Korean J Pediatr Infect Dis.  2007 May;14(1):83-90. 10.14776/kjpid.2007.14.1.83.

A clinical review of community acquired methicillin resistant staphylococcal scalded skin syndrome

• Heo SY
• Song YJ
• Kim SJ
• Park SY
• Kang DC
• Ma SH

• KMID: 2439967
• DOI: http://doi.org/10.14776/kjpid.2007.14.1.83

Abstract

PURPOSE
Staphylococcal scalded skin syndrome (4S) is a well known disease defined by clinical, microbiological and histological criteria caused by Staphylococcus aureus. This disease is uncommon but has been increasingly recognized. We investigated the clinical features of staphylococcal scalded skin syndrome.
METHODS
We reviewed retrospectively medical records of 53 patients diagnosis of staphylococcal scalded skin syndrome who were admitted to Changwon Fatima hospital from February 2002 to December 2005. These patients were divided into 3 clinical types; generalized type, intermediate type, abortive type. Age, sex ratio, clinical manifestations, laboratory findings, response to therapy and prognosis were investigated. RESULT: 1)The mean age of patients was 2.8 years, ranging from 20 days to 7 years. Male-to-female ratio was 1.9:1. 2) By clinical types, 6 patients were in the generalized type (11%), 29 patients in the intermediate type (55%), 18 patients in the abortive type (34%). The coexisting diseases were variable, including conjunctivitis (25 cases), atopic dermatitis (11 cases), otitis media (1 case). On laboratory findings, most of patients didn't have leukocytosis or increased C-reactive protein. 4) A total of fifteen Methicillin Resistant Staphylococcal Aureus (MRSA) strains were isolated from September 2003 through December 2005. Fourteen strains were positive for exfoliative toxin B gene by PCR and negative for enterotoxin, toxic shock syndrome toxin and Panton-Valentine leukocidin genes. 5) The mean duration of admission was 7.3 days. Patients were treated with vancomycin or amoxacillin/clavulanate or ampicillin/sulbactam or cefuroxime without significant sequelaes.
CONCLUSION
Recently, Staphylococcal scalded skin syndrome caused by exfoliative toxin B produced by MRSA in the Changwon area has been increasing.

Keyword

Community acquired methicillin resistant Staphylococcus aureus; Staphylococcal scalded skin syndrome; Exfoliative toxin B

MeSH Terms

C-Reactive Protein
Cefuroxime
Conjunctivitis
Dermatitis, Atopic
Diagnosis
Enterotoxins
Exfoliatins
Gyeongsangnam-do
Humans
Leukocidins
Leukocytosis
Medical Records
Methicillin Resistance*
Methicillin*
Methicillin-Resistant Staphylococcus aureus
Otitis Media
Polymerase Chain Reaction
Prognosis
Retrospective Studies
Sex Ratio
Shock, Septic
Staphylococcal Scalded Skin Syndrome*
Staphylococcus aureus
Vancomycin
C-Reactive Protein
Cefuroxime
Enterotoxins
Exfoliatins
Leukocidins
Methicillin
Vancomycin