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Background Staphylococcal-scalded skin syndrome (SSSS) is a potentially life-threatening disorder characterized by superficial skin blistering caused by exfoliative toxins produced by Staphylococcus aureus . This study aimed to investigate SSSS in a cohort of children admitted at a tertiary pediatric hospital in Italy. Methods Patients discharged with the diagnosis of staphylococcal infection and of SSSS between January 2010 and March 2023 were retrospectively identified using ICD-9-CM codes (695.81 and 041.1, respectively). Medical records were reviewed to extract epidemiological, clinical, and hematological data, treatment details (type and duration), length of hospitalization, and outcomes. Results Among 971 children with staphylococcal infection, 21 (2.1%) were diagnosed with SSSS. The mean age of 36.8 (interquartile range, IQR 8.5–50.7) months, with 86% under 5 years old. Incidence peaked in winter, summer, and autumn (27.3%, respectively), possibly due to viral co-infection. The admissions/year rate did not indicate an upward trend. Almost all children were healthy. No previous trauma, insect bites, drugs, vaccines, or allergy history have been reported; atopic dermatitis has been reported in one girl. Leukocytosis and elevated C-reactive protein were uncommon. Severe complications were seen in three cases (14.3%): one with severe dehydration with hyponatremia, one with sepsis and the last with Herpes Simplex Virus 1 (HSV1) infection. S. aureus was detected by culture from skin lesions in nine cases (42.9%), by real-time polymerase chain reaction ( RT-PCR ) assay on vesicle fluid in seven (33%), and by throat culture in one (4.7%). Drug susceptibility tests ruled out resistance and all children received intravenous (IV) antibiotics: oxacillin in 76% of patients, while teicoplanin and clindamycin in 19%. The median duration of IV and oral antibiotic therapy was 12.8 days (IQR 10–14). Only one patient was treated with IV immunoglobulin. The median hospitalization length was 7.8 days (IQR 5–9). All our cases had a favorable outcome. Conclusion Demographic, clinical. and hematological features of children with SSSS in this study were comparable with those reported in the literature. The improved awareness of pediatricians should faster diagnosis, which is mainly clinical, and early assessment of appropriate management.

This case reports a 14-month-old child with Staphylococcal Scalded Skin Syndrome (SSSS). The child presented generalized scaling erythema accompanied by skin pain, and perioral crusts and fissures and she required hospital admission for antibiotic treatment with intravenous cloxacillin and hidroelectrolyte replacement. SSSS is a blistering skin disorder, mainly affecting children, caused by specific Staphylococcus aureus strains producing exfoliative toxins. It shows erythema in skin folds progressing to blisters within 48 h, often with perioral crusts and fissures. Its diagnosis relies on clinical assessment and it often requires intravenous antibiotics for its treatment.

Staphylococcal scalded skin syndrome (SSSS) demonstrates dermal symptoms due to exfoliative toxin (ET) A or ETB produced by Staphylococcus aureus . We examined the association between anti-ETA antibodies and SSSS onset in neonates. Three preterm infants carried an ETA-producing strain of S. aureus , manifesting as either SSSS or bullous impetigo; a full-term infant carrying the same strain was asymptomatic. The infants (n=106) were categorized into three groups according to their gestational age (GA) as follows: <30 weeks, 30–37 weeks, and >37 weeks. The measured levels of anti-ETA antibody in the three infants displaying SSSS were low before the onset of dermal symptoms; only the asymptomatic full-term infant displayed a high antibody level. Anti-ETA antibody levels in the preterm group with a GA of <30 weeks were statistically lower than those in the term infant group; the prevalences of anti-ETA antibodies above a cutoff value in the three groups of neonates were 55 % (18/33) among preterm infants with a GA <30 weeks, 73 % (25/34) among those with a GA of 30–37 weeks, and 90 % (35/39) among infants with a GA >37 weeks. Conclusion : The presence of anti-ETA antibodies below a particular cutoff level might be associated with SSSS onset in preterm infants.

Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated exfoliating skin condition predominated by desquamation and blistering. Neonatal outbreaks have already been reported; however, our outbreak highlights the potential for SSSS following neonatal health promotion measures such as intra-muscular vitamin K administration and metabolic screening (heel prick) as well as effective case containment measures and the value of staff screening. Between February and June 2007, five confirmed cases of neonatal SSSS were identified in full-term neonates born in an Irish regional maternity hospital. All infants were treated successfully. Analysis of contact and environmental screening was undertaken, including family members and healthcare workers. Molecular typing on isolates was carried out. An outbreak control team (OCT) was assembled and took successful prospective steps to prevent further cases. All five Staphylococcus aureus isolates tested positive for exfoliative toxin A, of which two distinct strains were identified on pulsed-field gel electrophoresis analysis. Two cases followed staphylococcal inoculation during preventive measures such as intra-muscular vitamin K administration and metabolic screening (heel prick). None of the neonatal isolates were methicillin resistant. Of 259 hospital staff (70% of staff) screened, 30% were colonised with S. aureus , and 6% were positive for MRSA carriage. This is the first reported outbreak of neonatal SSSS in Ireland. Effective case containment measures and clinical value of OCT is demonstrated. Results of staff screening underlines the need for vigilance and compliance in hand disinfection strategies in maternity hospitals especially during neonatal screening and preventive procedures.

Exfoliative toxin A, produced by Staphylococcus aureus , causes blisters in bullous impetigo and its more generalized form, staphylococcal scalded-skin syndrome 1 , 2 , 3 . The toxin shows exquisite specificity in causing loss of cell adhesion only in the superficial epidermis. Although exfoliative toxin A has the structure of a serine protease, a target protein has not been identified 4 , 5 . Desmoglein (Dsg) 1, a desmosomal cadherin that mediates cell–cell adhesion, may be the target of exfoliative toxin A, because it is the target of autoantibodies in pemphigus foliaceus, in which blisters form with identical tissue specificity and histology. We show here that exfoliative toxin A cleaved mouse and human Dsg1, but not closely related cadherins such as Dsg3. We demonstrate this specific cleavage in cell culture, in neonatal mouse skin and with recombinant Dsg1, and conclude that Dsg1 is the specific receptor for exfoliative toxin A cleavage. This unique proteolytic attack on the desmosome causes a blister just below the stratum corneum, which forms the epidermal barrier, presumably allowing the bacteria in bullous impetigo to proliferate and spread beneath this barrier.

On day 30 of life, he was receiving respiratory support with nasal continuous positive airway pressure (CPAP), full breast milk feeds and no medication except vitamin supplements.

The aim of this study is to determine the prevalence of eta, etb and etd genes among clinical isolates of S. aureus. 91 isolates of the bacterium were isolated from different clinical sites during the period from 2019 to 2020 from Baghdad hospitals, all the isolates were diagnosed by different biochemical tests and molecular method (PCR) using nuc gene. the PCR technique was used to detect eta, etb and etd genes among the isolates, the results showed that  91(100%) of the isolates were have nuc gene. while, 83 ( 91.2%) of the isolates at least carrying one of the ET genes; 20 (22%) , 0 (0%) and 63 (69.2%) of the 91 isolates expressed eta, etb and etd genes, respectively. While, 8 (8.8%) of isolates were lacking of these genes. In addition, 14 (15.4%) of isolates were carrying both eta and etd genes. Although the etd gene was found in all sample types, but eta gene was found only in wound, ear, throat and nose while, etb gene was not found in all types of clinical samples.

Staphylococcal scalded skin syndrome (SSSS) and bullous impetigo are infections caused by Staphylococcus aureus. The pathogenesis of both conditions centers around exotoxin mediated cleavage of desmoglein-1, which results in intraepidermal desquamation. Bullous impetigo is due to the local release of these toxins and thus, often presents with localized skin findings, whereas SSSS is from the systemic spread of these toxins, resulting in a more generalized rash and severe presentation. Both conditions are treated with antibiotics that target S. aureus. These conditions can sometimes be confused with other conditions that result in superficial blistering; the distinguishing features are outlined below.