Abstract Ref Number = APCP976
A Case Series of Five Indonesian Neonates and Children with Staphylococcal Scalded Skin Syndrome
Rinda Martanti Riswandi,Ari Prayitno
Univ Indonesia Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
Background : Staphylococcal scalded skin syndrome (SSSS) is an acute blistering dermatosis due to exfoliative toxin released from Staphylococcus aureus, predominantly affected neonates and children due to their undeveloped immune system and renal capacity to excrete pathogenic toxins. This case series reports five cases of SSSS to describe clinical findings, diagnosis confirmation, antibiotic use and complications related to SSSS.
Case Presentation Summary : Of five cases reported, 60% were male ranging from 17 days to 3 years of age. Two cases had early nasopharyngeal infections and one case of otitis media, followed by a prodromal phase of fever. The clinical features comprise of generalized erythematous patches that developed within days to superficial epidermolysis, as toxin spread hematogenously. Laboratory results showed either leukocytosis, elevated C-reactive protein or procalcitonin. Skin swabs and blood culture were performed to support diagnosis. Only one case revealed positive S. aureus of conjunctiva culture and one case showed positive blood culture. Adequate fluid therapy was given at acute condition and intravenous ampicillin sulbactam was initiated as soon as clinical diagnosis confirmed. Topical fucidic acid 2% was attempted to eradicate colonization and emollients to moist the skin ruptures. Several complications were four bacterial conjunctivitis, one blepharitis and two otitis externa. Indication for hospitalization was to provide intravenous antibiotic, prompt hydration and clinical observation. Recovery of skin lesions was a sign of good response to therapy. The range of hospital stay was 5 to 9 days. Oral amoxicillin clavulanic acid was given at discharge for 10 to 14 days.
Learning Points/Discussion : Staphylococcal scalded skin syndrome was diagnosed clinically. Focal infections were varied; however, the clinical characteristics were similar at all ages and the predilections were usually generalized. Culture was rarely confirmed of S. aureus, either from blood or skin swab. Adequate hydration at initial phase and prompt intravenous antibiotic may prevent severe complications, resulted in good skin lesion recovery and short hospital stays.
Keywords: Staphylococcal scalded skin syndrome Neonates Children