Makhoul I R, Kassis I, Hashman N, Sujov P
Department of Neonatology, Rambam Medical Center and Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Pediatrics. 2001 Jul;108(1):E16. doi: 10.1542/peds.108.1.e16.
Exfoliative skin diseases are rare in neonates. When caused by coagulase-positive Staphylococcus aureus, scalded-skin diseases such as staphylococcal scalded-skin syndrome (SSSS), bullous impetigo, and staphylococcal scarlet fever may develop. These diseases might cause significant complications and mortality. SSSS is caused by staphylococcal exfoliative toxins A or B, which split the granular layer of the skin, induce proteolysis, and might exhibit superantigen activities, such as epidermolysis and lymphocyte mitogenicity. We describe a 1378-g premature male infant who was born at 29 weeks' gestation and developed SSSS on day 3 of life, with no clinical signs of neonatal sepsis. After cultures from the lesion and bloodstream were obtained, intravenous cloxacillin therapy was started. Infection control measures were implemented instantly and included isolation of the infected infant, personnel handwashing with hexachlorophene, and placement of exposed neonates into a cohort. The initial lesion expanded and additional lesions appeared, but 12 hours after initiation of antibacterial therapy, the lesions ceased to proliferate. Cultures from scalded-skin lesions grew coagulase-positive Staphylococcus aureus, whereas the bloodstream culture was sterile. The lesions resolved completely within 6 days, and the infant's subsequent course was uneventful. No similar skin lesions were noticed in other infants in the neonatal intensive care unit. We discuss recent advances in understanding the pathogenesis of neonatal SSSS, highlight the importance of early diagnosis and treatment, and stress the need for new adjunctive therapies for this disease.
剥脱性皮肤病在新生儿中较为罕见。由凝固酶阳性金黄色葡萄球菌引起时，可能会发展为烫伤样皮肤疾病，如葡萄球菌烫伤样皮肤综合征（SSSS）、大疱性脓疱疮和葡萄球菌性猩红热。这些疾病可能会导致严重的并发症和死亡。SSSS由葡萄球菌剥脱毒素A或B引起，它们会分离皮肤的颗粒层，诱导蛋白水解，并且可能表现出超抗原活性，如表皮松解和淋巴细胞促有丝分裂活性。我们报告一例1378克的早产男婴，孕29周出生，出生后第3天患SSSS，无新生儿败血症的临床体征。在从病变部位和血液中获取培养物后，开始静脉滴注氯唑西林治疗。立即实施了感染控制措施，包括隔离感染婴儿、用六氯酚洗手以及将暴露的新生儿集中安置。最初的病变扩大并出现了新的病变，但在开始抗菌治疗12小时后，病变停止扩散。烫伤样皮肤病变的培养物培养出凝固酶阳性金黄色葡萄球菌，而血培养无菌。病变在6天内完全消退，婴儿随后的病程平稳。新生儿重症监护病房的其他婴儿未出现类似的皮肤病变。我们讨论了新生儿SSSS发病机制的最新进展，强调了早期诊断和治疗的重要性，并强调了针对该疾病新辅助治疗的必要性。
