Scalded Skin Syndrome Research Articles

Staphylococcal Scalded Skin Syndrome Treated with Homoeopathy—A Case Report

AbstractStaphylococcal scalded skin syndrome (SSSS) is an acute superficial blistering skin disorder caused by the exfoliative toxins produced by gram-positive bacteria Staphylococcus aureus which predominantly affects children and neonates and can cause serious morbidity and mortality. The diagnosis of SSSS is based on clinical findings and requires prompt medical treatment with proper hygiene and adequate diet to achieve successful result. Here, a case of a two and half years old girl is presented with a blistering skin syndrome for past 2 days without taking any conventional medicinal treatment. It was treated successfully with individualised homoeopathic medicines Rhus toxicodendron with dilution 50 millesimal potency 4 (Rhus tox 0/4) with supportive care. Within 6 days of treatment, the patient responded well to the homoeopathy medicine. All the symptoms and signs of staphylococcal skin blister lesions were healed completely within 10 days of treatment without development of any complications and recurrence. Homoeopathy treatment has a positive curative effect in bacterial blister skin lesions. This case report represents an alternative for the treatment of SSSS.

Sequential Cases of Staphylococcal Scalded Skin Syndrome in Very Low Birth Weight Infants

Sequential Cases of Staphylococcal Scalded Skin Syndrome in Very Low Birth Weight Infants

Mind the clock: Prompt recognition of staphylococcal scalded skin syndrome and development of septic shock

Mind the clock: Prompt recognition of staphylococcal scalded skin syndrome and development of septic shock

Comparison of mortality and complications in adult versus pediatric staphylococcal scalded skin syndrome patients

Comparison of mortality and complications in adult versus pediatric staphylococcal scalded skin syndrome patients

The Curious Case of a Rash: Staphylococcal Scalded Skin Syndrome, a Pediatric Disease in an Adult Patient

The Curious Case of a Rash: Staphylococcal Scalded Skin Syndrome, a Pediatric Disease in an Adult Patient

Staphylococcal scalded skin syndrome: A case report

Staphylococcal scalded skin syndrome: A case report

Staphylococcus aureus Toxins: From Their Pathogenic Roles to Anti-virulence Therapy Using Natural Products

Staphylococcus aureus (S. aureus) produces a wide variety of toxins that cause various diseases in humans. S. aureus toxins are divided into three categories; (i) superantigens (SAgs) that interfere with receptor function and cause toxic shock syndrome (TSS) or staphylococcal food poisoning (SFP), (ii) exfoliative toxins (ETs) that destroy epidermal barrier functions and cause staphylococcal scalded skin syndrome (SSSS), and (iii) cytotoxins that cause cell lysis. Recently, anti-toxin neutralizing agents have been engineered and proven to be effective in preventing or treating staphylococcal diseases. However, neutralization of a single toxin may not sufficiently protect the host from S. aureus infection. Biofilm formation and the pathogenesis of S. aureus are closely associated with accessory gene regulator-quorum sensing (agr-QS) system that controls the expressions of many virulence factors including exotoxins. In addition to anti-toxin antibodies, indirect approaches involving targeting of the agr-QS system are considered a novel means of inhibiting the virulence of S. aureus and controlling various diseases caused by the pathogen. This review summarizes basic concepts of the pathogenic roles of S. aureus toxins, the molecular features of the agr-QS system, and of natural product-based anti-virulence therapies that target virulence, rather than growth.

Infection related severe skin damage

Infection plays an important role in the pediatric intensive care unit.Severe skin damage caused by bacterial infection often causes acute onset and high mortality, which should be paid attention to by clinicians.In this paper, the diagnosis, differential diagnosis and treatment of Staphylococcus aureus scalding syndrome and ecthyma gangrenosum caused by Pseudomonas aeruginosa infection were reviewed. Key words: Infection; Severe skin injury; Staphylococcal scalded skin syndrome; Pseudomonas aeruginosa infection

Prevalence and antimicrobial susceptibility pattern of Methicillin-Resistant Staphylococcus aureus isolated from various clinical samples of the patients attending in a Tertiary Care Teaching Hospital in Puducherry

Staphylococci spp has been reported as a major cause of hospital and community-associated infections. Staphylococcus aureus is the most common pathogen causing a variety of infections relatively begins minor skin in sections (abscess. cellulitis, staphylococcal scalded skin syndrome) to live threating systemic infections like endocarditis, septic arthritis, pneumonia joint, and bone infections, toxic shock syndrome. Methicillin resistance was reported in 1961 and emerged in the last several decades as one of the most important nosocomial pathogens which were reported just one year of the launch of methicillin. MRSA now a day a big problem is because it is creating life threating problems medical institutions. The knowledge of MRSA prevalence and current antibiogram profile is necessary for the selection of appropriate treatment for related infections. Isolation and identification of Staphylococcus aureus were done by standard conventional microbiological methods. The Methicillin-resistant Staphylococcus aureus strains were tested by using Cefoxitin 30μg disc on Mueller - Hinton agar and antibiotic susceptibility testing were done by Kirby-Bauer disc diffusion method according to Clinical and Laboratory Standards Insititute guidelines (CLSI). All the 164 MRSA (100%) strains were sensitive to Tigecycline, Vancomycin, Teicoplanin followed by Linezolid (92. 68%). Tigecycline, Vancomycin, Teicoplanin has until now excellent activity against clinical isolates of Methicillin-resistant Staphylococcus aureus.

344 The correlation between the diseases severity in children of Staphylococcal scalded skin syndrome and impetigo and serum levels of anti-Dsg1 antibodies and anti-Dsg3 antibodies

Objective:To explore the association of the serum levels of anti-Dsg1 antibodies and anti-Dsg3 antibodies with disease severity in children with Staphylococcal scalded skin syndrome and impetigo.Methods:Serum levels of anti-Dsg1 antibodies and anti-Dsg3 antibodies in 16 children with SSSS and 40 patients with impetigo by adopting the ELISA.Results:Serum anti-Dsg1 antibodies were positive in children with SSSS and impetigo, and the serum levels of anti-Dsg1 antibodies of children with SSSS were higher than those with impetigo; the difference was statistically significant. Serum anti-Dsg3 antibodies were negative in children with SSSS and those with impetigo. The serum levels of anti-Dsg1 antibodies were correlated with disease duration, body temperature, lesion area and peripheral neutrophil counts, but not correlated with the total number of the white blood cells in patients with SSSS. The serum levels of anti-Dsg1 antibodies with disease duration, body temperature and lesion area were correlated, but not correlated with the total number of the white blood cells and peripheral neutrophil counts in patients with impetigo.Conclusions:Serum anti-Dsg1 antibodies levels is positive in children with SSSS and impetigo, and the serum levels of anti-Dsg1 antibodies of children with SSSS is higher than those with impetigo. Serum anti-Dsg3 antibodies are negative in children with SSSS and impetigo. The serum levels of anti-Dsg1 antibodies are correlated with disease severity in patients with SSSS and impetigo. It suggests that serum anti-Dsg1 antibodies levels may be useful for illness monitoring.

Contemporary systematic review and meta-analysis of exfoliative toxin-producing Staphylococcus aureus strains isolated from patients in Iran

Exfoliative toxins of Staphylococcus aureus have been associated with Staphylococcal scalded-skin syndrome (SSSS) and bullous impetigo. Despite many reports on the exfoliative toxin-producing S. aureus in Iran over the past years, a comprehensive analysis of these studies are still rare endeavors. This systematic review aimed to determine the overall prevalence of exfoliative toxin genes (i.e. eta, etb, and etd) among S. aureus isolated from patients in Iran. An electronic search was conducted in the MEDLINE/PubMed, Scopus, and Google scholar databases for all documents published from 1 January 2010 through 1 December 2018. Of the 735 records identified from the databases, 14 studies fulfilled the eligibility criteria. The overall prevalence of eta, etb, and etd genes among S. aureus strains were 13.057% (95% CI: 2.930–28.885%), 3.601% (95% CI: 0.901–8.002%), and 21.922% (95% CI: 3.012–83.237%), respectively. The most prevalent genotypes of eta-positive S. aureus in Iran were staphylococcal cassette chromosome mec (SCCmec) type IV, accessory gene regulator (agr) group I, S. aureus Protein A (spa) type t021, and sequence type 30 (ST30). Regarding etb, the most common genotypes were SCCmec III, spa t005, and ST22. In conclusion, the prevalence of S. aureus strains harboring exfoliative toxin genes varies throughout Iran and that these strains, especially those carrying eta, might be more prevalent in some Iranian provinces, such as Mazandaran and Zanjan. Further researches are encouraged to understand the transmission, burden, and risk factors associated with infections caused by exfoliative toxin-producing S. aureus.

Síndrome de piel escaldada estafilocócica en lactante mayor

Background: Staphylococcal scalded skin syndrome (SSSS) is a rare condition, characterized by skin sputtering resulting from the action of exfoliative toxins (ET) produced by Staphylococcus aureus. The therapy consists on specific antibiotics and supportive treatment with interdisciplinary management. Clinical case: We present the case of an older infant admitted with bullous lesions and skin disruption of short evolution that begins in the genital region, with progression and compromise of 40% of total body surface requiring management in the pediatric intensive care unit (PICU). Conclusion: SSSS despite being an infrequent disease, presents a characteristic clinical feature that allows pediatricians to differentiate it from other infectious pathologies of the skin, and thus make an early diagnosis.

Reliability and accuracy of smartphones for paediatric infectious disease consultations for children with rash in the paediatric emergency department

ObjectiveSmartphones and associated messaging applications have become the most common means of communication among health care workers and the general population. The aim of this study was to evaluate the reliability and accuracy of smartphones for the diagnosis of rash in children admitted to emergency departments during the night shift.MethodsThe images of the children who were admitted to the paediatric emergency department with rash were included in this study, and at least two images taken with smartphones by residents or paediatric infectious disease fellows were re-directed to the chief consultant of the Paediatric-Infectious Department via smartphone. Initial diagnosis by the consultant was recorded, and the patient’s physical examination was performed by another clinician on the first working day; diagnostic tests were planned by this clinician. The definitive diagnosis was recorded and compared with the initial diagnosis.ResultsAmong the 194 patients, the most common final diagnoses were chickenpox (varicella-zoster infections) in 33 patients (17.0%) and skin infections (including impetigo, ecthyma, erysipelas and cellulitis) in 33 patients (17.0%). The initial diagnosis, which was performed via WhatsApp on a smartphone, was identical to the final diagnosis in 96.3% of the cases. Incompatible initial diagnoses included 4 measles cases, 1 staphylococcal scalded skin syndrome case, 1 cutaneous leishmaniasis case and 1 petechial rash case.ConclusionsOur study has shown that the use of a smartphone-based instant messaging application for transmitting images of paediatric rash is accurate and useful for diagnosis. However, physical examination and medical history are still the primary methods. Consultation via smartphones in emergency departments for paediatric rashes during nightshifts would help both clinicians and patients.

Urgent Surgical Treatment of Aortic Endocarditis in Infants and Children.

Infective endocarditis (IE) in the pediatric population can present asa life-threatening condition. Optimal timing for surgical intervention should consider surgical risks versus the risk of neurologic complications. We herein report our experience with this group of critically ill children. Retrospective analysis of patient charts of all patients who underwent urgent surgical treatment of aortic IE from 1994 to 2014 was performed. Nine patients with acute storming IE of the aortic valve or the ascending aorta were urgently operated (eight normal heart, one congenital aortic stenosis), age ranged from 8weeks to 4.2years. Causative organisms were Staphylococcus aureus (2), Staphylococcus coagulase negative (1), Kingella kingae (2), Streptococcus pneumoniae (2), or culture negative (2). Presenting symptoms other than hemodynamic instability were neurologic decompensation (5) coronary embolization (1) and cardiogenic shock due to scalded skin syndrome (1). CT and MRI demonstrated significant brain infarcts in four patients. Operations performed were the Ross operation (7) and ascending aortic reconstruction (2). There were no operative deaths. At a median follow-up of 6years (range 2-196months), all patients are alive and well. Re-intervention included homograft replacement (2) and transcatheter Melody valve implantation (1). At their last follow-up, the neo-aortic valvewas functional in all patients with minimal regurgitation and all had full resolution of the neurological deficits. Urgent surgical treatment for aortic valve IE in infants is challenging. Although surgery is complex and pre-disposing conditions such as sepsis, neurologic and cardiac decompensations are prevalent, operative results are excellent and gradual and significant neurologic improvement was noted over time.

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.

Neonatal Skin Emergencies.

Although the majority of neonatal skin rashes can be safely monitored without intervention, there are a significant few that are dermatologic emergencies. When called to assess a neonate, it is important to distinguish what requires immediate diagnosis and treatment from those that represent benign etiologies. The skin may be the first clue to certain infections such as herpes simplex virus, syphilis, varicella, cytomegalovirus, fungal infections, and staphylococcal scalded skin syndrome, all of which require immediate testing and some of which may lead to severe sequelae. Cutaneous findings in neonates may also indicate the need for further evaluation. Purpura fulminans, sclerema neonatorum, neonatal lupus, and blueberry muffin rash can be indications of other underlying disorders and are reviewed as well. This article outlines these potential neonatal dermatologic emergencies and highlights the important clinical clues to each. [Pediatr Ann. 2019;48(1):e36-e42.].

Staphylococcal Scalded Skin Syndrome-A Casereport

Staphylococcal scalded skin syndrome [SSSS] or Ritter's disease is a vesiculating skin disease most commonly caused by Staphylococcus aureus, a gram positive commensal which asymptomatically colonizes the skin. Rarely, few strains cause SSSS. A study in the Czech Republic showed an incidence of approximately 25 cases per 100, 000 children younger than one year of age[1]. It can occur in outbreaks, particularly in nurseries. It is far less common in adults. When they do occur, cases in adults typically involve those with immunosuppression such as HIV/AIDS, severe renal impairment or renal failure, or in those withmalignancy.

Clinical Features of Staphylococcal Scalded Skin Syndrome Caused by Community-Associated Methicillin-Resistant Staphylococcus aureus in Changwon City, Korea, during 2006 and 2015

목적: 경남 창원지역에서 발생한 포도알균 열상 피부 증후군의 임상 및 역학적 특징을 알아보았다. 방법: 2006년부터 2015년까지 포도알균 열상 피부 증후군으로 진단받은 69명의 환자들을 대상으로 의무기록을 검토하였다. 항생제 감수성 검사는 Clinical and Laboratory Standards Institute의 지침에 따라 한천 평판 우무 희석법을 시행하였으며, MRSA는 oxacillin 감수성 검사로 표현형을 확인한 후, mecA 유전자를 polymerase chain reaction로 증폭하여 최종 확인하였다. 결과: 환자들의 중간연령은 2.0세이었고(범위, 0.2-6세) 임상형은 전신형이 3명(4.3%), 중간형이 53명(76.8%), 부전형이 13명(18.9%)이었다. 환자들은 연중 발생하였으나, 주로 7월부터 10월 사이에 많이 발생하였다. 배양검사를 실시한 60명의 환자 중 54명에게서 MRSA 균이 배양되었고 모든 환자들이 특별한 합병증 없이 회복되었다. 결론: 2006년부터 2015년 사이에 창원지역에서 포도알균 열상 피부 증후군 환자의 지속적인 발생이 있었다. SSSS 환자 발생에 대한 지속적인 모니터링이 필요할 것으로 생각된다.

STAPHYLOCOCCAL SCALDED SKIN SYNDROME IN A VERY LOW BIRTH WEIGHT PRETERM INFANT

Staphylococcal scalded skin syndrome (SSSS) is an exfoliative dermatitis produced by the toxins of some strains of staphylococci, predominantly phage Group 2, strains 71 and 55. It has been reported mostly in children under 5 years of age with few cases only reported in very preterm infants. The disease can be life threatening in very low birth weight preterm babies. We are reporting one such case to emphasize the importance for clinicians to not only recognize the clinical manifestations of SSSS but also the need to closely monitor infants, especially VLBW infants with SSSS for bacterial sepsis and other complications.

2319. Molecular Epidemiology of Staphyloccoccus aureus Isolated From Korean Children

BackgroundMajor community acquired-methicillin-resistant Staphylococcus aureus (CA-MRSA) clones have been reported worldwide including ST1 in Asia, Europe, United States, ST8 in Europe and United States and ST30 in Australia, Europe and South America. Panton–Valentine leukocidin (PVL) positive ST30-SCCmec IV has been reported as an important CA-MRSA in Singapore, Japan and Latin America, however reports in Korean children are limited. Therefore we investigated the antimicrobial resistance and molecular characteristics of S. aureus among children in Korea.Methods S. aureus previously isolated from children at Seoul National University Bundang Hospital (2010–2016) were analyzed for multilocus sequence type, SCCmec typing, and PCR of PVL, qac A/B, smr and mupA genes. Electronic medical records were reviewed for clinical data and antibiotic susceptibility results.ResultsA total of 79 isolates from skin and soft-tissue infection (SSTI) (N = 41, 51.9%), bone and joint infection (N = 26, 32.9%) and staphylococcal scalded skin syndrome (SSSS) (N = 12, 15.2%) were included. Among these, 32 (40.5%) were MRSA. Among children with underlying diseases (20.3%, 16/79), 56.3% (9/16) were MRSA. After excluding these cases, among children ≤1 month of age, 84.6% (11/13) were MRSA, whereas in children ≥2 months of age, 95.2% (20/21) of SSTI, and 90.0% (18/20) of bone and joint infection were MSSA. All SSSS cases were MRSA. Among MSSA strains, ST30 (N = 28, 59.6%) was the predominant clone and among ST30, 96.6% (28/29) were MSSA. MRSA strains included ST72-SCCmec IV (N = 15, 46.9%), ST89-SCCmec IV (N = 10, 31.3%), ST 5-SCCmec II (N = 3, 9.4%) and ST1-SCCmec IV (N = 3, 9.4%). ST30 was the most common clone in SSTI and bone and joint infection whereas ST89-SCCmec IV was most common in SSSS. PVL was detected in 3 strains (3.8%, ST30-SCCmec IV N = 1, MSSA ST30 N = 2) and qac A/B in 3 strains (MRSA = 3), smr in 3 strains (MSSA = 1, MRSA=2) and mupA in 7 strains (MRSA = 5, MSSA = 2).ConclusionThe molecular epidemiology of S. aureus in Korean children differed from other countries. Among children with SSTI and bone and joint infection, ST30 was the predominant strain, and the majority was MSSA. Among MRSA isolates, ST72-SCCmec type IV was the most common clone in SSTI and bone and joint infection, and ST89-SCCmec type IV in SSSS.Disclosures H. Lee, National Research Foundation of Korea: Grant Investigator, Grant recipient