Progression from Bullous Impetigo to Staphylococcal Scalded Skin Syndrome: A Case Study and Clinical Insights
Kannan N1, Prabhu K2, Jamunarani A3, Thatiparthi Stephen*4
Journal of Angiotherapy 6(1) 1-3 https://doi.org/10.25163/angiotherapy.6162181290707122
Submitted: 29 November 2021 Revised: 11 December 2021 Published: 07 January 2022
Abstract
Background: Staphylococcus aureus is known for causing various skin infections, including Bullous Impetigo and Staphylococcal Scalded Skin Syndrome (SSSS). Both conditions result from exfoliative toxins released by the bacterium but differ in their severity and systemic involvement. Bullous Impetigo presents as localized fluid-filled blisters, while SSSS involves widespread epidermal detachment and systemic symptoms. Methodology: A 10-month-old male infant with no significant past medical history presented with a rapidly worsening skin condition. Initially, the patient developed macules with shiny crusts around the perioral and periorbital areas, which evolved into larger bullae over two days, accompanied by fever. Diagnostic workup included swabs and tissue cultures, which identified amoxicillin-susceptible Staphylococcus aureus. A punch biopsy showed acantholysis and polymorphous infiltrates consistent with Bullous Impetigo transitioning to SSSS. Results: The patient was treated with intravenous amoxicillin-clavulanic acid and supportive care. There was significant improvement, with complete re-epithelialization of the skin observed within 12 days. Conclusion: This case highlights the potential for Bullous Impetigo to progress to SSSS, emphasizing the importance of early diagnosis and intervention. Clinicians should be vigilant for signs of progression from localized to systemic staphylococcal infections to ensure timely and effective treatment, preventing severe complications and optimizing patient outcomes.
Keywords: Staphylococcus aureus, Bullous Impetigo, Staphylococcal Scalded Skin Syndrome, exfoliative toxins, skin infections.
References
Amagai, M., Matsuyoshi, N., Wang, Z. H., Andl, C., & Stanley, J. R. (2000). Toxin in bullous impetigo and staphylococcal scalded-skin syndrome targets desmoglein 1. Nature Medicine, 6(11), 1275-1277. https://doi.org/10.1038/81385
Courjon, J., Hubiche, T., Phan, A., Tristan, A., Bès, M., Vandenesch, F., Etienne, J., Del Giudice, P., & Gillet, Y. (2013). Skin findings of Staphylococcus aureus toxin-mediated infection in relation to toxin encoding genes. Pediatric Infectious Disease Journal, 32(7), 727-730. https://doi.org/10.1097/INF.0b013e31828e89f5
Elharrouni, A., Elimam, M., Dassouly, R., Hnach, K. H., Elloudi, S., Douhi, Z., ... & Mernissi, F. Z. (2019). Case of bullous impetigo developing into staphylococcal scalded skin syndrome: Case report. Journal of Health Care and Research, 1(4), 4. https://doi.org/10.36502/2019/hcr.6151
Hubiche, T., Bes, M., Roudiere, L., Langlaude, F., Etienne, J., & Del Giudice, P. (2012). Mild staphylococcal scalded skin syndrome: An underdiagnosed clinical disorder. British Journal of Dermatology, 166(1), 213-215. https://doi.org/10.1111/j.1365-2133.2011.10515.x
Lamand, V., Dauwalder, O., Tristan, A., Casalegno, J. S., Meugnier, H., Bes, M., Dumitrescu, O., Croze, M., Vandenesch, F., Etienne, J., & Lina, G. (2012). Epidemiological data of staphylococcal scalded skin syndrome in France from 1997 to 2007 and microbiological characteristics of Staphylococcus aureus associated strains. Clinical Microbiology and Infection, 18(12), E514-E521. https://doi.org/10.1111/1469-0691.12053
Lasek-Duriez, A., Léauté-Labrèze, C., & la Société française de dermatopédiatrie. (2009). Signes cutanés des sévices à enfants (à l'exclusion des sévices sexuels). Annales de Dermatologie et de Vénéréologie, 136(11), 838-844. https://doi.org/10.1016/j.annder.2008.10.048
Mockenhaupt, M., Idzko, M., Grosber, M., Schöpf, E., & Norgauer, J. (2005). Epidemiology of staphylococcal scalded skin syndrome in Germany. Journal of Investigative Dermatology, 124(4), 700-703. https://doi.org/10.1111/j.0022-202X.2005.23642.x
Plano, L. R., Adkins, B., Woischnik, M., Ewing, R., & Collins, C. M. (2001). Toxin levels in serum correlate with the development of staphylococcal scalded skin syndrome in a murine model. Infection and Immunity, 69(8), 5193-5197. https://doi.org/10.1128/IAI.69.8.5193-5197.2001
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