RESUMO
ABSTRACT: Staphylococcal scalded skin syndrome is a superficial blistering disorder caused by exfoliative toxin-releasing strains of Staphylococcus aureus. Bacterial toxins are released hematogenously, and after a prodromal fever and exquisite tenderness of skin, patients present with tender erythroderma and flaccid bullae with subsequent superficial generalized exfoliation. The head-to-toe directed exfoliation lasts up to 10 to 14 days without scarring after proper treatment. Children younger than 6 years are predominantly affected because of their lack of toxin-neutralizing antibodies and the immature renal system's inability to excrete the causative exotoxins. The epidemiology, pathophysiology, and essential primary skin lesions used to diagnose staphylococcal scalded skin syndrome are summarized for the pediatric emergency medicine physician.
Assuntos
Infecções Estafilocócicas , Síndrome da Pele Escaldada Estafilocócica , Criança , Serviço Hospitalar de Emergência , Humanos , Pele/patologia , Síndrome da Pele Escaldada Estafilocócica/diagnóstico , Síndrome da Pele Escaldada Estafilocócica/patologia , Síndrome da Pele Escaldada Estafilocócica/terapia , Staphylococcus aureusRESUMO
BACKGROUND: Staphylococcal scalded skin syndrome (SSSS) is a blistering dermatosis caused by exfoliative toxins released from Staphylococcus aureus. OBJECTIVES: To describe the incidence, costs, length of stay (LOS), comorbidities and mortality of SSSS in U.S. children. METHODS: The Nationwide Inpatient Sample 2008-2012 was analysed, including a 20% sample of U.S. hospitalizations and 589 cases of SSSS. RESULTS: The mean annual incidence of SSSS was 7·67 (range 1·83-11·88) per million U.S. children, with 45·1 cases per million U.S. infants age < 2 years. In multivariable logistic regression models, SSSS was significantly associated with the following (shown as adjusted odds ratio and 95% confidence interval): female sex (1·12, 1·00-1·25), age (2-5 years: 13·31, 11·82-14·99; 6-10 years: 2·93, 2·35-3·66; 11-17 years: 0·44, 0·31-0·63); race/ethnicity (black: 0·69, 0·58-0·84) and season (winter: 2·04, 1·66-2·50; summer: 3·47, 2·86-4·22; autumn: 3·04, 2·49-3·70), with increasing odds over time (2010-2011: 2·28, 2·07-2·51; 2012: 2·98, 2·69-3·30). The geometric mean (95% confidence interval) LOS and cost of hospitalization for patients with vs. without SSSS were 3·2 (3·0-3·4) vs. 2·4 (2·4-2·5) days and $4624·0 ($4250-$5030) vs. $1872 ($1782·7-$1965). Crude inpatient mortality rates (with 95% confidence intervals) were similar for children with vs. without SSSS (0·33%, 0·00-0·79% vs. 0·36%, 0·34-0·39%). SSSS was associated with other infections, including in the upper respiratory tract and skin. CONCLUSIONS: The prevalence of SSSS appears to be increasing over time, and was associated with a number of sociodemographic factors and other infections. Further studies are needed to confirm these findings and reduce rising rates of SSSS.
Assuntos
Síndrome da Pele Escaldada Estafilocócica/mortalidade , Adolescente , Criança , Pré-Escolar , Comorbidade , Custos e Análise de Custo , Humanos , Incidência , Lactente , Recém-Nascido , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Prevalência , Características de Residência/estatística & dados numéricos , Fatores Socioeconômicos , Síndrome da Pele Escaldada Estafilocócica/economia , Síndrome da Pele Escaldada Estafilocócica/terapia , Estados Unidos/epidemiologiaAssuntos
Impetigo , Síndrome da Pele Escaldada Estafilocócica , Criança , Pré-Escolar , Humanos , Impetigo/diagnóstico , Impetigo/etiologia , Impetigo/patologia , Impetigo/terapia , Lactente , Pediatria , Síndrome da Pele Escaldada Estafilocócica/diagnóstico , Síndrome da Pele Escaldada Estafilocócica/etiologia , Síndrome da Pele Escaldada Estafilocócica/patologia , Síndrome da Pele Escaldada Estafilocócica/terapiaRESUMO
Staphylococcal scalded skin syndrome is a potentially life-threatening disorder caused most often by a phage group II Staphylococcus aureus infection. Staphylococcal scalded skin syndrome is more common in newborns than in adults. Staphylococcal scalded skin syndrome tends to appear abruptly with diffuse erythema and fever. The diagnosis can be confirmed by a skin biopsy specimen, which can be expedited by frozen section processing, as staphylococcal scalded skin syndrome should be distinguished from life threatening toxic epidermal necrolysis. Histologically, the superficial epidermis is detached, the separation level being at the granular layer. The diffuse skin loss is due to a circulating bacterial exotoxin. The aetiological exfoliating toxin is a serine protease that splits only desmoglein 1. The exfoliative toxins are spread haematogenously from a localized source of infection, causing widespread epidermal damage at distant sites. Sepsis and pneumonia are the most feared complications. The purpose of this review is to summarize advances in understanding of this serious disorder and provide therapeutic options for both paediatric and adult patients. Recent epidemiological studies have demonstrated that paediatric patients have an increased incidence of Staphylococcal scalded skin syndrome during the summer and autumn. Mortality is less than 10% in children, but is between 40% and 63% in adults, despite antibacterial therapy. Previously, intravenous immunoglobulin had been recommended to combat Staphylococcal scalded skin syndrome, but a recent study associates its use with prolonged hospitalization.
Assuntos
Antibacterianos/uso terapêutico , Gerenciamento Clínico , Imunoglobulinas Intravenosas/uso terapêutico , Plasma , Síndrome da Pele Escaldada Estafilocócica/diagnóstico , Síndrome da Pele Escaldada Estafilocócica/terapia , Adulto , Fatores Etários , Biópsia , Criança , Humanos , Pele/microbiologia , Pele/patologia , Síndrome da Pele Escaldada Estafilocócica/mortalidade , Infecções Cutâneas Estafilocócicas/complicações , Staphylococcus aureus/isolamento & purificação , Taxa de Sobrevida , Resultado do TratamentoAssuntos
Comorbidade , Síndrome da Pele Escaldada Estafilocócica/diagnóstico , Síndrome da Pele Escaldada Estafilocócica/epidemiologia , Adulto , Distribuição por Idade , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Índice de Gravidade de Doença , Distribuição por Sexo , Síndrome da Pele Escaldada Estafilocócica/terapia , Taxa de Sobrevida , Estados Unidos/epidemiologiaRESUMO
This Commentary describes breakthroughs in understanding the interactions between desmoglein 1 and plakogloben in staphylococcal-mediated blistering skin diseases.
Assuntos
Vesícula/etiologia , Exfoliatinas/efeitos adversos , Processamento de Proteína Pós-Traducional/fisiologia , Síndrome da Pele Escaldada Estafilocócica/etiologia , Animais , Vesícula/genética , Vesícula/terapia , Desmogleína 1/genética , Desmogleína 1/fisiologia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/etiologia , Doenças do Recém-Nascido/genética , Doenças do Recém-Nascido/terapia , Camundongos , Pênfigo/congênito , Pênfigo/etiologia , Pênfigo/genética , Pênfigo/terapia , Processamento de Proteína Pós-Traducional/genética , Síndrome da Pele Escaldada Estafilocócica/complicações , Síndrome da Pele Escaldada Estafilocócica/genética , Síndrome da Pele Escaldada Estafilocócica/terapia , gama Catenina/genética , gama Catenina/fisiologiaRESUMO
Staphylococcal scalded skin syndrome (SSSS) is the clinical term used to describe a range of blistering skin disorders induced by the exfoliative toxins of Staphylococcus aureus and prevalently affects neonates, infants and toddlers who lack antibodies to S. aureus toxins. SSSS is a highly contagious disease and is characterised by erythema and fever, followed by the formation of large fragile superficial blisters, which rupture only to leave extensive areas of denuded skin. A diagnosis of SSSS relies on the clinical picture, as well as on histological and microbiological findings. Neonates and young infants are particularly susceptible to a lack of the protective skin barrier, which may cause excessive protein and fluid losses, hypothermia and secondary infection. Due to a complete denudation of skin, the patients also suffer from almost unbearable pain. In our communication, we present an innovative temporary coverage of the denuded skin with Suprathel (PolyMedics Innovations GmbH, Denkendorf, Germany). Suprathel relieves pain, prevents heat loss and secondary infection, accelerates wound healing, does not need to be changed and makes daily care easy for the nurses and is well tolerable for the patient.
Assuntos
Curativos Oclusivos , Poliésteres/uso terapêutico , Síndrome da Pele Escaldada Estafilocócica/terapia , Alemanha , Humanos , Lactente , Recém-Nascido , Masculino , Síndrome da Pele Escaldada Estafilocócica/patologiaRESUMO
This case report describes the clinical course of a child who developed staphylococcal scalded skin syndrome (SSSS) after a burn injury. The intent is to aid other units in recognizing the presentation of SSSS after a pediatric burn and to optimize subsequent management. The main clinical finding was of rapid, progressive, superficial epidermal loss at sites separate from the original burn, involving 55% of the total body surface area, 13 days after a 6% scald burn to the face, neck, and chest. Diagnosis was confirmed by multidisciplinary team clinical assessment and histopathology of an intraoperative skin biopsy. This confirmed epidermal cleavage at the granular cell layer. These findings were later supported by Staphylococcus aureus cultured from the burn wound, and a positive epidermolytic toxin A assay. Management was with general medical supportive care, clindamycin and flucloxacillin intravenous antibiotic therapy, and cleansing and dressing of the areas of epidermal loss. Key learning points from this case were that SSSS presented after a burn injury and that 13 days elapsed between the burn and SSSS. Factors differentiating it from toxic epidermal necrolysis are described, including the value of histopathology in confirming the diagnosis. The prompt use of antibiotics and attentive wound care are advocated as an effective management strategy.
Assuntos
Queimaduras/complicações , Queimaduras/terapia , Síndrome da Pele Escaldada Estafilocócica/diagnóstico , Síndrome da Pele Escaldada Estafilocócica/terapia , Queimaduras/patologia , Pré-Escolar , Humanos , Masculino , Síndrome da Pele Escaldada Estafilocócica/etiologiaRESUMO
Many pediatric skin conditions can be safely monitored with minimal intervention, but certain skin conditions are emergent and require immediate attention and proper assessment of the neonate, infant, or child. We review the following pediatric dermatology emergencies so that clinicians can detect and accurately diagnose these conditions to avoid delayed treatment and considerable morbidity and mortality if missed: staphylococcal scalded skin syndrome (SSSS), impetigo, eczema herpeticum (EH), Langerhans cell histiocytosis (LCH), infantile hemangioma (IH), and IgA vasculitis.
Assuntos
Dermatopatias/diagnóstico , Criança , Diagnóstico Diferencial , Emergências , Hemangioma Capilar/diagnóstico , Hemangioma Capilar/terapia , Histiocitose de Células de Langerhans/diagnóstico , Histiocitose de Células de Langerhans/terapia , Humanos , Vasculite por IgA/diagnóstico , Vasculite por IgA/terapia , Impetigo/diagnóstico , Impetigo/terapia , Erupção Variceliforme de Kaposi/diagnóstico , Erupção Variceliforme de Kaposi/terapia , Síndromes Neoplásicas Hereditárias/diagnóstico , Síndromes Neoplásicas Hereditárias/terapia , Dermatopatias/terapia , Síndrome da Pele Escaldada Estafilocócica/diagnóstico , Síndrome da Pele Escaldada Estafilocócica/terapia , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/terapiaRESUMO
Staphylococcal scalded skin syndrome (SSSS) is a major exfoliating skin infection primarily seen in neonates and young children that can lead to serious morbidity. Although this condition is not commonly encountered, evidence indicates that the incidence and prevalence of this infection is increasing. It is essential that emergency care providers are knowledgeable regarding the differential diagnosis and clinical-decision making process for accurate and timely diagnosis and treatment. This case study highlights the challenges faced in the emergency department in the diagnosis and management of SSSS, including pathophysiology, epidemiology, differential diagnosis and medical management.
Assuntos
Emergências , Síndrome da Pele Escaldada Estafilocócica/diagnóstico , Síndrome da Pele Escaldada Estafilocócica/terapia , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Humanos , Lactente , Masculino , Diagnóstico de EnfermagemRESUMO
Staphylococcus aureus may cause cutaneous and systemic infections such as staphylococcal scalded skin syndrome (SSSS) and toxic shock syndrome (TSS). Although exfoliative toxins A and B, which cause SSSS, and TSS toxin-1 may be produced by different strains of S aureus, the two syndromes rarely occur simultaneously. We describe a patient admitted to the intensive care department with an exfoliative generalized erythroderma, signs of shock, and biopsy specimen findings consistent with SSSS. This patient presented after a tooth extraction. Symptoms recurred after dismissal, and he was readmitted. Subsequent test results were positive for exfoliative toxin B and TSS toxin-1, suggesting concurrent SSSS and TSS. For patients with acute, exfoliative, generalized erythroderma, TSS and SSSS should be considered. Although rare, it is possible to see both syndromes present concurrently.
Assuntos
Choque Séptico/diagnóstico , Síndrome da Pele Escaldada Estafilocócica/diagnóstico , Extração Dentária , Adulto , Diagnóstico Diferencial , Tratamento de Emergência , Humanos , Masculino , Complicações Pós-Operatórias , Choque Séptico/complicações , Choque Séptico/microbiologia , Choque Séptico/terapia , Síndrome da Pele Escaldada Estafilocócica/complicações , Síndrome da Pele Escaldada Estafilocócica/microbiologia , Síndrome da Pele Escaldada Estafilocócica/terapia , Staphylococcus aureus/classificação , Staphylococcus aureus/isolamento & purificaçãoRESUMO
Staphylococcal scalded skin syndrome (SSSS) is a rare toxin-mediated condition caused by Staphylococcus aureus, which causes blistering and desquamation of the skin. Between November 2005 and April 2006, four children were admitted to critical care beds in the South West Regional Paediatric Burns Unit because of SSSS affecting more than 50% of the body surface area. Details of these cases are presented, highlighting the potential severity of the condition. The cases also illustrate that fluid overload is a common complication of the condition, despite hypovolaemia being the more obvious risk, and that both hyponatraemia and leukopenia are frequent findings. These summaries clearly demonstrate the need for paediatric critical care in a tertiary burns unit for children with SSSS affecting a large proportion of the body surface area. The cluster of admissions prompted us to write a management protocol for children with severe SSSS and a summary of this is provided. Most children with SSSS will initially present to general paediatric units, where mild cases will be managed, but severe cases should be promptly referred to a tertiary paediatric burns unit for multi-disciplinary care in a critical care environment.
Assuntos
Cuidados Críticos/métodos , Síndrome da Pele Escaldada Estafilocócica/terapia , Analgesia/métodos , Bandagens , Unidades de Queimados , Criança , Pré-Escolar , Nutrição Enteral/métodos , Feminino , Hidratação/métodos , Humanos , Hiponatremia/etiologia , Hiponatremia/terapia , Tempo de Internação/estatística & dados numéricos , Contagem de Leucócitos , Masculino , Equipe de Assistência ao Paciente , Síndrome da Pele Escaldada Estafilocócica/diagnóstico , Síndrome da Pele Escaldada Estafilocócica/patologia , Desequilíbrio Hidroeletrolítico/etiologia , Desequilíbrio Hidroeletrolítico/terapiaAssuntos
Síndrome da Pele Escaldada Estafilocócica/diagnóstico , Staphylococcus epidermidis , Diagnóstico Diferencial , Exantema/etiologia , Feminino , Humanos , Recém-Nascido , Pele/microbiologia , Pele/patologia , Síndrome da Pele Escaldada Estafilocócica/terapia , Staphylococcus epidermidis/isolamento & purificação , Síndrome de Stevens-Johnson/diagnósticoRESUMO
This report concerns an 18-month-old boy who presented with a 6% total body surface area scald. The subject of this report is unique in that he developed the largest exfoliation described in literature. After 3 days an epidermal exfoliation with the appearance of a deliberately inflicted scald developed. As the exfoliation progressed to over 95% total body surface area the suspicion of child abuse or neglect could be abandoned. The diagnosis Staphylococcal scalded skin syndrome was set, due to the finding of Staphylococcus aureus on swabs, the lack of mucosal engagement, and the patient's age. The boy's skin healed within 3 weeks. The few reports published are all case reports and most frequently described visually infected burns with smaller epidermal exfoliations, and clinically based exfoliation diagnosis. S. aureus often cause burn wound infections that can lead to complications caused by cross-infection. It is important for burn surgeons and intensive care specialists to be aware of the increased possibility of Staphylococcal scalded skin syndrome occurring in patients who have a reduced barrier to infection such as burn patients and also, that the diagnosis can be difficult to make.
Assuntos
Queimaduras/terapia , Síndrome da Pele Escaldada Estafilocócica/terapia , Superfície Corporal , Queimaduras/complicações , Queimaduras/diagnóstico , Maus-Tratos Infantis/diagnóstico , Diagnóstico Diferencial , Humanos , Lactente , Masculino , Índice de Gravidade de Doença , Síndrome da Pele Escaldada Estafilocócica/complicações , Síndrome da Pele Escaldada Estafilocócica/diagnóstico , Staphylococcus aureus , Índices de Gravidade do TraumaAssuntos
Impetigo/diagnóstico , Staphylococcus aureus Resistente à Meticilina , Escarlatina/diagnóstico , Choque Séptico/diagnóstico , Infecções Estafilocócicas/diagnóstico , Síndrome da Pele Escaldada Estafilocócica/diagnóstico , Abscesso/microbiologia , Criança , Diagnóstico Diferencial , Emergências , Humanos , Impetigo/terapia , Fatores de Risco , Escarlatina/terapia , Choque Séptico/microbiologia , Choque Séptico/terapia , Dermatopatias Vesiculobolhosas/etiologia , Dermatopatias Vesiculobolhosas/terapia , Infecções Estafilocócicas/terapia , Síndrome da Pele Escaldada Estafilocócica/terapiaAssuntos
Dermatopatias Vesiculobolhosas/diagnóstico , Candidíase/diagnóstico , Candidíase/terapia , Diagnóstico Diferencial , Eosinofilia/diagnóstico , Eosinofilia/terapia , Eritema/diagnóstico , Eritema/terapia , Foliculite/diagnóstico , Foliculite/terapia , Herpes Simples/diagnóstico , Herpes Simples/terapia , Humanos , Recém-Nascido , Melanose/diagnóstico , Melanose/terapia , Miliária/diagnóstico , Miliária/terapia , Escabiose/diagnóstico , Escabiose/terapia , Dermatopatias Vesiculobolhosas/terapia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/terapia , Síndrome da Pele Escaldada Estafilocócica/diagnóstico , Síndrome da Pele Escaldada Estafilocócica/terapia , Staphylococcus aureus , Sífilis Congênita/diagnóstico , Sífilis Congênita/terapiaRESUMO
Vesiculobullous disorders are thankfully uncommon. A brief overview of the literature is presented together with our experience of managing these cases on a paediatric burns unit in the six years 1992 1998. The advantages of management on such a unit are outlined and include a facility for major dressings and frequent changes and a familiarity with fluid resuscitation in the child with major skin loss. The financial cost of treatment and rehabilitation of these children is high.
Assuntos
Dermatopatias Vesiculobolhosas , Unidades de Queimados , Pré-Escolar , Epidermólise Bolhosa Juncional/patologia , Epidermólise Bolhosa Juncional/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Dermatopatias Vesiculobolhosas/patologia , Dermatopatias Vesiculobolhosas/terapia , Síndrome da Pele Escaldada Estafilocócica/patologia , Síndrome da Pele Escaldada Estafilocócica/terapia , Síndrome de Stevens-Johnson/patologia , Síndrome de Stevens-Johnson/terapiaRESUMO
Staphylococcal scalded-skin syndrome, an exfoliative dermopathy, affects neonatal and infant children. A classification of this disorder, as well as etiology and therapeutic modalities, is discussed. Topical medications such as used for treating partial-thickness burns cannot always be used in the newborn because of potential toxicity. Supportive therapy, specific antibiotics, and relatively inert dressings are recommended.
Assuntos
Síndrome da Pele Escaldada Estafilocócica/patologia , Infecções Cutâneas Estafilocócicas/patologia , Diagnóstico Diferencial , Humanos , Recém-Nascido , Masculino , Síndrome da Pele Escaldada Estafilocócica/diagnóstico , Síndrome da Pele Escaldada Estafilocócica/terapia , Síndrome de Stevens-Johnson/diagnósticoRESUMO
Burn units bring together resources to manage large complex wounds, organ failures, and the hypermetabolic response to injury. These resources can also facilitate management of other problems such as purpura fulminans, toxic epidermal necrolysis, staphylococcal scalded skin syndrome, and major mechanical soft-tissue injuries. During a recent 10-year interval 2.4% of all acute admissions to a regional pediatric burn facility were in this category and form the basis for this review.
Assuntos
Unidades de Queimados , Recursos em Saúde , Dermatopatias/terapia , Lesões dos Tecidos Moles/terapia , Doença Aguda , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Púrpura/terapia , Síndrome da Pele Escaldada Estafilocócica/terapia , Síndrome de Stevens-Johnson/terapiaRESUMO
Staphylococcal scalded skin syndrome (SSSS) mainly affects infants and young children. Very few cases of adult SSSS have been reported. Adult SSSS is usually associated with immunosuppression, overwhelming sepsis, and kidney failure. We report the case of an immunocompetent 51-year-old woman without renal failure who sustained SSSS after a 7-day course of oral prednisone administered postoperatively.