Week 3 - Case 1 Flashcards
What causes SSSS and what does SSSS stand for?
Staphylococcal Scalded Skin Syndrome
-It’s cause by Staphylococcus aureus and a previous systemic infection
What does VINDICATE stand for?
Vascular Infection (viral, bacterial, fungal) Neoplasm Drugs (medications or illicit drugs) Inflammatory/Idiopathic Congenital Autoimmune Trauma Endocrine/Metabolic
What does a typical SSSS case involve?
Ill child for the past few weeks, runny nose, not eating well, generalized rash, red eyes, red tounge, slightly inflamed throat, a few large cervical lymph nodes
- General erythematous rash present with exfoliation on the face, back of the neck, ears and feet (red, flaking skin)
- Do a skin culture to confirm your diagnosis
What is childhood exanthema?
A skin rash accompanying a disease or fever
What are possible causes of Childhood Exanthema?
- Viral Exanthemas
- Scarlet fever
- Thermal burns
- Pemphigus
- Kawasaki disease
- SSSS
What is associated with the chicken pox virus?
Varicella zoster - prodrome of fever and malaise
-Rash with blisters followed by scabs on body and head
Diagnosis: can culture lesions but most diagnosis made by history and exam
What causes fifths disease?
This is also “slapped cheeks” syndrome caused by Parvovirus B19.
-It is associated with fever and joint pain.
Diagnosis is done by history and exam, no lab.
What is pemphigus? What does this disease create antibodies against?
-Blistering, autoimmune disease
-Autoantibodies against desmoglein, which glues epidermal cells together
Diagnosis: Skin punch biopsy
What organism causes scarlet fever and how does the disease progress?
Group A strep -Begins with fever and sore throat -Rash begins on neck and chest -Red tongue with white patch on back of tongue Diagnosis: throat swab for strep antigen
What does Kawasaki disease cause and how is it diagnosed?
-Autoimmune vasculitis
-Affects skin, mucous membrane, blood vessels and heart
-High fever and rash, red eyes, enlarged lymph nodes
Diagnosis: history and physical only, no lab that helps
SSSS - what does the gram stain look like?
Gram +, purple, cocci in clusters/clumps
Staphylococcus aureus
What is a diagnostic test to determine if an organism is SSSS? What toxins does SSSS produce?
The staph should be coagulase positive. Releases exfoliatin (epidermolysin), an extracellular toxin
What is the typical presentation of SSSS?
-Erythematous rash near eyes and mouth, red eyes (conjunctiva), exfoliation of skin
-Can occur in newborns or babies
-Starts as skin redness followed by exfoliation of skin 2-5 days later
-Typically associated with fever
Diagnosis: based on history and appearance
Lab test: CRP increased, platelet count normal, Grams stain positive, blood or tissue cultures will confirm the diagnosis later
What does the exfoliatin toxin do?
It splits the upper epidermis below the granular cell layer.
How to treat SSSS?
- Beta-lactamase resistant Penicillin (ampicillin/sulbactam) or Penicillinase-resistant penicillin (Nafcillin)
- Isolate the child - easily transmitted
