Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Regional outbreak of staphylococcal scalded skin syndrome in healthy children

건강한 소아에서 포도알균화상피부증후군의 지역적 유행

  • Do, Hyun Jeong (Department of Pediatrics, Gyeongsang National University College of Medicine) ;
  • Park, Eun Sil (Department of Pediatrics, Gyeongsang National University College of Medicine) ;
  • Lim, Jae Young (Department of Pediatrics, Gyeongsang National University College of Medicine) ;
  • Park, Chan Hoo (Department of Pediatrics, Gyeongsang National University College of Medicine) ;
  • Woo, Hyang Ok (Department of Pediatrics, Gyeongsang National University College of Medicine) ;
  • Youn, Hee Shang (Department of Pediatrics, Gyeongsang National University College of Medicine) ;
  • Seo, Ji Hyun (Department of Pediatrics, Gyeongsang National University College of Medicine)
  • 도현정 (경상대학교 의과대학 소아과학교실) ;
  • 박은실 (경상대학교 의과대학 소아과학교실) ;
  • 임재영 (경상대학교 의과대학 소아과학교실) ;
  • 박찬후 (경상대학교 의과대학 소아과학교실) ;
  • 우향옥 (경상대학교 의과대학 소아과학교실) ;
  • 윤희상 (경상대학교 의과대학 소아과학교실) ;
  • 서지현 (경상대학교 의과대학 소아과학교실)
  • Received : 2009.05.15
  • Accepted : 2009.12.10
  • Published : 2010.01.15
Download PDF
⟨ Previous Next ⟩

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.

목 적 : 포도알균화상피부증후군(4S)은 황색 포도알균과 관련된 표재성 수포가 생기는 거의 드문 피부 질환이다. 저자들은 3세 이상의 건강한 소아에서 4S의 지역적 유행을 경험하였다. 방 법 : 저자들은 4S를 진단받았던 환아들을 대상으로 의학적 기록을 후향적으로 분석하였다. 신생아들의 경우 외인성 감염이 대부분이었으므로 이 연구에서 제외되었다. 임상적 특징, 실험 결과, 황색 포도알균의 항생제 내성과 분리, 항생제 치료와 보존적 치료법을 분석하였다. 결 과 : 2001년 10월부터 2004년 9월까지 본원에 입원하였던 4S를 진단받은 55명의 소아들을 대상으로 하였다. 환아들의 평균 나이는 3세였다. 55명의 환아 중에서 9명이 전신형, 13명이 중간형이었으며 나머지 33명이 성홍열모양 피부발진이 있었다. 모든 환아들은 진주의 인접한 지역에 살고 있었다. 황색 포도알균은 9명의 환아에서 분리되었고, 분리된 모든 황색 포도알균은 methicilline 저항성을 가지고 있었다. 2명을 제외한 환아들은 flocloxacillin 또는 nafcillin 또는 cefotaxime 정맥 주사로 치료하였다. 모든 환아들은 2-3주간의 추적 기간 동안 완전히 회복되었다. 결 론 : 저자들은 이전에 건강했던 소아들에서 4S의 지역적 유행을 경험하였다. 이 질환의 유행을 막기 위해서 4S를 일으키는 황색 포도알균의 매개체를 찾기 위한 더 많은 연구가 필요하다. 부가적으로 methicilline 저항성 황색 포도알균이 많으므로 4S를 치료하기 위한 지침서가 확립되어야 할 것으로 사료된다.

Keywords

References

  1. Patel GK, Finlay AY. Staphylococcal scalded skin syndrome: diagnosis and management. Am J Clin Dermatol 2003;4:165-75 https://doi.org/10.2165/00128071-200304030-00003
  2. Melish, ME. Staphylococci, streptococci and the skin: review of impetigo and staphylococcal scalded skin syndrome. Semin. Dermatol 1982;9:335-7
  3. Ladhani S, Joannou CL, Lochrie DP, Evans RW, Poston SM. Clinical, microbial and biochemical aspects of the exfoliative toxin causing staphylococcal scalded skin syndrome. Clin Microbiol Rev 1999;12:224-42
  4. Ladhani S, BSC M, Joannou CL. Difficulties in diagnosis and management of the staphylococcal scalded skin syndrome. Pediatr Infect Dis J 2000;19:819-21 https://doi.org/10.1097/00006454-200009000-00002
  5. Kang JD, Park SD. Reclassification of staphylococcal scalded skin syndrome by clinical analysis of 25 cases. Korean J Dermatol 2004;42:398-405
  6. Lyer S, Jones DH. Community-acquired methicillin-resistant Staphylococcus aureus skin infection; a retrospective analysis of clinical presentation and treatment of a local outbreak. J Am Acad Dermatol 2004;50:854-8 https://doi.org/10.1016/j.jaad.2003.12.043
  7. Dancer SJ, Simmons NA, Poston SM, Noble WC. Outbreak of staphylococcal scalded skin syndrome among neonates. J Infect 1988;16:87-103 https://doi.org/10.1016/S0163-4453(88)96249-4
  8. Dave J, Reith S, Nash JQ, Marples RR, Dulake C. A double outbreak of exfoliative-toxin producing strains of Staphylococcus aureus in a maternity unit. Epidemiol Infect 1994;112:103-14 https://doi.org/10.1017/S0950268800057460
  9. Farrell AM. Staphylococcal scalded-skin syndrome. Lancet 1999;354:880-1 https://doi.org/10.1016/S0140-6736(99)90120-4
  10. Curran JP, Al-Salihi FL. Neonatal staphylococcal scalded skin syndrome: massive outbreak due to an unusual phage type. Pediatrics 1980;66:285-90
  11. Faden HS, Burke JP, Glasgow LA, Everett JR 3rd. Nursery outbreak of scalded-skin syndrome. Scarletiniform rash due to phage group I Staphylococcus aureus. Am J Dis Child 1976;130:265-8
  12. Begier EM, Frenette K, Barrett NL, Mshar P, Petit S, Boxrud DJ, et al. A high-morbidity outbreak of methicillin-resistant Staphylococcus aureus among players on a college football team, facilitated by cosmetic body shaving and turf burns. Clin Infect Dis 2004;39:1446-53 https://doi.org/10.1086/425313
  13. Ladhani S, Newson T. Familial outbreak of staphylococcal scalded skin syndrome. Pediatr Infect Dis J 2000;19:578-9 https://doi.org/10.1097/00006454-200006000-00021
  14. Park JW, Hwang DK, Yu HS. Staphylococcal scalded skin syndrome, review of 20 cases. Korean J Dermatol 2002;40:1051-7

Cited by

  1. 2006년부터 2015년까지 창원 지역에서 발생한 지역사회관련 메티실린내성 황색포도알균에 의한 포도알균 열상 피부증후군의 임상양상 vol.26, pp.1, 2010, https://doi.org/10.14776/piv.2019.26.e5
  2. The spectrum of staphylococcal scalded skin syndrome: a case series in children vol.45, pp.3, 2020, https://doi.org/10.1111/ced.14116
  3. Staphylococcal scalded skin syndrome: An epidemiological and clinical review of 84 cases vol.38, pp.1, 2010, https://doi.org/10.1111/pde.14470