza ako ekzémové lézie, ako je atopická dermatitída, a aplikácia steroidnej masti zhoršuje lézie. Počas aplikácie antibiotickej masti vyhľadajte čo najskôr lekársku pomoc.
#Bacitracin
#First-generation cephalosporins (e.g. Cefradine)
#Bacterial culture
#Third-generation cephalosporins (e.g. Cefditoren Pivoxil)