Staphylococcal scalded skin syndrome - Stafylokocker Skållad Hud Syndrom
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Ett spädbarn med Stafylokocker Skållad Hud Syndrom (Staphylococcal scalded skin syndrome)
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ReferencesStaphylococcal Scalded Skin Syndrome är ett tillstånd där huden lossnar på grund av toxiner som produceras av vissa Staphylococcus‑bakterier. Tillståndet är ovanligt hos barn över sex år och kan även förekomma hos vuxna med nedsatt immunförsvar eller allvarliga njurproblem. Huvudsymtomet är omfattande hudpeeling efter en inflammation. Svårighetsgraden varierar från några få blåsor till omfattande hudförlust, vilket kan leda till kraftigt temperaturfall och instabilt blodtryck.
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.
En 10-månader gammal pojke kom in med rinnande näsa och åt dåligt. Läkarna sa att det var en övre luftvägsinfektion. Två dagar senare kom han tillbaka eftersom han inte blev bättre och hade nya problem som svullet ansikte och irriterad hud runt munnen. Under de följande två dagarna blev pojken sämre. Hans armar och ben svullnade upp och huden började lossna. Tillbaka på sjukhuset märkte läkarna ett rött utslag i ansiktet och i hudvecken, som bleknade vid beröring. De diagnostiserade honom med staphylococcal scalded skin syndrome (SSSS) och fick honom att ta antibiotika genom en ven.
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.
En 2‑årig tjej kom in med ett utslag som hade spridit sig över hela kroppen under 48 timmar, efter ett insektsbett i ansiktet dagen innan. Vid undersökningen fanns ett omfattande utslag bestående av små knölar som smälte samman, och vid lätt beröring visade huden ett positivt Nikolsky‑tecken. Det fanns inga tecken på att slemhinnorna var påverkade. Blodproverna visade inga tecken på infektion.
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.
Syndromet induceras av epidermolytiska exotoxiner (exfoliatin A och B) som frisätts av S. aureus. Prognosen för Stafylokocker Skållad Hud Syndrom (staphylococcal scalded skin syndrome) hos barn är utmärkt, med fullständig återhämtning inom 10 dagar efter behandling och utan betydande ärrbildning. Tillståndet måste dock särskiljas noggrant från toxisk epidermal nekrolys, som har en dålig prognos.
○ Diagnos och behandling
Feldiagnostik, t.ex. eksemskador som atopisk dermatit, och applicering av steroidsalva kan förvärra lesionerna. Sök läkare så snart som möjligt om du använder antibiotikasalva.
#Bacitracin
#First-generation cephalosporins (e.g. Cefradine)
#Bacterial culture
#Third-generation cephalosporins (e.g. Cefditoren Pivoxil)