儿童金黄色葡萄球菌烫伤样皮肤综合征

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.
临床表现
Desquamation and erosions are seen on the trunk. 躯干可见皮肤脱屑和侵蚀
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.
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 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 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 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 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 almost complete resolution of his rash. 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
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 缘糜烂并伴有脓性分泌物。

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。
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。
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。


Berk，David R，Bayliss，et al. MRSA，Staphylococcal Scalded Skin Syndrome，and Other Cutaneous Bacterial Emergencies〔J〕. Pediatric Annals，2010，10（39）:627-633.
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。


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.

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
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。
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
概述

Staphylococcus aureus causes a variety of infectious diseases，ranging from superficial skin infections to severe,toxin-mediated systemic infections.
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。

流行病学

葡萄球菌性烫Baidu Nhomakorabea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。