Generalized Staphylococcal Scalded Skin Syndrome in an Anephric Boy Undergoing Hemodialysis

Borchers, Stephen L.; Gomez, Edward C.; Isseroff, R. Rivkah

doi:10.1001/archderm.1984.01650430098018

Cited by 22 publications

(7 citation statements)

References 44 publications

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“…Patients undergoing haemodialysis are at risk of SSSS due to infection by S . aureus via vascular access port, an inability to excrete ET, and the immunological deficits that accompany renal failure . Of the two exotoxins that are firmly linked to producing SSSS, ETA and ETB, the latter appears to be the more virulent.…”

Section: Risk Factorsmentioning

confidence: 99%

“…Unlike paediatric patients with SSSS, adults may present differently; a majority of adults grow S . aureus from blood cultures (Table ) . In addition, as opposed to paediatric patients who are usually in otherwise good health when they develop SSSS, virtually all adults with SSSS were immunocompromised, with chronic renal disease, HIV infection, graft‐versus‐host disease, malignant neoplasms, chemotherapy, intravenous drug abuse or diabetes mellitus .…”

Section: Clinical Features In Adultsmentioning

confidence: 99%

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Staphylococcal scalded skin syndrome: diagnosis and management in children and adults

Handler

Schwartz

2014

Acad Dermatol Venereol

130

135

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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.

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Section: Risk Factorsmentioning

confidence: 99%

Section: Clinical Features In Adultsmentioning

confidence: 99%

Staphylococcal scalded skin syndrome: diagnosis and management in children and adults

Handler

Schwartz

2014

Acad Dermatol Venereol

130

135

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“…In one study, only 3% of children had a positive blood culture (101), in contrast to 20 (62.5%) of 32 adults (48). Of note, children with renal disease tend to have bacteremia with generalized SSSS rather than the localized form (34). Bacteriological studies of the skin are not usually useful in differentiating SSSS from TEN, since the skin of patients with generalized SSSS is usually sterile and that of patients with TEN is often colonized by S. aureus (67,236).…”

Section: Diagnosis and Investigationsmentioning

confidence: 99%

Clinical, Microbial, and Biochemical Aspects of the Exfoliative Toxins Causing Staphylococcal Scalded-Skin Syndrome

et al. 1999

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SUMMARY The exfoliative (epidermolytic) toxins of Staphylococcus aureus are the causative agents of the staphylococcal scalded-skin syndrome (SSSS), a blistering skin disorder that predominantly affects children. Clinical features of SSSS vary along a spectrum, ranging from a few localized blisters to generalized exfoliation covering almost the entire body. The toxins act specifically at the zona granulosa of the epidermis to produce the characteristic exfoliation, although the mechanism by which this is achieved is still poorly understood. Despite the availability of antibiotics, SSSS carries a significant mortality rate, particularly among neonates with secondary complications of epidermal loss and among adults with underlying diseases. The aim of this article is to provide a comprehensive review of the literature spanning more than a century and to cover all aspects of the disease. The epidemiology, clinical features, potential complications, risk factors, susceptibility, diagnosis, differential diagnoses, investigations currently available, treatment options, and preventive measures are all discussed in detail. Recent crystallographic data on the toxins has provided us with a clearer and more defined approach to studying the disease. Understanding their mode of action has important implications in future treatment and prevention of SSSS and other diseases, and knowledge of their specific site of action may provide a useful tool for physiologists, dermatologists, and pharmacologists.

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“…Blood cultures were positive for S. aureus in fewer than 3% of children with SSSS. 40 In our review of the literature, 18 (46.2%) of the 39 patients with SSSS had a positive blood However, in our patient, ET-producing MRSA strains, isolated from blood and bile cultures, were the organisms responsible for SSSS, while ET-non-producing MRSA and MSSA, isolated from skin lesion, pharyngeal swab, and nasal swab, were coincidental. From the results of the coagulase and phage typing, MRSA isolated from blood culture was identical to that isolated from bile culture; thus, the portal entry for the MRSA infection may have been the biliary tract.…”

Section: Discussionmentioning

confidence: 52%

Staphylococcal scalded-skin syndrome in an adult due to methicillin-resistant Staphylococcus aureus

Ito

Yoh

Toda

et al. 2002

Journal of Infection and Chemotherapy

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Generalized Staphylococcal Scalded Skin Syndrome in an Anephric Boy Undergoing Hemodialysis

Cited by 22 publications

References 44 publications

Staphylococcal scalded skin syndrome: diagnosis and management in children and adults

Staphylococcal scalded skin syndrome: diagnosis and management in children and adults

Clinical, Microbial, and Biochemical Aspects of the Exfoliative Toxins Causing Staphylococcal Scalded-Skin Syndrome

Staphylococcal scalded-skin syndrome in an adult due to methicillin-resistant Staphylococcus aureus

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