|LETTER TO EDITOR
|Year : 1991 | Volume
| Issue : 3 | Page : 160-161
Umbilical sepsis - An important cause of staphylococcal scalded skin syndrome in the tropical countries
Vinay Kulkarni, Mohan Gharpuray
Source of Support: None, Conflict of Interest: None
|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 2020 Jan 24];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 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.,,,,, 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.
| References|| |
|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. |
|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. |
|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. |
|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. |
|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. |
|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. |
|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. |
[Figure - 1], [Figure - 2]