Staphylococcal scalded skin syndrome (SSSS) is an exfoliative infectious disorder caused by the exfoliative toxins of Staphylococcus aureus. The condition usually affects infants and children younger than 5 years of age. However, SSSS is rarely observed in adults. Adult SSSS is usually associated with renal failure, immunosuppression, malignancy, alcohol abuse, or HIV infection. In contrast to infant cases, adult SSSS is often accompanied with a high mortality rate, sepsis and poor prognosis. We report a rare case of SSSS in an immunocompetent 34-year-old man without renal failure.
Adult ; Alcoholism ; Child ; Exfoliatins ; HIV Infections ; Humans ; Immunosuppression ; Infant ; Prognosis ; Renal Insufficiency ; Sepsis ; Staphylococcal Scalded Skin Syndrome ; Staphylococcus aureus

The prevalence and molecular characteristics of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) and methicillin-susceptible S. aureus (CA-MSSA) from children with skin infection were investigated by staphylocoagulase (SC) typing, multilocus sequence typing (MLST), SCCmec typing and virulent toxins, including Panton-Valentine leucocidin (PVL), and exfoliative toxins (ET). Among 69 cases of CA-S. aureus for a 3 month period from March to June, 2014 at hospital in Busan, 28 (40.6%) were MRSA and 41 (59.4%) were MSSA. Of the 28 CA-MRSA isolates, two major clones were identified as SC type Vb-ST72-SCCmec type IV (53.6%) and SC type l-ST89-SCCmec type II variant (42.8%), and the remaining one (3.6%) was SC type lll-ST8-SCCmec type IV. In CA-MSSA, the prevalent clone was SC type Vb-ST72 (29.3%), followed by SC type Vb-ST188 (21.9%), SC type Va-ST121 (19.5%) and SC type lV-ST30 (9.6%). None was positive for PVL gene, and all of the SC type l-ST89-SCCmec type II variant clones were ETB gene positive. The data suggest that there are significant clonal relatedness with specific SC types, and genetic diversities in both community strains isolated from children with skin infections.
Busan ; Child* ; Clone Cells ; Coagulase ; Exfoliatins ; Genetic Variation ; Humans ; Korea ; Leukocidins ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus ; Multilocus Sequence Typing ; Prevalence ; Skin* ; Staphylococcus aureus*

OBJECTIVES: Staphylococcal scalded skin syndrome (4S), a blistering dermatosis caused by exfoliative toxins from Staphylococcus aureus, occurs frequently in patients with atopic dermatitis (AD). However, association between 4S and AD has not rarely been reported. We investigated the characteristics of 4S according to AD status.METHODS: The study included 146 children with 4S who visited Busan St. Mary's Hospital from 2007–2018. Clinical features were analyzed from medical records and pictures, and 4S was classified as localized or generalized. We also retrospectively investigated the preceding conditions and test results related to AD.RESULTS: Among 146 patients with 4S, median age was 2.0 years, and 35 (24.0%) had AD. Since 2007, the incidence of both 4S and AD have increased, without obvious seasonal patterns. Generalized and localized disease occurred in 90 and 56 patients, respectively. Twenty-four of 35 patients with AD (68.6%) and 32 of 111 (28.8%) without AD had localized disease. Significant differences were observed between the groups (P = 0.000). Among those with AD, the most common preceding condition was skin infection or unknown (45.2%); however, respiratory disease was the most common (47.9%) among patients without AD. Eosinophil levels were higher in the AD group (P = 0.002), and there were no statistically significant differences in total immunoglobulin E (IgE), Dermatophagoides farinae (Df IgE), egg-white IgE, and culture results between the groups.CONCLUSIONS: Localized 4S frequently occurred without preceding conditions in children with AD and usually arose from skin infection compared to generalized 4S.
Blister ; Busan ; Child ; Dermatitis, Atopic ; Dermatophagoides farinae ; Eosinophils ; Exfoliatins ; Humans ; Immunoglobulin E ; Immunoglobulins ; Incidence ; Medical Records ; Retrospective Studies ; Seasons ; Skin ; Skin Diseases ; Staphylococcal Scalded Skin Syndrome ; Staphylococcus aureus

BACKGROUND: Staphylococcal scalded skin syndrome (SSSS) is defined as a spectrum of superficial blistering skin disease caused by the exfoliative toxins of Staphylococcus (S.) aureus. The spectrum of the disease includes generalized, localized (bullous impetigo), abortive and intermediate forms. OBJECTIVE: The purpose of this study is to reclassify clinical types of SSSS by reviewing the clinical and microbiologic features of SSSS and to redefine the clinical types exactly. METHODS: We retrospectively reviewed medical records, clinical photographs and the microbiologic results of 25 patients with SSSS and studied them according to the new classification. We defined the 3 clinical types as follows: i) The Generalized type is defined as a case where tender erythroderma and large thin bullae occur on the whole body excluding the mucous membrane, palms and soles. The nikolsky sign is positive. ii) The intermediate type is defined as a case where tender erythroderma and vesicles or pustules occur in the regionally limited area. The Nikolsky sign is positive. iii) The abortive type is defined as a case where tender erythema occurs only on the whole body or in regionally limited areas. The nikolsky sign is negative. All patients of SSSS have periorificial, radial crusting and fissuring. RESULTS: We could reclassify the clinical types of SSSS into 3 types (generalized, intermediate, abortive) according to this retrospective clinical study. Of the 25 patients, 3 patients were of the generalized type, 13 patients were of the intermediate type and 9 patients were of the abortive type. All the types have the acute eczematous lesion on the periorbital and perioral areas. The male to female sex ratio was 1: 1.3. The mean age of onset was 2.9 years. Cultures from the suspected site of the primary infection were positive in 14 out of 21 patients, and colonized sites were the throat (29%), conjunctiva (21%), nasal cavity (21%), ear (21%) and skin (8%) in 14 patients. Methicillin-sensitive S. aureus and methicillin-resistant S. aureus were 8 cases and 6 cases, respectively. In all clinical types, the most common complication was conjunctivitis (54.5%). Four cases were accompanied by atopic dermatitis. All the patients were cured with first generation cephalosporin without significant sequelae. CONCLUSION: We reclassified SSSS into generalized, intermediate and abortive types with reference to our 25 cases and previously existing papers, and offered a correct definition for the 3 types.
Age of Onset ; Blister ; Classification ; Colon ; Conjunctiva ; Conjunctivitis ; Dermatitis, Atopic ; Dermatitis, Exfoliative ; Ear ; Erythema ; Exfoliatins ; Female ; Humans ; Male ; Medical Records ; Methicillin Resistance ; Mucous Membrane ; Nasal Cavity ; Pharynx ; Retrospective Studies ; Sex Ratio ; Skin ; Skin Diseases ; Staphylococcal Scalded Skin Syndrome* ; Staphylococcus

BACKGROUND: Staphylococcal scalded skin syndrome is a superficial blistering skin disease caused by exfoliative toxins of Staphylococcus aureus. Adult cases are rare but accompanied by high mortality rates and poor prognoses. A rapid diagnosis, including distinguishing this disease from toxic epidermal necrolysis, and immediate treatment are essential. An increasing number of methicillin-resistant Staphylococcus aureus cases has been reported recently, which further complicates the treatment options. OBJECTIVE: We performed this study to evaluate clinical features and courses, and to investigate microbiological and histological manifestations of staphylococcal scalded skin syndrome in Korean children and adults. METHODS: We retrospectively reviewed, among 14 children (including 2 neonates) and 3 adults, medical records, clinical photographs, microbiological results and histological findings, including frozen section on the blister roof and Tzanck smear in some patients. RESULTS: The adult patients had longer disease durations than children (mean 24.7 versus 9.9 days). One adult patient died of pneumonia and sepsis. The children recovered without complications. All of cultured Staphylococcus aureus in 11 of the 17 patients were methicillin-resistant. On the frozen sections, the roof of the blister consisted of the uppermost epidermis. Taking specimens from fresh blisters was important for clear diagnosis. CONCLUSION: Adult patients had longer disease durations and poorer prognoses than children. The frozen section on the roof of fresh blister and the Tzanck smear were convenient methods for early and dependable diagnosis. Given the prevalence of methicillin-resistant strains of Staphylococcus aureus, treating the condition with antibiotics covering this strain should be considered.
Adult ; Anti-Bacterial Agents ; Blister ; Child ; Epidermal Necrolysis, Toxic ; Epidermis ; Exfoliatins ; Frozen Sections ; Humans ; Infant, Newborn ; Medical Records ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Pneumonia ; Prevalence ; Prognosis ; Retrospective Studies ; Sepsis ; Skin Diseases ; Sprains and Strains ; Staphylococcal Scalded Skin Syndrome ; Staphylococcus aureus

In the present study, Staphylococcus (S.) hyicus strains isolated in Russia (n = 23) and Germany (n = 17) were investigated for the prevalence of the previously described genes sheta and shetb. Sheta was detected in 16 S. hyicus strains. Sheta-positive strains were mainly found among strains isolated from exudative epidermitis, and frequently together with the exfoliative toxin-encoding genes exhD and exhC. Partial sequencing of sheta in a single S. hyicus strain revealed an almost complete match with the sheta sequence obtained from GenBank. None of the S. hyicus strains displayed a positive reaction with the shetb-specific oligonucleotide primer used in the present study. According to the present results, the exotoxin encoding gene sheta seems to be distributed among S. hyicus strains in Russia and Germany. The toxigenic potential of this exotoxin, which does not have the classical structure of a staphylococcal exfoliative toxin, remains to be elucidated.
Animals ; Cattle ; Cattle Diseases/epidemiology/microbiology ; DNA Primers ; Dog Diseases/epidemiology/microbiology ; Dogs ; Epidermitis, Exudative, of Swine/epidemiology ; Exfoliatins/*genetics/immunology ; Germany ; Pneumonia/epidemiology/veterinary ; Russia ; Staphylococcal Infections/immunology/veterinary ; Staphylococcus aureus/genetics/*pathogenicity ; Swine ; Swine Diseases/epidemiology ; Virulence/*genetics ; Virulence Factors/genetics/immunology

The Staphylococcus (S.) intermedius group (SIG) has been a main research subject in recent years. S. pseudintermedius causes pyoderma and otitis in companion animals as well as foodborne diseases. To prevent SIG-associated infection and disease outbreaks, identification of both staphylococcal exotoxins and staphylococcal cassette chromosome mec (SCCmec) types among SIG isolates may be helpful. In this study, it was found that a single isolate (one out of 178 SIG isolates examined) harbored the canine enterotoxin SEC gene. However, the S. intermedius exfoliative toxin gene was found in 166 SIG isolates although the S. aureus-derived exfoliative toxin genes, such as eta, etb and etd, were not detected. SCCmec typing resulted in classifying one isolate as SCCmec type IV, 41 isolates as type V (including three S. intermedius isolates), and 10 isolates as non-classifiable. Genetic relatedness of all S. pseudintermedius isolates recovered from veterinary staff, companion animals, and hospital environments was determined by pulsed-field gel electrophoresis. Strains having the same band patterns were detected in S. pseudintermedius isolates collected at 13 and 18 months, suggesting possible colonization and/or expansion of a specific S. pseudintermedius strain in a veterinary hospital.
Animals ; Bacterial Toxins/genetics/metabolism ; Cat Diseases/epidemiology/*microbiology ; Cats ; Chromosomes, Bacterial/genetics/metabolism ; Dog Diseases/epidemiology/*microbiology ; Dogs ; Electrophoresis, Gel, Pulsed-Field/veterinary ; Enterotoxins/genetics/metabolism ; Exfoliatins/genetics/metabolism ; Exotoxins/*genetics/metabolism ; Hospitals, Animal ; Humans ; Medical Staff, Hospital ; Molecular Sequence Data ; Pets/microbiology ; Polymerase Chain Reaction/veterinary ; Republic of Korea/epidemiology ; Staphylococcal Infections/epidemiology/microbiology/*veterinary ; Staphylococcus/genetics/isolation & purification ; Staphylococcus intermedius/*genetics/*isolation & purification