staphylococcal scalded skin syndrome in children
Introduction
Introduction to Staphylococcus aureus scalded skin syndrome in children This syndrome was first described by Ritter in 1878 and is believed to occur only in neonates or infants with specific dermatitis, also known as neonatal exfoliative dermatitis, also known as neonatal pemphigus, which was later named Ritter syndrome. At present, the golden grape scalded skin syndrome is called according to the cause, pathology, treatment and prognosis, and the drug is the main cause, including other types and special hairstyles. The toxic epidermal necrolysis is called non-gold grape exfoliative dermatitis (TEN). ). This syndrome is characterized by redness and swelling of the whole body, large exfoliation, and scalded rosy wounds. It is a serious skin disease. basic knowledge Sickness ratio: 0.05% Susceptible people: infants and young children Mode of infection: non-infectious Complications: sepsis, cellulitis, pneumonia
Cause
Causes of Staphylococcus aureus scalded skin syndrome in children
Cause:
The pathogen is coagulase-positive Staphylococcus aureus, which belongs to phage group II, type 71 or 51/71, type 3B/71, which can produce epidermal toxins, which are exfoliated toxins, causing skin damage. Other authors have passed Radioimmunoassay was used to confirm the lack of anti-epidermal lysin antibody in the serum of patients with acute phase. However, this antibody was present in the serum of normal and convalescent patients. Therefore, the pathogenesis of this disease is Staphylococcus aureus infection and immune function. Low results.
Pathogenesis
Degeneration and necrosis of epidermal cells, fissure plane and blister formation in the upper granular layer of the epidermis, basophilic cells in the lower part of the epidermis, a small number of lymphocytes around the blood vessels, polymorphonuclear leukocytes, and tissue cell infiltration.
Prevention
Prevention of septic skin-like skin syndrome in children with Staphylococcus aureus
Do a good job of skin and mucous membrane cleaning to prevent infectious skin diseases.
Complication
Complications of Staphylococcus aureus scalded skin syndrome in children Complications sepsis cellulitis pneumonia
May be associated with lymphadenopathy, with symptoms of systemic poisoning, but also sepsis, cellulitis, pneumonia and so on.
Symptom
Symptoms of Staphylococcus aureus scalded skin syndrome Common symptoms Scab flaky dermatitis Redness pustule Mucosa damage Abdominal anorexia Drowsiness burns
According to the severity of clinical manifestations, it is divided into 3 types in children.
1. Neonatal exfoliative dermatitis type (week type) Most occur in newborns 1 to 5 weeks after birth. There are many skin or mucosal suppuration infections before onset, and the onset is urgent. The erythema occurs around the mouth or around the eyelids. 2 days spread to the trunk and limbs, the whole body skin is a generalized large erythema, loose blisters on the basis of erythema, Nissl's sign positive, skin wrinkles, a little friction to form a large piece of shedding, bare ruddy base wound Like scald, the skin of the hands and feet can be peeled off by gloves. After the exudate is crusted, a large piece of suede can be peeled off. Afterwards, the color of the erosion gradually changes from bright red to purple and dark red, no longer peeling off, and the scorpion is beginning to appear. The scraps can be cured after 7 to 14 days, and there are radial cleft palate in the mouth. Most children have obvious skin lesions, which may be accompanied by local lymphadenopathy, irritability, lethargy, bloating, anorexia and other systemic symptoms. , cellulitis, pneumonia, etc., mucosal damage is less common but may have cheilitis, stomatitis and conjunctivitis.
2. Bullous impetigo type (localized) occurs mostly in school-age children. The bullae are concentrated in the exposed parts of the body and around the mouth. There are red halos around the blisters, and most of the pustules can find pathogenic bacteria.
3. Scarlet fever-like rash type (set-down type) Skin lesions are scarlet-like erythema with obvious tenderness; the Pascal line can exist, but there is no bayberry tongue, the skin lesions start from the face, gradually develop to the whole body, no bullae, also No epidermal exfoliation, desquamation after 2 to 5 days, 10 days from the beginning of infection, conjunctivitis can be found in the pathogenic bacteria.
Examine
Examination of pediatric staphylococcal scalded skin syndrome
1. Blood samples were examined for peripheral blood leukocyte counts, and neutrophils were significantly increased.
2. Examination of pathogens Most pathogens can be found in the pustules. The pathogenic bacteria can be found from the conjunctivitis at the beginning of infection, and the blood culture is positive when the sepsis is caused.
Regular X-ray, B-ultrasound.
Diagnosis
Diagnosis and identification of septic skin-like skin syndrome in children with Staphylococcus aureus
According to the age of onset (1 to 5 weeks) and the clinical manifestations of loose bullae and epidermal exfoliation on the basis of erythema, and positive bacterial culture can be diagnosed.
Differential diagnosis
1. Neonatal impetigo rash is mainly pustule, no epidermal large exfoliation, Nissl's sign negative.
2. Desquamous erythroderma occurs in infants 2 to 4 months after birth. The rash often begins in the scalp and trunk, and is characterized by seborrheic dermatitis. The skin of the body is reddened with a history of fine gray scales and diarrhea. .
3. Drug-induced scalded skin syndrome (TEN) Adults, children also have a history of useful drugs before the disease, early morphological erythema lesions, mucosal damage, long course, more than 2 to 3 weeks, Pathological changes characterized by exfoliation of the entire epidermis, formation of blistering under the epidermis, damage to basal cells and deposition of IgG.
