Clinical Analysis Of156Cases Children With Staphylococcal Scalded Skin Syndrome

ObjectiveBy investigating the clinical manifestations,diagnosis and antidiastole,assistant exsaminantion, therapy and prognosis in staphylococcal scalded skinsyndrome patients, to guide the clinical diagnosis, treatment of childrenstaphylococcal scalded skin syndrome and to reduce the misdiagnosis rate andmortality.MethodsTo investigation and record retrospectively clinical data of56casesstaphylococcal scalded skin syndrome from Nocember2011to December2013, whohospitaled in the First Affiliated Hospital,Zhengzhou University. Estabilshing thedatabase of all staphylococcal scalded skin syndrome patients by excel software,designing the data sheet about patients’ information,recording every patients’ clinicalmassages about age, sex, environment,onset time, course of disease, initialmanifestion, misdiagnosis, clinical manifestation, comorbidity, treatment andprognosis. Laboratory results such as blood and urine routine, ESR, C-reactiveprotein, C3, C4, IgA, IgG, IgM, liver and renal function, elettonlyte, blood glucose,lipids, bacterial culture, PCT, hemagglutination test and auxiliary examination such as ECG, abdominal ultrasound, DR. To assess the epidemiology, clinical manifestations,comorbidity, laboratory and radiographic examination, treatment and prognosis ofthe156cases staphylococcal scalded skin syndrome. The statistic datas are analyzedby SPSS17.0software packet, themeasurement datas by the t examination,theenumberationdatas by the2examination, and the satistical significance wasdesignated at P <0.05by bilateral P examination.Results1. Gerneral Condition The average age of onset of156casea staphylococcalscalded skin syndrome was3.51±0.24years old. The maximum was11years oldand the minimum was six months.3to5years old children of staphylococcal scaldedskin syndrome were the most common. The number of men were more than women(P <0.05). Children from rural were significantly higher than the city. The diseasehappened from September to November more often.2. Predisposing Fators Staphylococcal scalded skin syndrome patients withsignificant incentives was40cases before onset(25.6%). The incentives ofstaphylococcal scalded skin syndrome were20cases upper respiratory tract infection,12cases trauma,6cases imperigo,2cases herpes simplec respectively.116casesstaphylococcal scalded skin syndrome had no incentives.3. Misdignosis In this study, misdiagnosis rate of the disease was as high as35.9%. The misdiagnosis cases were atopic dermatitis,skin infections,impetigo,pemphigus, contact dermatitis, eczema, virus infection,herpes simplex.12cases canconfirm the diagnosis of staphylococcal scalded skin syndrome. The diagnosis of88cases were not clear.4. Clincal Feature156cases of children with staphylococcal scalded skinsyndrome were accompanied by different degrees of diffuse flush.134cases（85.9%）of children with skin performance was given priority to with proximal limb and fold.22cases (14.1%) was given priority to with head face and hindquarters cadres.136cases (87.2%) with eye week erythema, emission type fold, desquamation, andsecretion.147cases (94.2%) with spots around the mouth, radial plica.121patients (77.6%) with comment illness of eyes and mouth.98cases (62.8%) of children werewith pustules based on the erythema.85cases (54.5%) with skin stripped andpositive murphy sign. Patients’ symptoms: In the early onset,77cases (49.35%)withskin tenderness.39cases (25.0%) with itching. In the very period,142cases (91.0%)skin tenderness,18cases (11.5%) with itching. In the recovery,135cases (86.5%)accompanied by itching. Staphylococcal scalded skin syndrome in addition to the skinoften can have other systemic symptom. There were41cases staphylococcal scaldedskin syndrome accompanied by fevebr.4cases accompanied by diarrhea.5. Auxiliary Examination Routine blood: There were95cases of increasedwhite blood cells and neutrophils count.10cases of decreased red blood cells.30cases of increased platelets. Positive urine ketone body in49cases.4cases wereoccult blood positive. Urine protein positive in7cases. Uric bilirubin in11caseswere positive. Nitrite positive in2cases. Urine leucocyte4cases were positive.98cases of routine urine without exception. Defecate occult blood positive in2cases.Biochemical examination: There were142cases of the normal range. No obviousabnormal in14. Immune function was abnormal in96. No abnormal60cases. ASOand ESR increased5cases each.29routine PCT inspectors had13cases (44.8%)appeared PCT decreased. In the light and heavy treatment group comparison，the riseof white count, ASO, ESR, prealbumin and the decrease TP, IgA, IgG, C3and C4hadsignificantly statistical differences(P＜0.05).In this group,59cases patients experimented bacterial culture. There were38cases of staphylococcus aureus,3cases of epidermis staphylococcus aureus,1caseof hemolysis staphylococcus aureus. To analysis38cases of drug susceptibilityresults. The drug resistance rate of S. aureus bacteria to penicillin, erythromycin,clindamycin, tetracycline, chloramphenicol, gentamicin and ciprofloxacin were95.23%,83.25%,78.45%,83.25%,15.56%,11.25%,4.20%. To ceftriaxone,cefuroxime, cefazolin, horse, acid sodium, west land, characters and vancomycinresistant bacteria have not been discovered.6. Treat ment Statistical analysis was carried out on the65cases of antibioticswith glucocorticoid therapy group and87treated with antibiotics only. Heat fadingaway, erythema blister fading away, tenderness fade time and hospital stay between two groups of patients had no obvious statistical significance (P>0.05). Butantibiotics with glucocorticoid therapy group can effectively control the condition.We did not find significant side effects of glucocorticoid. But in the heavystaphylococcal scalded skin syndrome group, two kinds of treatment in heat fadingaway, erythema blister fading away, tenderness fade time and hospital stay hadstatistically significant (P <0.05).7. Prognosis In this study,156cases staphylococcal scalded skin syndromewere all cured. Cure rae was100%. As compared with the prior research at home andabroad, the death rate was decreased obviously.Conclusions1. Staphylococcal scalded skin syndrome mainly occured in3to5years old age.It was more common in rural areas than urban. The disease happened from Septemberto November more often.2. The prognosis of staphylococcal scalded skin syndrome was good and themisdiagnosis rate was high in this study. The most common misdiagnosis cases wereatopic dermatitis.3. Infection and immune dysfunctionare were important factors ofstaphylococcal scalded skin syndrome in children.4. When the condition was heavier or skin lesion spread throughout the body,glucocorticoid combined cephalosporin antibiotics in the treatment of staphylococcalscalded skin syndrome should be applied actively. Premature discontinuationeffective antibiotics can lead to illness to over and over again.