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

Mazori, Daniel R.; Leonard, Alexis; Alexander, J. B.; Glick, Sharon A.

doi:10.1111/ced.14116

Cited by 4 publications

(8 citation statements)

References 8 publications

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“…As previously described, preceding cutaneous infection and URI symptoms were common prior to onset of rash 11 . The majority of patients presented with superficial desquamation whereas only a portion presented with blisters, suggesting different points of presentation within their disease course 18 . The most common vital sign abnormality at presentation was fever (45.6%), followed by tachycardia in a total of 10 patients (8.5%).…”

Section: Discussionmentioning

confidence: 63%

Staphylococcal scalded skin syndrome: Clinical features, ancillary testing, and patient management

Gray

Olson

Brintz

et al. 2022

Pediatric Dermatology

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Background/Objectives: The utility of ancillary testing in improving diagnostic precision or improving patient outcomes in staphylococcal scalded skin syndrome (SSSS) is unclear. Similarly, an optimal antibiotic regimen has yet to be established. Our goal was to describe clinical characteristics and ancillary work-up of SSSS, report bacterial resistance patterns, and examine patient outcomes under varying therapeutic strategies with the aim of developing an evidence-based management algorithm.Methods: We performed a retrospective review of pediatric patients diagnosed with SSSS at Intermountain Healthcare facilities between 2010 and 2021. A Kruskal-Wallis rank sum test was used to assess median length of stay between different antibiotic regimens.Results: Eighty-five cases were identified. The most common ancillary tests obtained were a complete blood count (88%), followed by chemistry analysis (80%). Blood cultures were collected in more patients (79%) compared to aerobic cultures (60%). No blood culture was positive for Staphylococcus aureus. All S. aureus isolates were methicillin-sensitive. Of those found resistant to clindamycin (36%), all demonstrated macrolide-induced clindamycin resistance. None were constitutively resistant to clindamycin. There was no statistical difference between antibiotic regimen and length of stay (p = .691). Receiving opiate medications was the only risk factor associated with prolonged hospitalization (p = .001). Conclusions: Ancillary testing does not improve diagnostic precision and can be reduced. Clindamycin does not improve patient outcomes, suggesting beta-lactams should be considered first line. Susceptibility patterns in our cohort demonstrate inducible clindamycin resistance as opposed to constitutive. K E Y W O R D S antibiotics, clindamycin, length of stay, staphylococcal scalded skin syndrome, treatment 1 | BACKGROUND Staphylococcal scalded skin syndrome (SSSS) is a rare, toxin-mediated desquamating skin disease caused by the bacterium Staphylococcus aureus. The disease is caused by exfoliative toxins A and B (ETA and ETB) on phage type 2 staphylococci, strains 71 and 55. Clinical manifestations include fragile bullae, desquamation, a positive Nikolsky sign and crusting around the nose, eyes, and mouth. 1,2 SSSS is considered a clinical diagnosis that can made by patient history and physical exam. Nonetheless, multiple ancillary tests are frequently sought during work-up. Retrospective cohort reviews indicate such testing does not improve patient outcomes. In a study by

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Section: Discussionmentioning

confidence: 63%

Staphylococcal scalded skin syndrome: Clinical features, ancillary testing, and patient management

Gray

Olson

Brintz

et al. 2022

Pediatric Dermatology

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“…If cultures are obtained, they are usually negative in children, as in this case [1]. Many of the case reports reviewed reported negative or inconclusive cultures as well [3][4][5][6][7]. Literature suggests that routine cultures are not necessary unless the child is at risk for bacteremia, such as a febrile neonate, an immunocompromised child, or a child with a serious illness [1].…”

Section: Discussionmentioning

confidence: 99%

“…Cephalosporins and anti-staphylococcal penicillins are the mainstays of treatment. Clindamycin, although not necessary for coverage, is commonly used in conjunction with these drugs because of its ability to inhibit S. aureus toxin production [5]. Flucloxacillin with clindamycin is the most commonly reported regimen in the literature [1,[4][5][6][7][8][9][10][11][12].…”

Section: Discussionmentioning

confidence: 99%

“…A notable aspect of this case is the lack of immunodeficiency in this patient. Several case reports in the literature present cases of SSSS in infants who are days to weeks old, making it understandable why they may be immunodeficient as their immune systems have not yet had time to develop [5,7,8,10,13].…”

Section: Discussionmentioning

confidence: 99%

“…Although SSSS is seen more often in children, performing a PubMed literature search of case reports using keywords "staphylococcal scalded skin syndrome" and filtering to include infants aged birth to 23 months returned only 16 published case reports within the last ten years. Of the 16 case reports identified, several presented with a clear source of infection [3][4][5][6][7][8] or clear signs of infection upon initial presentation of a desquamating rash [9]. Here, we present a case of SSSS with an uncommon presentation as the only initial signs were cutaneous edema and erythema with a subacute onset of severe infection rather than the acute presentation that typically occurs with SSSS.…”

Section: Introductionmentioning

confidence: 94%

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Staphylococcal Scalded Skin Syndrome in a Ten-Month-Old Male

Baatz¹,

Holley²,

Ahlert³

et al. 2022

Cureus

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A 10-month-old male presented with rhinorrhea and decreased oral intake and was diagnosed with an upper respiratory infection. Two days later, he returned to the clinic due to a lack of improvement and the onset of new symptoms, including facial edema and perioral skin irritation. That evening, he became febrile at 100.4 °F and went to the emergency department at the local children's hospital. No further workup was done and the parents were instructed to continue with the current treatment regimen. Over the next 48 hours, the patient's symptoms worsened with the new onset of bilateral extremity edema and desquamation. The patient was returned to the emergency department. A physical exam was notable for a blanching, desquamating, erythematous rash on the face and creases of the arms, legs, and groin. A positive Nikolsky sign was reported. A clinical diagnosis of staphylococcal scalded skin syndrome (SSSS) was made, and the patient was started on intravenous clindamycin. This case illustrates a severe presentation of SSSS in a pediatric patient, demonstrating the challenges it poses to diagnosis and treatment.

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A review of staphylococcal scalded skin syndrome

Medugu,

Imran,

Musa-Booth

et al. 2023

Af J Clin Exp Micro

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Staphylococcal scalded skin syndrome (SSSS) is characterized by widespread epithelial necrosis and/or superficial blistering of the skin following infection by some toxigenic strains of Staphylococcus aureus. The disease primarily affects children under the age of 5 years, but it can also occur in adults. Due to the recent increase in reported cases of SSSS, we have reviewed the epidemiology, pathogenesis, clinical features, diagnosis, treatment, and prevention, including the development of vaccines for S. aureus infections. Electronic databases including PubMed, Google Scholar and websites of the Center for Disease Prevention and Control (CDC), and the World Health Organization (WHO), were searched for publications on SSSS written in English language. Our review showed that SSSS is more common in children, amongst whom it carries a mortality rate of <5%, as opposed to mortality rate of >50% in affected adults. Penicillinase-resistant penicillins are recommended for the treatment of SSSS, and administration of fresh frozen plasma (FFP) may aid early recovery. Important staphylococcal vaccine candidates are also highlighted in the review.

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

Cited by 4 publications

References 8 publications

Staphylococcal scalded skin syndrome: Clinical features, ancillary testing, and patient management

Staphylococcal scalded skin syndrome: Clinical features, ancillary testing, and patient management

Staphylococcal Scalded Skin Syndrome in a Ten-Month-Old Male

A review of staphylococcal scalded skin syndrome

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