Herpes zoster is caused by reactivation of latent varicella-zoster virus that resides in a dorsal root ganglion. Herpes zoster can develop at any time after a primary infection or varicella vaccination. The incidence ...Herpes zoster is caused by reactivation of latent varicella-zoster virus that resides in a dorsal root ganglion. Herpes zoster can develop at any time after a primary infection or varicella vaccination. The incidence among children is approximately 110 per 100,000 person-years. Clinically, herpes zoster is characterized by a painful, unilateral vesicular eruption in a restricted dermatomal distribution. In young children, herpes zoster has a predilection for areas supplied by the cervical and sacral dermatomes. Herpes zoster tends to be milder in children than that in adults. Also, vaccine-associated herpes zoster is milder than herpes zoster after wild-type varicella. The diagnosis of herpes zoster is mainly made clinically, based on a distinct clinical appearance. The most common complications are secondary bacterial infection, depigmentation, and scarring. Chickenpox may develop in susceptible individuals exposed to herpes zoster. Oral acyclovir should be considered for uncomplicated herpes zoster in immunocompetent children. Intravenous acyclovir is the treatment of choice for immunocompromised children who are at risk for disseminated disease. The medication should be administered ideally within 72 hours of rash onset.展开更多
Background Staphylococcal-scalded skin syndrome(SSSS),also known as Ritter disease,is a potentially life-threatening disorder and a pediatric emergency.Early diagnosis and treatment is imperative to reduce the morbidi...Background Staphylococcal-scalded skin syndrome(SSSS),also known as Ritter disease,is a potentially life-threatening disorder and a pediatric emergency.Early diagnosis and treatment is imperative to reduce the morbidity and mortality of this condition.The purpose of this article is to familiarize physicians with the evaluation,diagnosis,and treatment of SSSS.Data sources A PubMed search was completed in Clinical Queries using the key terms"Staphylococcal scalded skin syn-drome"and"Ritter disease".Results SSSS is caused by toxigenic strains of Staphylococcus aureus.Hydrolysis of the amino-terminal extracellular domain of desmoglein 1 by staphylococcal exfoliative toxins results in disruption of keratinocytes adhesion and cleavage within the stratum granulosum which leads to bulla formation.The diagnosis is mainly clinical,based on the findings of tender erythroderma,bullae,and desquamation with a scalded appearance especially in friction zones,periorificial scabs/crusting,positive Nikolsky sign,and absence of mucosal involvement.Prompt empiric treatment with intravenous anti-staphylococcal antibiotic such as nafcillin,oxacillin,or flucloxacillin is essential until cultures are available to guide therapy.Clarithromycin or cefuroxime may be used should the patient have penicillin allergy.If the patient is not improving,critically ill,or in com-munities where the prevalence of methicillin-resistant S.aureus is high,vancomycin should be used.Conclusion A high index of suspicion is essential for an accurate diagnosis to be made and treatment promptly initiated.展开更多
文摘Herpes zoster is caused by reactivation of latent varicella-zoster virus that resides in a dorsal root ganglion. Herpes zoster can develop at any time after a primary infection or varicella vaccination. The incidence among children is approximately 110 per 100,000 person-years. Clinically, herpes zoster is characterized by a painful, unilateral vesicular eruption in a restricted dermatomal distribution. In young children, herpes zoster has a predilection for areas supplied by the cervical and sacral dermatomes. Herpes zoster tends to be milder in children than that in adults. Also, vaccine-associated herpes zoster is milder than herpes zoster after wild-type varicella. The diagnosis of herpes zoster is mainly made clinically, based on a distinct clinical appearance. The most common complications are secondary bacterial infection, depigmentation, and scarring. Chickenpox may develop in susceptible individuals exposed to herpes zoster. Oral acyclovir should be considered for uncomplicated herpes zoster in immunocompetent children. Intravenous acyclovir is the treatment of choice for immunocompromised children who are at risk for disseminated disease. The medication should be administered ideally within 72 hours of rash onset.
文摘Background Staphylococcal-scalded skin syndrome(SSSS),also known as Ritter disease,is a potentially life-threatening disorder and a pediatric emergency.Early diagnosis and treatment is imperative to reduce the morbidity and mortality of this condition.The purpose of this article is to familiarize physicians with the evaluation,diagnosis,and treatment of SSSS.Data sources A PubMed search was completed in Clinical Queries using the key terms"Staphylococcal scalded skin syn-drome"and"Ritter disease".Results SSSS is caused by toxigenic strains of Staphylococcus aureus.Hydrolysis of the amino-terminal extracellular domain of desmoglein 1 by staphylococcal exfoliative toxins results in disruption of keratinocytes adhesion and cleavage within the stratum granulosum which leads to bulla formation.The diagnosis is mainly clinical,based on the findings of tender erythroderma,bullae,and desquamation with a scalded appearance especially in friction zones,periorificial scabs/crusting,positive Nikolsky sign,and absence of mucosal involvement.Prompt empiric treatment with intravenous anti-staphylococcal antibiotic such as nafcillin,oxacillin,or flucloxacillin is essential until cultures are available to guide therapy.Clarithromycin or cefuroxime may be used should the patient have penicillin allergy.If the patient is not improving,critically ill,or in com-munities where the prevalence of methicillin-resistant S.aureus is high,vancomycin should be used.Conclusion A high index of suspicion is essential for an accurate diagnosis to be made and treatment promptly initiated.
