지역사회 획득 메치실린 내성 포도알균에 의한 포도알균 열상 피부 증후군의 임상적 고찰

Abstract

Purpose : Staphylococcal scalded skin syndrome (4S) is a well known disease defined by clinical, microbiological and histological criteria caused by Staphylococcus aureus. This disease is uncommon but has been increasingly recognized. We investigated the clinical features of staphylococcal scalded skin syndrome. Methods : We reviewed retrospectively medical records of 53 patients diagnosis of staphylococcal scalded skin syndrome who were admitted to Changwon Fatima hospital from February 2002 to December 2005. These patients were divided into 3 clinical types; generalized type, intermediate type, abortive type. Age, sex ratio, clinical manifestations, laboratory findings, response to therapy and prognosis were investigated. Result : 1)The mean age of patients was 2.8 years, ranging from 20 days to 7 years. Male-to-female ratio was 1.9:1. 2) By clinical types, 6 patients were in the generalized type (11%), 29 patients in the intermediate type (55%), 18 patients in the abortive type (34%). The coexisting diseases were variable, including conjunctivitis (25 cases), atopic dermatitis (11 cases), otitis media (1 case). On laboratory findings, most of patients didn't have leukocytosis or increased C-reactive protein. 4) A total of fifteen Methicillin Resistant Staphylococcal Aureus (MRSA) strains were isolated from September 2003 through December 2005. Fourteen strains were positive for exfoliative toxin B gene by PCR and negative for enterotoxin, toxic shock syndrome toxin and Panton-Valentine leukocidin genes. 5) The mean duration of admission was 7.3 days. Patients were treated with vancomycin or amoxacillin/ clavulanate or ampicillin/sulbactam or cefuroxime without significant sequelaes. Conclus ion : Recently, Staphylococcal scalded skin syndrome caused by exfoliative toxin B produced by MRSA in the Changwon area has been increasing. (Korean J Pediatr Infect Dis 2007;14:83-90)