A 6-week-old infant develops multiple erythematous pustules on the face, scalp, and upper trunk. The lesions contain a yellowish exudate. Culture grows Staphylococcus aureus sensitive to flucloxacillin. Which complication is most feared in young infants with staphylococcal skin infection?
- A Erythema multiforme
- B Neonatal pemphigus from anti-desmoglein antibodies
- C Infantile acropustulosis
- D Staphylococcal scalded skin syndrome (SSSS) from exfoliative toxin ✓
Explanation
Staphylococcal scalded skin syndrome (SSSS, Ritter disease in neonates) is the most feared complication of Staphylococcus aureus skin infection in young infants. It is caused by exfoliative toxins A and B (ETs), serine proteases that cleave desmoglein-1 in the superficial epidermis, causing intraepidermal cleavage and widespread bullae and desquamation resembling scalded skin. Nikolsky's sign is positive. The primary infection may be localized (conjunctivitis, omphalitis, pustules), but hematogenous spread of toxin produces generalized skin failure. IV antistaphylococcal antibiotics (flucloxacillin or cloxacillin) are the treatment of choice.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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