Staphylococcal scalded skin syndrome in a premature newborn caused by methicillin-resistant Staphylococcus aureus: case report

Abstract

CONTEXT: Staphylococcal scalded skin syndrome is an exfoliative skin disease. Reports of this syndrome in newborns caused by methicillin-resistant Staphylococcus aureus are rare but, when present, rapid diagnosis and treatment is required in order to decrease morbidity and mortality. CASE REPORT: A premature newly born girl weighing 1,520 g, born with a gestational age of 29 weeks and 4 days, developed staphylococcal scalded skin syndrome on the fifth day of life. Cultures on blood samples collected on the first and fourth days were negative, but Pseudomonas aeruginosa and Enterococcus sp. (vancomycin-sensitive) developed in blood cultures performed on the day of death (seventh day), and Pseudomonas aeruginosa and Serratia marcescens were identified in cultures on nasopharyngeal, buttock and abdominal secretions. In addition to these two Gram-negative bacilli, methicillin-resistant Staphylococcus aureus was isolated in a culture on the umbilical stump (seventh day). The diagnosis of staphylococcal scalded skin syndrome was based on clinical criteria. RESUMO CONTEXTO:A síndrome da pele escaldada estafilocócica é uma doença esfoliativa de pele. São raros os relatos desta síndrome causada por Staphylococcus aureus resistente à meticilina em neonatos, mas, quando presentes, exigem diagnóstico e tratamento rápidos para diminuir a morbidade e mortalidade. RELATO DE CASO: Uma menina recém-nascida prematura, pesando 1.520 g ao nascimento, com idade gestacional de 29 semanas e 4 dias, desenvolveu síndrome da pele escaldada estafilocócica no quinto dia de vida. As culturas de sangue coletadas no primeiro e quarto dias foram negativas, mas houve desenvolvimento de Pseudomonas aeruginosa e Enterococcus sp. (vancomicina sensível) na hemocultura realizada no dia do óbito (sétimo dia) e Pseudomonas aeruginosa e Serratia marcescens foram identificadas nas culturas de secreção da nasofaringe, nádega e da secreção abdominal. Na cultura do coto umbilical (sétimo dia), além desses dois bacilos Gram-negativos, foi isolado o Staphylococcus aureus resistente à meticilina. O diagnóstico da síndrome da pele escaldada estafilocócica foi baseado em critério clínico.

Recurrent Staphylococcal Scalded Skin Syndrome in an Extremely Low-Birth-Weight Neonate

“…17 Two other case studies reported fatal septicemia due to Pseudomonas aeruginosa following development of SSSS in neonates. 18,19 The recurrence in our infant may be secondary to the combination of decreased renal clearance of exotoxins in addition to the immature immune system of ELBW infant and inability to develop antibody response to the toxin. Renal immaturity in infants decreases the ability to clear the epidermotrophic toxins.…”

Pediatric cutaneous emergencies and their outcome: Study from a tertiary care center in South India

“…Methicillin-resistant Staphylococcus aureus (MRSA) prevalence in children was 21.9% in a hospital-based Indian study,[19] which was seen in only two of our children (SSSS and Staphylococcal scarlatina). Fatality is reported in MRSA-induced SSSS,[20] stressing the importance to recognize and treat appropriately. The commonest presentation of rickettsial infection was fever with maculopapular exanthem except for one child who presented with purpura fulminans.…”

Staphylococcal scalded skin syndrome caused by methicillin-resistant Staphylococcus aureus with superadded fungal infection in a neonate

“…5,6 Factors that may be responsible for higher incidence of SSSS in neonates are lack of immunity to exfoliative toxins and renal immaturity which results in decreased clearance of the toxins. 7 There have been scattered reports of isolated cases of SSSS from different parts of India. 8,9 In our case, the condition of the neonate was further complicated by superadded fungal infection which is a rare presentation.…”