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LETTER TO EDITOR
Year : 1991  |  Volume : 57  |  Issue : 3  |  Page : 160-161

Umbilical sepsis - An important cause of staphylococcal scalded skin syndrome in the tropical countries




Correspondence Address:
Vinay Kulkarni


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How to cite this article:
Kulkarni V, Gharpuray M. Umbilical sepsis - An important cause of staphylococcal scalded skin syndrome in the tropical countries. Indian J Dermatol Venereol Leprol 1991;57:160-1

How to cite this URL:
Kulkarni V, Gharpuray M. Umbilical sepsis - An important cause of staphylococcal scalded skin syndrome in the tropical countries. Indian J Dermatol Venereol Leprol [serial online] 1991 [cited 2019 Oct 18];57:160-1. Available from: http://www.ijdvl.com/text.asp?1991/57/3/160/3661


To the editor

Staphylococcal scalded skin syndrome (SSSS), which ranges in severity from a lo­calized form, so called bullous impetigo - to a generalized syndrome, is linked with group 2 Staphylococcus aureus[1] The aetiology is linked to elaboration of a distinctive exotoxin (epidermolysin)by these resident group 2, mostly phage;e type 71 staphylococci.

Through the disease seems to be rela­tively uncommon it is not at all rare. In the course of last 5 years of dermatological prac­tice, we have come across 7 cases of SSSS. All of them were neonates and had developed the severe, generalized disease during the first 10 days of life. In all of them the most probable site of infection was the umbilical stump. Surprised by this high frequency of umbilical sepsis as the source of SSSS, we consulted major dermatology text books and in none of them could find any reference to umbilical sepsis.[1],[2],[3],[4],[5],[6] The only reference stating that the causative staphylococcus may colo­nize in the nose, conjunctivae or umbilical stump was noted in the dermatologic  Atlas More Details section of one of the books. The probable reason behind this, seems to us, to be the relative absence of umbilical sepsis in the neonates in the developing countries, where all the dermatology texts are written.

In the tropical countries, it is a common experience that many of the deliveries are still carried out at home by poorly trained assis­tants, using non-sterile instruments and tech­niques. In all of our cases the babies were delivered at home by poorly trained assistants. After the cord is cut it is tied by unsterile thread and many a times a variety of sub­stances (including cow dung) may be applied to the stump inviting sepsis. In this situation it is not at all surprising that umbilical sepsis is common. If the infecting organisms hap­pened to be group 2, phage type 71 staphy­lococci, one is naturally asking for SSSS.

Due to lack of proper diagnostic facilities we were not able to type the bacterial isolates from our cases but after our 4th case atleast a smear was done from the infected umbilical stump, which invariably showed presence of staphylococci. Also there was no other de­monstrable site of infection in any of our cases, which substantiates our assumption that the infected umbilicus was the site of in­fection.

The letter is written to point at this situa­tion in the tropical countries, which needs further investigations, and also proper mention in the dermatology text-books[7].

 
  References Top

1.Elias PM and Fritsch PO : Staphylococcal scalded skin syndrome, in : Dermatology in General Medi­cine, Editors, Fitzpatrick TB, Eisen AZ, Wolff K et al : McGraw Hill, New York, 1987; p 567-571.  Back to cited text no. 1    
2.Swartz MN and Weinberg AN : Infections due to gram-positive bacteria, in : Dermatology in Gen­eral Medicine, Editors, Fitzpatrick TB, Eisen AZ, Wolff K et al : McGraw Hill, New York,1987; p 2114-2115.  Back to cited text no. 2    
3.Pye RJ : Bullous eruptions, in : Textbook of Der­matology, Editors, Rook A, Wilkinson DS, Ebling FJG et al: Oxford University Press, Bombay,1087; p 1656-1957.  Back to cited text no. 3    
4.Atherton DJ and Rook A : The Newborn, in : Text­book of Dermatology, Editors, Rook A, Wilkinson DS, Ebling FJG et al : Oxford University Press, Bombay, 1987; p 259.  Back to cited text no. 4    
5.Esterly NB : Staphylococcal scalded skin syndrome, in : Clinical Dermatology, Editor, Demis DJ : Harper and Row, Philadelphia, 1987; vol.1, unit 1-16, p 1­6.  Back to cited text no. 5    
6.Ruiz-Maldonado R : Neonatal skin diseases, in Textbook of Paediatric Dermatology, Editors, Ruiz­Maldonado R, Parish RC, Beare JM : Grune and Stratton, Philadelphia, 1989; p 63-64.  Back to cited text no. 6    
7.Fitzpatrick TB and Johnson RA : Differential diag­nosis of rashes in the acutely ill febrile patient and in life-threatening diseases, in : Dermatology in General Medicine, Editors, Fitzpatrick TB, Eisen AZ, Wolff K et al : McGraw Hill, New York,1987; p 1789.  Back to cited text no. 7    


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