Staphylococcal scalded skin syndrome

Abstract

            Staphylococcal scalded skin syndrome (SSSS) is a type of disorder that develops due to a toxin produced by a staphylococcal infection. The toxin binds to a specific target protein which is very high in the epidermis thereby producing a reddening of the skin and blistering of the skin. The term paper provides a discussion of Staphylococcal scalded skin syndrome using the ideas presented in different research papers. In one of the studies, the researcher reviewed previous studies and developed a specific ELISA to establish the distribution of anti-Exfoliative toxin A antibodies in pre-term infants. The second research study sought to investigate Staphylococcal scalded skin syndrome in neonates using a review of neonates with a diagnosis of SSSS from January 2004 to January 2012.  

Material and Methods

            The study that involved the use of anti-Exfoliative toxin required the approval by the Ethics Committee and informed consents for the study as obtained from the parents and patients. The ETA and serum samples were necessary, and ETA was acquired from Toxin Technology, Sarasota USA with a purity of above 95 %. The serum samples were obtained from the patients and collected before and after the onset of S. aureus infection. Other samples were obtained from the infants born at the hospital during the period.  The enzyme-linked immune sorbent assay plates (ELISA) were coated with ETA and diluted in a buffered phosphate saline for a night. The ETA was removed and the serum samples transferred to the wells. The complexes of Antigen-Antibody were detected using peroxidase-conjugated polyclonal antibodies against human IgG. Reading was carried out at 450 nm on a Spectra Max PLUS384 and results expressed as optical density (Saida, Kawasaki, et. al., 2015). 

            For the second experiment, the researcher obtained the ethics approval from the Human Research Ethics Committee. The researcher conducted a retrospective search of the medical records database from January 2004 to 2012 for the newborns presented with SSSS within 30 days of birth. The diagnosis was clinical and was supported by Histologic diagnosis and microbiologic examination. Case notes were analyzed according to the age of the patient, the living area, time from onset of admission, history of maternal infection, gestation age, and other physical examination findings. The setting of the study was at the Children’s Hospital of Chongqing Medical University, which is a referral center for Pediatrics in South West China (Li, Hua, Wei, & Qiu, 2014).    

Results

            From the first study, the anti-ETA antibody OD values were low in cases 1, 2, and 3, but high in case 4. All the patients reported increased anti-ETA antibody levels few months after the infection. For the term and preterm infants, the anti-ETA results varied by gestation age. The prevalence of anti-ETA antibodies in the neonates with less than 30 weeks, 30-37 weeks, and more than 37 weeks were 55%, 73%, and 90% respectively. The levels for the preterm infants group with gestation age of fewer than 30 weeks were statistically lower than those of the term infants group. The preterm infant groups with a gestational age of 30 to 37 weeks, and the term infants had no significant difference (Saida, Kawasaki, et. al., 2015).  

            For the second research on SSSS, the results indicated that 39 of the 56000 neonates admitted to the selected department throughout the study period had Staphylococcal scalded skin syndrome. 8 cases were reported in the first four years and 31 in the subsequent years. The mean age at diagnosis was 7.7 days with a range of 2 hours to 30 days. The peaks of incidence were recorded during the summer-autumn seasons. 

            Of the 34 patients diagnosed with Staphylococcal scalded skin syndrome, the researcher prepared cultures and 8 were S. aureus positive from the results of the venous blood samples, five from the bullae fluid, and two from the throat swab samples. The samples had zero resistance to vancomycin, ciprofloxacin, nitrofurantoin, gentamicin, and oxacillin; 6.2 % were resistant to tetracycline and amoxicillin with clavulanic acid and 14.3 % resistant to cephalosporins. The samples were fully resistant to penicillin and ampicillin. The severity of the impaired skin and the clinical judgment helped to estimate the antibodies used for treatment. There were no significant differences between the response to therapy methods used, but the patients treated with intravenous gamma globulin had longer hospitalizations than others (Li, Hua, Wei, & Qiu, 2014).   

            The prognosis results indicated that all the patient’s body temperatures returned to normal within three days after admission. Pneumonia was the most common complication, but healing occurred without scarring. The range of the hospitalization length was 1 to 22 days.  

Discussion

            For the first study, the methicillin-sensitive S. aureus (MSSAs) from each of the patients were identical clones that produced ETA and transferred to the neonatal intensive care unit (NICU). ET is an exotoxin produced by S. aureus, and ETA was generated by the strain used in the cases. The anti-ETA antibodies help to neutralize the effects of ETA but the relationship between the start of SSSS and the prevalence of anti-ET remains unknown. The study was the first to measure the antibodies against ETA in the preterm infants. For cases 1 to 3, there was no anti-ETA antibody level above the cutoff value before the infection. However, case 4 had high values of the antibody. It explains the onset of SSSS in the cases of patients 1 to 3 and lack of symptoms for case 4. The severity of the disease varies among the three cases 1 to 3. The factors like immunological immaturity and renal clearance of ET help to explain the differences in disease severity.

            Staphylococcal aureus causes bullous impetigo (BI) to staphylococcal scalded skin syndrome (SSSS). The conditions are prevalent among the infants below five years because of the lack of particular anti-ETA and anti-ETB antibodies. The maternal anti-ETA antibodies are passed on to newborn babies since some newborns are reported to have ETA-antibodies in their umbilical blood. The study revealed that the prevalence of anti-ETA antibodies above the cutoff level in preterm infants is due to the low levels of antibodies against the toxins. Case 4 did not develop a positive staphylococcal culture due to the likelihood of a potent natural antibacterial immunity and presence of the different types of anti-staphylococcal antibodies. The discussion of the onset of SSSS by anti-ETA antibody levels is challenging. SSSS in neonates is mild and usually treatable by use of antibiotics. However, the drugs are not fully reliable due to the antimicrobial resistance of the clinical strains of S. aureus. The study confirms that a significant portion of anti-ETA antibody was present in the immunoglobulin that supports the use of the immunoglobulin element of donors blood (IVIg) as an alternative for the treatment of Staphylococcal scalded skin syndrome.

            From the results obtained in the second study, it is evident that S. aureus causes different infectious diseases that can be superficial on the skin to the severe and toxic systemic infections. Staphylococcal scalded skin syndrome is a disorder that causes blistering of the superficial layer of the skin. There was a significant increase in the hospital admissions for patients with SSSS for the analyzed data. The researchers isolated the S. aureus in 23.5 % of the cultured cases, and only 2.9 % were from the blood culture. The low positive rates have an association with the high rates of cases that received antibiotics before admission. The results show the challenges encountered in the isolation of S. aureus for the individuals with SSSS.

            An early diagnosis, assessment, and treatment with the appropriate antibiotics are essential for successful management of SSSS. The medications in use were antibiotics but also offered supportive care that contributed to 0% mortality in the study. The results are similar to the previous studies, but they had a higher mortality rate.

Critique of the papers

            In the first study, the researchers did not show data related to the anti-ETA antibody as found presented in the immunoglobulin. Thus, the conclusion made about the results could be liable for compromise. The researchers ought to provide the comparative results to ascertain that the findings were similar to the previous studies. The design used was appropriate for the study and the sample selection criteria used effectively in identifying the appropriate participants for the study.

            For the second study, the researchers limited the study population by using a small number which could compromise the results. For instance, the determination of whether intravenous gamma globulin therapy was appropriate required a better reliance on multiple data sources. The data on SSSS in neonates is limited thereby affecting the interpretation of the research results due to lack of a proper theoretical framework. The reliance on the recorded data from 2004 to 2012 could affect the findings since there was no method of validating the accuracy of the records at the time of storage. However, the study was effective in investigating SSSS in neonates.

New Ideas

            The future research should incorporate the ideas obtained the studies to examine the relationship between anti-ETA antibodies and the SSSS onset in neonates as well as the effective treatment methods for SSSS. The researchers ought to examine the specific cause of the low or high levels of anti-ETA antibodies at the onset of SSSS and the effective methods of treating the disorder after infection.                           

Conclusion

            The patients with SSSS are likely to have a low level of the anti-ETA antibody as well as the preterm infants. The healthy and full term infants have high levels of anti-ETA antibodies and hence the method can be useful in determining the prevalence to Staphylococcal scalded skin syndrome. In another study, the use of clinical manifestations, history, and laboratory tests proves to be appropriate in distinguishing the superficial skin disorders. A neonate diagnosed with Staphylococcal scalded skin syndrome requires immediate treatment. More research is necessary on the alternative methods of treatment of Staphylococcal scalded skin syndrome to the use of antibiotics. In both studies, the results indicate that the type of disorder is not highly prevalent in children, but there are few cases in isolation.    

References

Li, M. Y., Hua, Y., Wei, G. H., & Qiu, L. (2014). Staphylococcal Scalded Skin Syndrome in        Neonates: An 8-Year Retrospective Study in a Single Institution. Pediatric Dermatology,       31(1), 43-47. doi:10.1111/pde.12114

Saida, K., Kawasaki, K., Hirabayashi, K., Akazawa, Y., Kubota, S., Kasuga, E., & ... Koike, K.   (2015). Exfoliative toxin A staphylococcal scalded skin syndrome in preterm infants:    European Journal Of Pediatrics, 174(4), 551-555. doi:10.1007/s00431-014-2414-3

Sherry Roberts is the author of this paper. A senior editor at Melda Research in nursing writing services if you need a similar paper you can place your order for Customized Research Papers.