葡萄球菌性烫伤样皮肤综合征15例临床分析

Clinical analysis of 15 cases of staphylococcal scalded skin syndrome

目的 :总结葡萄球菌性烫伤样皮肤综合征 (SSSS)的临床特点及治疗经验 ,分析其发病机制 .方法 :对 1 995 0 5 /2 0 0 3 1 0SSSS患者 1 5例进行回顾性分析 ,内容包括 8mo～ 5a患儿的临床表现、治疗方法及其疗效 .结果 :全部患儿均存在口周放射状皲裂、皮肤红斑、表皮剥脱及皮肤触痛 ,尼氏征阳性 .1 3例作分泌物细菌培养 ,1 0例阳性 ,其中 4例分离出耐甲氧西林金黄色葡萄球菌 (MRSA) ,6例为金黄色葡萄球菌 .8例白细胞计数 >1 0× 1 0 9/L .7例病理组织学示 :表皮上层水疱 ,可见棘层松解细胞 .应用敏感抗生素后 2～ 3d症状明显改善 ,5～ 6d内皮损基本消失 ,全部病例痊愈出院 .结论 :SSSS好发于婴幼儿 ,耐甲氧西林金黄色葡萄球菌 (MR SA)的感染不容忽视 ,早期、及时地应用敏感的抗生素 ,保护创面 。

AIM: To review the clinical characteristics and treatment of staphylococcal scalded skin syndrome (SSSS) and to explore its mechanisms. METHODS: Fifteen inpatients (aged 8 months to 5 years) with SSSS from May 1995 to October 2003 were retrospectively analyzed, which included their clinical presentation, treatment and efficacy. RESULTS: All cases were presented with actinomorphic cracks in oral pheriphery, skin erythema, epidermis exfoliation and tenderness and Nikolsky sign was positive in all the patients. Ten of thirteen cases showed positive staphylococus aureus growth in involved area and Methicillin resistant St. aureus (MRSA) were isolated from four cases. White blood cell count of eight cases exceeded 10×10 9/L and histopathological sections from seven cases showed blister with acantholytic keratinocytes in upper layer of epidermis. All the cases improved greatly two or three days after sensitive antibiotics administration and five or six days after treatment, all the patients were discharged from the hospital, with lesions vanishing completely. CONCLUSION: SSSS tends to affect infants. Methicillin resistant staphylococcus infection should take into consideration in the pathogenesis of SSSS. Early administration of sensitive antibiotics, lesions protection and secondary infection prevention are important in the treatment of SSSS.