Diagnosis Of Staphylococcal Scalded Skin Syndrome Research Articles

Fatal staphylococcal scalded skin syndrome in a newborn.

Staphylococcal scalded skin syndrome (SSSS) is characterized by superficial blistering of the skin caused by exfoliative toxins of Staphylococcus aureus. SSSS predominantly affects children under five-year-old. We present a case of a 30-day-old female infant who developed circumscribed flaccid blisters within erythematous skin, with positive Nikolsky’s sign, without mucosal involvement. The ruptured blisters resulted in desquamation and scalded skin, then extending rapidly. The diagnosis of SSSS was achieved clinically and the patient was treated with intravenous cloxacillin. However, despite the given treatment in limited resources setting, the patient died due to sepsis. This case report highlights the difficulties in treating SSSS in limited-facilities hospital setting and underlines its life-threatening complications, such as sepsis. It is also aimed at raising awareness of SSSS as a possible differential diagnosis of superficial blistering and exfoliative skin disorders, especially in children population.

A case report on Staphylococcal Scalded Skin Syndrome in a 3 year old: Clinical diagnosis and management

Staphylococcal-scalded skin syndrome (SSSS) is a blistering skin disorder which is considered as a pediatric emergency. This life-threatening syndrome is caused by Staphylococcal exfoliative toxins produced by Staphylococcus aureus. Although it can affect any age group, children below 5 years of age are at utmost risk. The specific antibodies to exotoxins and increased exotoxin clearance, minimize the frequency of SSSS in adults. Mortality in infancy is low (4%) and is less than 10 % in children but is between 40% and 63% in adults. Clinical features of SSSS may range from a few localized blisters to generalized desquamation covering the entire body. The histopathological evaluation of the skin biopsy helps in the definitive diagnosis of SSSS. Here we present a case of a 3 year old female child with low grade fever associated with erythematous rashes all over the body and severe itching. A clinical diagnosis of Staphylococcal Scalded Skin Syndrome (SSSS) was made. With appropriate treatment using intravenous Flucloxacillin and supportive care, the child’s symptoms were completely resolved within a week.

The Role of Gram Staining in Staphylococcal Scalded Skin Syndrome

Staphylococcal scalded skin syndrome (SSSS) is a severe blistering disease common in children. The diagnosis of SSSS is often difficult to distinguish from other blistering diseases in children. Here, we report a case of SSSS with a particular diagnostic step to elucidate the disease, which is the Gram stain. We propose the use of the Gram stain as a cost-effective diagnostic step in SSSS to shorten the time from presentation to treatment, especially in resource-limited areas.

A rare early presentation of staphylococcal scalded skin syndrome in a Neonate

Staphylococcal Scalded Skin Syndrome (SSSS) is caused by the exfoliative toxins (ETs) of Staphylococcus aureus. We present a case of a 3 days old infant with complaints of fever and diffuse erythematous exfoliation all over the body with bilateral conjunctivitis. The diagnosis of SSSS was reached based on clinical features and positive blood culture report. He responded well to the antibiotics paracetamol, and intravenous fluids for rehydration. He was discharged after 14 days, with complete resolution of symptoms. Having a high clinical suspicion for SSSS, early diagnosis/treatment, and following strict aseptic measures in neonatal intensive care unit are important.

Staphylococcal Scalded Skin Syndrome in Neonates: An 8‐Year Retrospective Study in a Single Institution

Staphylococcal scalded skin syndrome (SSSS) is a rare disorder in children. Complications may occur without timely treatment. Mortality in children with SSSS is approximately 4%. Other than a limited number of case reports, data on SSSS in neonates are limited. The objective of the current study was to investigate SSSS in neonates. A retrospective review of neonates with a diagnosis of SSSS from January 2004 to January 2012 was performed. Population distribution, historical features, physical examination findings including laboratory tests, antibiotic therapies, and outcomes were evaluated. Thirty-nine cases were included, 31 (79.5%) in the last 4 years. The mean patient age was 17.4 ± 7.7 days. Boys (25 cases) were more commonly affected, and occurrence during summer and autumn months was more frequent. The face was the most common body part affected and the area most commonly initially affected. Fever, high white blood cell count, and high C-reactive protein levels were uncommon. Pneumonia was the most frequent complication (74.4%). The positive rate of Staphylococcus aureus isolation was low (23.5%). Drug susceptibility tests showed that amoxicillin with clavulanic acid and cephalosporins were effective in practice. The median length of hospitalization was 9.0 days. All of the 39 neonates were cured without scarring. This study established basic epidemiologic characteristics of a group of neonates diagnosed with SSSS. In the presence of a clinical suspicion of SSSS, even with apparently normal laboratory tests, immediate treatment with cephalosporins, β-lactamase-resistant semisynthetic penicillin, or both is advocated.

Positive Nikolsky Sign due to Staphylococcal Scaled Skin Syndrome

Figure 2. The patient 7 days after the diagnosis of SSSS. A 16-month-old previously healthy girl was admitted for acute onset of a tender, diffuse, erythematous, and exfoliating rash that was began on the neck and axilla and then spread to the face, trunk, genitalia, and extremities. The patient had increasing pain when she was touched or held, and her skin began to peel hours before admission. The examining physician elicited a positive Nikolsky sign; exfoliation affected 70% of the total body surface (Figure 1). There were no clinical signs of infection. Staphylococcus aureus was isolated from nasal and pharyngeal cultures. Investigation for exfoliative toxin gene expression by polymerase chain reaction was positive for exfoliative toxin B, confirming the diagnosis of staphylococcal scalded skin syndrome (SSSS). After a course of antibiotic therapy, the patient recovered completely within 15 days without scarring (Figure 2). Nikolsky sign is present when lateral traction of the skin leads to sloughing. Although the differential diagnosis includes pemphigus vulgaris, empidermolysis bullosa, secondand third-degree burns, the most common cause is exfoliative toxin-producing S aureus (causing bullous impetigo, Lyell disease, Ritter disease, or SSSS), and the clinical scenario is usually compelling. Toxic epidermal necrolysis also can cause a positive Nikolsky sign; this disorder occurs more frequently in older individuals and as an adverse drug effect. In SSSS, exfoliative toxin is disseminated hematogenously, targets the protein desmoglein I in the zona granulosa of the epidermis, and causes superficial cleavage of tissue with blistering. Clinical staphylococcal infection may or may not be present. Most cases of SSSS occur in

Diagnostic dilemma: extremely low birth weight baby with staphylococcal scalded-skin syndrome or toxic epidermal necrolysis

Exfoliative skin diseases of the neonate are relatively rare but when present require rapid diagnosis and treatment to decrease morbidity and mortality associated with these entities. We present the case of a 795 g premature male infant who developed exfoliative lesions on day of life 66. Skin and blood cultures were obtained and intravenous antibiotics initiated. Results of a Tzanck smear suggested toxic epidermal necrolysis (TEN), so the infant was emergently transferred to a local children's hospital with burn unit capabilities for further care. Further histopathological evaluation of the skin biopsy confirmed the diagnosis of staphylococcal scalded-skin syndrome (SSSS). The desquamation ceased 24 h after the initiation of antibiotic therapy, and the skin lesions resolved within 10 days. We discuss the pathogenesis of SSSS and TEN and highlight the importance of early diagnosis so appropriate treatment can be initiated.

A case of staphylococcal scalded skin syndrome in an adult

The staphylococcal scalded skin syndrome (SSSS) is a febrile, self-limited illness. It generally affects infants and children; however a few adults, particularly those with immunosuppression, have developed a similar condition. In adult cases, mortality is high. Here, we report a very rare case of SSSS in an adult without underlying diseases. A 68-year-old man was admitted to our hospital because of spondylitis and arthritis of the right knee joint.The clinical findings and bacteriologic examinations as well as the skin biopsy were consistent with the diagnosis of SSSS. The patient was supported by a mechanical ventilator and successfully treated with antibiotics.