Clinical Analysis Of 520 Cases With SSSS And Review Of Literature

Background: Staphylococcal scalded skin syndrome(SSSS) is an infectious skin disease induced by the exfoliative toxins(ETs) of toxin-producing staphylococcus aureus.It has the characteristic skin lesions of tender erythema,vesicle formation and exfoliation.It primarily affects neonates and young children and rarely occurs in adults.ETs produced by staphylococcus aureus can bind desmoglein 1(Dsg1) and expose the active site of ETs. Dsg1 is cleaved by serine protease activity of ETs. Disruption of this structure would result in loss of cell-to-cell adhesion and separation at the level of the zona granulosa,which results in vesicle formation and exfoliation.SSSS Contains three forms,bullous impetigo(localized form), staphylococcal scarlantiniform rash(milder or abortive form) and generalized form.Objective: We report 520 confirmed cases of infant generalized form of SSSS. Through the literature of SSSS and the statistical analysis of the 520 cases by epidemiology, Clinical diagnosis and treatment,we could get some conclusions which would benefit the future Clinical diagnosis and treatment and prevention of infant SSSS.Material and Methods: We report 520 confirmed cases of infant generalized form of SSSS,which were Admitted to the Second Hospital of Jilin University between September 1988 and December 2009.The data for the retrospective study were analyzed with application of SPSS 17.0 for windows software, t-test,to test ofα=0.05.Results:1. Years of onset: The number of cases grew rapidly from 2005.The number of the cases from 2005 and 2009 is 71.2% of the total.2. Months of onset: Low incidence of month is from December to June; high incidence of month is from July to November.3. We compared the cases which had been treated by Aztreonam alone and the cases which hadn't been treated by Aztreonam.The two sets of data had no significant difference after statistical analysis.4. 504 cases had been treated by glucocorticoid.We didn't find significant side effects of glucocorticoid.5. The overall mortality is 0.6% which is significantly lower than the lever previously reported.Conclusion: 1. Respiratory tract infection and skin infections were the predisposing factor of infant SSSS.2. SSSS was significant seasonal onset.The onset of SSSS was Significantly higher in summer and autumn, especially between August to November,which was related to hot weather in summer,high onset of respiratory tract infection and skin infections.3. The cases of infant generalized form of SSSS which were admitted to the hospital between 2005 and 2009 Significant increase,which need us to enhance the prevention of SSSS.4. The cases reported had the evidence of contact transmission.This proved that we had the contact transmission of SSSS in our country.5. Staphylococcus aureus isolated from the patients of infant generalized form of SSSS is neither sensitive nor specific.The staphylococcus aureus can't be the evidence of SSSS.Diagnostic tests for ET from The fluid in the blisters and serum would be the gold standard of SSSS.6. Skin pathology can't be the routine examination of SSSS.The pathology of blister epidermis could be the ideal alternative.7. Sensitive antibiotic in adequate doses early is the preferred option in SSSS theray to the cases presenting localized infection or secondary infection.8. Antibiotic is not essential to the cases that don't presene localized infection or secondary infection. The removal of toxins and intensive care could be the preferred option.9. Appropriate amount of glucocorticoid with Sensitive antibiotic for the cases of infant generalized form of SSSS couldn't cause significant adverse reactions.10.The cases reported had a significant treatment effect and the mortality is much lower,which may relate to the use of sensitive antibiotic,glucocorticoid and immunoglobulin.