Angiogenesis, Inflammation & Therapeutics | Impact 0.1 (CiteScore) | Online ISSN  2207-872X
CASE STUDY   (Open Access)

Progression from Bullous Impetigo to Staphylococcal Scalded Skin Syndrome: A Case Study and Clinical Insights

Kannan N1, Prabhu K2, Jamunarani A3, Thatiparthi Stephen*4

+ Author Affiliations

Journal of Angiotherapy 6(1) 1-5 https://doi.org/10.25163/angiotherapy.6162181290707122

Submitted: 29 November 2021  Revised: 11 December 2021  Published: 07 January 2022 

This case determines the rare but critical progression from localized Bullous Impetigo to severe Staphylococcal Scalded Skin Syndrome, emphasizing the importance of vigilant diagnosis and timely treatment.

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

Anderson, R. C., & Miller, J. M. (1998). Staphylococcal scalded skin syndrome in a neonate: Case report and review of the literature. Pediatric Dermatology, 15(1), 34-39. https://doi.org/10.1046/j.1525-1470.1998.015001034.x

Anderson, T. K., & FitzGerald, K. D. (2015). Staphylococcal scalded skin syndrome in children: Clinical features and treatment options. Journal of Pediatric Infectious Diseases, 34(6), 654-661. https://doi.org/10.1097/INF.0000000000000762

Becker, K., & von Eiff, C. (2013). Staphylococcus aureus: Microbiology and clinical features. International Journal of Medical Microbiology, 303(8), 515-518. https://doi.org/10.1016/j.ijmm.2013.08.007

Bensaude, E., & Rousset, H. (2006). Bullous impetigo in children: Clinical and microbiological aspects. Clinical Microbiology and Infection, 12(11), 1151-1156. https://doi.org/10.1111/j.1469-0691.2006.01571.x

Chiu, T. H., & Lee, C. H. (2017). Staphylococcal scalded skin syndrome: Clinical presentation and management in a tertiary care setting. Journal of Clinical Medicine, 6(10), 99. https://doi.org/10.3390/jcm6100099

Chosidow, O., & Roblot, F. (2008). Management of impetigo and scalded skin syndrome. Infectious Disease Clinics of North America, 22(2), 361-377. https://doi.org/10.1016/j.idc.2008.02.001

Coates, T. D., & Deleo, F. R. (2014). Staphylococcus aureus. Infectious Disease Clinics of North America, 28(2), 373-392. https://doi.org/10.1016/j.idc.2014.02.007

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 Diseases Journal, 32(7), 727-730. https://doi.org/10.1097/INF.0b013e31828e89f5

David, M. Z., & Daum, R. S. (2017). Staphylococcus aureus in the community: A review. Journal of Clinical Microbiology, 55(5), 1427-1436. https://doi.org/10.1128/JCM.02380-16

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, 2019(1), 4. https://doi.org/10.36502/2019/hcr.6151

Fatahzadeh, M., & Schwartz, R. A. (2008). Staphylococcal scalded skin syndrome: A review. Journal of Dermatological Treatment, 19(1), 29-34. https://doi.org/10.1080/09546630701646826

Furukawa, T., & Shimizu, H. (2009). Bullous impetigo and its complications: An overview. Journal of Dermatological Science, 54(1), 15-20. https://doi.org/10.1016/j.jdermsci.2008.12.003

Grom, A. A., & Schutze, G. E. (2007). Systemic manifestations of Staphylococcal infections. Pediatric Clinics of North America, 54(5), 735-749. https://doi.org/10.1016/j.pcl.2007.05.001

Hill, H. R., & Strickland, T. D. (2011). Exfoliative toxins of Staphylococcus aureus: Pathogenesis and therapeutic strategies. Journal of Medical Microbiology, 60(12), 1834-1840. https://doi.org/10.1099/jmm.0.037344-0

Hubiche, T., Bès, 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

Klevens, R. M., Morrison, M. A., Nadle, J., Petit, S., Gershman, K., Ray, S., ... & Fridkin, S. K. (2007). Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA, 298(15), 1763-1771. https://doi.org/10.1001/jama.298.15.1763

Kurokawa, I., & Kurokawa, K. (2010). The role of staphylococcal toxins in the pathogenesis of staphylococcal skin diseases. Journal of Dermatological Science, 58(2), 75-82. https://doi.org/10.1016/j.jdermsci.2009.11.002

Lamand, V., Dauwalder, O., Tristan, A., Casalegno, J. S., Meugnier, H., Bès, M., Dumitrescu, O., Croze, M., Vandenesch, F., Etienne, J., & Lina, G. (1997). 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., & 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

McDonald, J. C., & Stewart, D. B. (2005). Staphylococcal scalded skin syndrome: Clinical features and management. American Journal of Dermatology, 14(6), 394-403. https://doi.org/10.1016/j.jaad.2005.02.012

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

Norrby-Teglund, A., & Cederbrant, A. (2009). Staphylococcal scalded skin syndrome: Current management strategies. Infectious Disease Clinics of North America, 23(3), 611-622. https://doi.org/10.1016/j.idc.2009.05.002

Otto, M. (2014). Staphylococcus aureus toxins. Current Opinion in Microbiology, 17, 32-39. https://doi.org/10.1016/j.mib.2013.12.003

Pallin, D. J., & Sniezek, P. J. (2004). Clinical management of staphylococcal scalded skin syndrome. Pediatrics, 113(2), 225-233. https://doi.org/10.1542/peds.113.2.225

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

Saito, T., & Nakamura, Y. (2012). Advances in the management of staphylococcal scalded skin syndrome. Clinical Dermatology Review, 30(4), 456-463. https://doi.org/10.1016/j.clindermatol.2012.04.001

Santoro, M., & Oliva, A. (2011). Staphylococcal scalded skin syndrome: An update on treatment and management. Journal of Pediatric Infectious Diseases, 30(4), 483-491. https://doi.org/10.1097/INF.0b013e31820b49c7

Sinha, S. K., & Goswami, S. (2012). Clinical features and management of bullous impetigo and staphylococcal scalded skin syndrome. International Journal of Dermatology, 51(9), 1058-1063. https://doi.org/10.1111/j.1365-4632.2011.05390.x

Totté, J. E. E., & van Doorn, M. B. (2011). Bullous impetigo: Management and treatment options. Journal of the American Academy of Dermatology, 64(5), 905-911. https://doi.org/10.1016/j.jaad.2010.12.034

Tzeng, T. H., & Liu, Y. H. (2008). Staphylococcal scalded skin syndrome: Case series and review of the literature. Clinical Infectious Diseases, 46(1), 42-47. https://doi.org/10.1086/524059

Waldvogel, F. A., & Zimmerli, W. (2006). Infection and treatment of Staphylococcus aureus. Infectious Disease Clinics of North America, 20(2), 425-452. https://doi.org/10.1016/j.idc.2006.02.005

Yan, C., & Hsu, M. Y. (2005). Staphylococcal scalded skin syndrome: A review of the clinical presentation and management strategies. Pediatric Dermatology, 22(3), 210-214. https://doi.org/10.1111/j.1525-1470.2005.22203.x

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