Neonatal staphylococcal scalded skin syndrome: clinical and outbreak containment review

Abstract

Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated exfoliating skin condition predominated by desquamation and blistering. Neonatal outbreaks have already been reported; however, our outbreak highlights the potential for SSSS following neonatal health promotion measures such as intra-muscular vitamin K administration and metabolic screening (heel prick) as well as effective case containment measures and the value of staff screening. Between February and June 2007, five confirmed cases of neonatal SSSS were identified in full-term neonates born in an Irish regional maternity hospital. All infants were treated successfully. Analysis of contact and environmental screening was undertaken, including family members and healthcare workers. Molecular typing on isolates was carried out. An outbreak control team (OCT) was assembled and took successful prospective steps to prevent further cases. All five Staphylococcus aureus isolates tested positive for exfoliative toxin A, of which two distinct strains were identified on pulsed-field gel electrophoresis analysis. Two cases followed staphylococcal inoculation during preventive measures such as intra-muscular vitamin K administration and metabolic screening (heel prick). None of the neonatal isolates were methicillin resistant. Of 259 hospital staff (70% of staff) screened, 30% were colonised with S. aureus, and 6% were positive for MRSA carriage. This is the first reported outbreak of neonatal SSSS in Ireland. Effective case containment measures and clinical value of OCT is demonstrated. Results of staff screening underlines the need for vigilance and compliance in hand disinfection strategies in maternity hospitals especially during neonatal screening and preventive procedures.

Exantemas escarlatiniformes en la infancia

“…La incidencia de esta enfermedad es mayor en recién nacidos, en quienes se llamó pénfigo neonatorum de Ritter, y en menores de cinco años, por disminución en la depuración de las toxinas, falta de anticuerpos antitoxina o ambas cosas. Esta entidad rara vez afecta los adultos 3,4,12,17 . El foco más frecuente son las infecciones leves de las vías respiratorias superiores y, con menor frecuencia, de las conjuntivas, la región perioral, el ombligo, el periné y el sistema urinario.…”

Rapid containment of nosocomial transmission of a rare community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) clone, responsible for the Staphylococcal Scalded Skin Syndrome (SSSS)

“…These toxins induce epidermal blistering through the cleavage of the cell-cell adhesion molecule desmoglein-1, which is only expressed by keratinocytes in the granular cell layer, leading to a spectrum of illnesses ranging from mild localized blistering to extensive generalized lesions [2, 5]. ETs producing S. aureus strains have been associated with specific genetic backgrounds, on the basis of their phage types, accessory gene regulator ( agr ) groups and macrorestriction profiles [3–10]. …”

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

“…12 Neonates are also exposed to the risk of acquiring infections caused by Staphylococcus aureus, which colonizes both mothers and staff in the hospital environment, 13,14 considering that one third of the immunocompetent population carries this microorganism. 6 The resistance presented by methicillin-resistant Staphylococcus aureus extends to all β-lactam antibiotics and therefore this is an etiological agent of utmost importance, with regard to both nosocomial infections (hospital-acquired methicillin-resistant…”

“…9 It has been suggested that the action of these toxins is due to their ability to cleave: thus, a protease that targets desmoglein desmosomal adhesion molecule-1 10 leads to loss of cell-to-cell contact in the epidermis,bubbles that are fragile and burst easily, which leaves this area of skin wet and unprotected, such that development of this syndrome is favored. 6 In neonates, staphylococcal scalded skin syndrome produces strains that colonize sites such as the nose and umbilical cord. 12 Neonates are also exposed to the risk of acquiring infections caused by Staphylococcus aureus, which colonizes both mothers and staff in the hospital environment, 13,14 considering that one third of the immunocompetent population carries this microorganism.…”