Regional outbreak of staphylococcal scalded skin syndrome in healthy children

Abstract

= Abstract = Purpose : Staphylococcal scalded skin syndrome (SSSS) is a relatively uncommon superficial blistering skin disease that is due to Staphylococcus aureus. We had experienced a regional outbreak of SSSS over 3 years in healthy children. Methods : We retrospectively reviewed the medical records of those patients diagnosed as SSSS. Most of neonatal cases were nosocomial infections and excluded from the analysis. The clinical features, laboratory findings, the isolation and antibiotic resistance of S. aureus, the antibiotic management and other supportive treatments were analyzed. Results : Fifty-five patients with SSSS were admitted to our hospital from October 2001 to September 2004. The median age of patients was 3.0 years. Of the 55 patients, 9 were the generalized type, 13 were the intermediate type and 33 were the scarletiniform rash. All the patients were living in neighborhood of the Jinju area. S. aureus were isolated from 9 of the patients and all of the isolated S. aureus were methicillin resistant. All the patients except two were treated with intravenous flocloxacillin or nafcillin and/or cefotaxime. All the patients recovered during the follow-up period of 2 to 3 weeks. Conclusion : We experienced a regional outbreak of SSSS in previous healthy children. Further study for finding the carriers of S. aureus caused SSSS and preventing the spread of this disease is needed. Additionally, guidelines for treating SSSS due to methicillin resistant S. aureus should be established. (Korean J Pediatr 2010;53:48-55)

The spectrum of staphylococcal scalded skin syndrome: a case series in children

“…Although the reason for the clinical variability in SSSS is unknown, differences in toxin load have been hypothesized to play a role, with milder phenotypes possibly occurring in patients with increased renal toxin clearance and/or higher levels of neutralizing antibodies . Despite this variability, our case series and previous articles demonstrate that the spectrum of SSSS is unified by some degree of desquamation in sites prone to friction: periorificial, flexural and/or acral …”

“…While this classic severe phenotype is widely recognized in children, SSSS in fact exists on a spectrum with mild and moderate variants. [2][3][4][5] Understanding the variability of SSSS is crucial as the condition is potentially fatal; however, with medical management, the mortality rate in children is as low as 0.33%. 6 To increase awareness of the heterogeneity of SSSS, we report four cases that represent a range of phenotypes.…”

“…Treatment of mild SSSS has included oral, IV and intramuscular antibiotics. [2][3][4][5] In one case series, all patients improved with IV antibiotics, although the authors stated that 'oral treatment might have been sufficient'. 3 In our cases, owing to diagnostic uncertainty, the GPS empirically started IV antibiotics and continued them while cultures were pending, as all patients had started to improve.…”

“…3 Despite this variability, our case series and previous articles demonstrate that the spectrum of SSSS is unified by some degree of desquamation in sites prone to friction: periorificial, flexural and/or acral. [2][3][4][5] Bullous impetigo is considered a localized form of SSSS in which the presence of exfoliative toxins A and/or B is limited to site(s) of mucocutaneous S. aureus infection. If haematogenous dissemination of these toxins occurs, impetigo may progress to SSSS, as was the case with Patient 4.…”

“…In addition, patients are traditionally febrile, irritable, lethargic and anorexic. While this classic severe phenotype is widely recognized in children, SSSS in fact exists on a spectrum with mild and moderate variants . Understanding the variability of SSSS is crucial as the condition is potentially fatal; however, with medical management, the mortality rate in children is as low as 0.33% .…”