儿童金黄色葡萄球菌烫伤样皮肤综合征

Macular rash with Nikolsky's sign
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Staphylococcal scalded skin syndrome: diagnosis and management in children and adults
202M1/.4Z/2. 6Handler, R.A. Schwartz*
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临床表现 Staphylococcal scalded skin syndrome after intra-articular
金黄色葡萄球菌可引起各种各样的感染性疾病，包括严重的表皮 感染和毒素介导的全身性感染。
S. aureus produces many extracellular products, including toxins, that affect host cell function or morphology. Staphylococcal toxic shock syndrome (STSS) and staphylococcal scalded skin syndrome (SSSS) are 2 distinct toxin-mediated diseases with very distinct cutaneous features.
A six-year-old boy was hospitalized with a
rash and fever. He had been well until two
days before admission, when general
pruritus developed. That evening, small
injection of hyaluronic acid
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Mod Rheumatol (2011 on day of admission, showing round ulceration on forehead, oval skin lesion on left cheek (A), and erosion on abdomen (B).
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临床表现
Staphylococcal Scalded Skin Syndrome in a newbornwith generalized bullous epidermolysis.
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临床表现
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临床表现
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A newborn, age 17 days and 20 hours, (A) was admitted a few hours after the diagnosis of SSSS. Skin erythema and exfoliating rash were seen on the face and subsequently diffused to the whole body. Blistering and positive Nikolsky’s sign and the discomfort of the newborn were obvious. (B) Three days later the erythema subsided and the blisters dried up and crusted. (C) The same patient 11 days later, with intact skin and no scaring. The child’s parents consented to the publication of this picture.
Ladhani等于1999年报道本病病死率3%-4%。 好发于6岁及以下幼儿，罕见的成人葡萄球菌性烫伤样皮肤综合征
患者伴有原发疾病，如免疫抑制、免疫异常、肾功能不全等。 一般病程在1～2周。
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蔡爱东，李军，周兆群，等. 儿童葡萄球菌烫伤样皮肤综合征36例临床析 〔J〕. 实用医学杂志，2010，2（14）:2594-2595.
天后皮疹完全消退出院。
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临床表现
入院第1天前臂可见表皮脓疱和水疱
入院第6日足部表皮起疱和糜烂
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入院第4天，随着SSSS进展，全身及躯干 可见皮肤广泛的起疱和糜烂
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临床表现
Evolution to scaly phase, more pronounced at periorificial areas.
该病好发于婴幼儿，可能由于6岁以下的儿童特异性免疫尚未发育 完善，体内抗表皮剥脱毒素的抗体不足，肾脏排泄毒素的能力较 差。
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流行病学
葡萄球菌性烫伤样皮肤综合征（staphylococcal scalded skin syndrome，SSSS），是一种主要由凝固酶阳性嗜菌体Ⅱ组71型和 51型金黄色葡萄球菌引起。
the Ritter’s disease
Staphylococcal Scalded Skin Syndrome
儿童金黄色葡萄球菌烫伤样皮肤综合征
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概述
Staphylococcus aureus causes a variety of infectious diseases，ranging from superficial skin infections to severe,toxin-mediated systemic infections.
2-3d内迅速蔓延全身广泛分布，在弥漫性红斑上出现松弛大疱， 其上表皮皱起，尼氏征阳性。表皮易剥脱而露出鲜红色水肿糜烂 面，特征类似于Ⅱ度烫伤样皮损。
1-2d后可见痂皮脱屑，口周呈特征性的放射状皲裂，手足皮肤可 呈手套或袜套样脱皮，以后不再剥脱，而出现糠秕状脱屑。
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Berk，David R，Bayliss，et al. MRSA，Staphylococcal Scalded Skin Syndrome，and Other Cutaneous Bacterial Emergencies〔J〕. Pediatric Annals，2010，10（39）:627-633.
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案例1入院当日显示，前额溃疡形成，左侧面颊椭圆形皮肤缺损，下腹部糜烂。
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临床表现
Case 1 three days after admission, showing a new round pink injury on nose (A), crusty lesions on right ear (B)
14、抱最 大的希 望，作 最大的 努力。2 021年5 月16日 星期日 上午5 时41分5 1秒05: 41:512 1.5.16
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16、业余 生活要 有意义 ，不要 越轨。2 021年5 月16日 星期日 5时41 分51秒0 5:41:5 116 Ma y 2021
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临床表现
病程早期自口、眼四周等部位出现皮肤损害，主要为红斑、水疱， 随着病程的进展，皮疹范围迅速扩大，蔓延至颈、胸、背、腋下、 腹股沟等部位，表现为弥漫性红斑及红斑基础上松弛性水疱、大 疱，水疱破裂后表皮剥脱，类似烫伤样，尼氏征阳性。
患儿感明显的疼痛，不能触碰。 首发症状：65例首发临床表现中口周放射状皲裂，眶周红斑、睑
金黄色葡萄球菌产生大量细胞外产物，包括毒素，影响宿主细胞 功能和形态。葡萄球菌中毒性休克综合征（STSS）和金黄色葡萄 球菌烫伤样皮肤综合征（SSSS）是两种独特的以皮肤受累为特征 的毒素介导的疾病。
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概述
金黄色葡萄球菌性烫伤样皮肤综合征是一种急性感染性皮肤病， 临床特征为全身泛发性红斑、松弛性大疱、表皮剥脱及尼氏征阳 性，重症者可并发败血症，发生多器官系统功能受累，甚至危及 生命。
water blisters developed at the base of his
nose and face. During the next two days, the
lesions spread despite treatment with
cephalexin, which had been initiated one day before admission. The child’s temperature was 38.3°C on admission. He appeared
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临床表现
Desquamation and erosions are seen on the trunk.
躯干可见皮肤脱屑和侵蚀
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一个6岁男孩因发热和皮疹入院。 A six-year-old boy was hospitalized with a rash and fever.
separation of the outer layer of epidermis
from the basal layer), and a biopsy of a skin
specimen revealed that the level of cleavage 患儿入院2天前出现皮肤瘙痒。入院当晚，患儿鼻子和面部出现小水疱。 was at the granular layer. The boy was 在随后的2天，尽管使用头孢氨苄治疗，皮损区域扩散。他的面部，脖 treated with intravenous nafcillin, and his
17、一个 人即使 已登上 顶峰， 也仍要 自强不 息。上 午5时41 分51秒 上午5 时41分0 5:41:5 121.5. 16
临床表现
Staphylococcal scalded skin syndrome. Characteristic
desquamation in gravely ill woman.
子，后背部，肛周，大腿，腋窝大量松弛的大水疱样皮疹。尼氏征阳性 condition improved over the next few days.
（上皮表层从基底层分离）。皮肤样本活检显示颗粒细胞层分裂。患儿 He was discharged after seven days, with 予静脉注射萘夫西林治疗，随后的几天患儿状态逐渐改善。患儿入院7 almost complete resolution of his rash.
extremely uncomfortable but not acutely ill.
He had numerous flaccid bullae on his face,
neck, axilla, perianal region, upper back, and thighs. Nikolsky’s sign was present (ready
缘糜烂并伴有脓性分泌物。
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儿童金黄色葡萄球菌性烫伤样皮肤综合征（SSSS）168例临床 及实验室检测分析
China Continuing Medical Education, Vol. 7, No.24
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临床表现
患儿均为全身型，发病时皮疹最先见于面部，尤其是口、眼四周 的无特异性皮肤红斑，后迅速向下蔓延到腋、腹股沟、躯干和四 肢近端，直至泛发到全身。
病例1入院后3天，显示鼻子处一个新的粉红色皮损，右耳硬性皮损。
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临床表现
Case 1 three days after admission, showing left aspect of neck (C) and abdomen (D).
病例1入院后第3天显示左侧面颊和腹部硬性皮损。