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Flashcards in Week 3 - Case 1 Deck (16):
0

What does VINDICATE stand for?

Vascular
Infection (viral, bacterial, fungal)
Neoplasm
Drugs (medications or illicit drugs)
Inflammatory/Idiopathic
Congenital
Autoimmune
Trauma
Endocrine/Metabolic

1

What causes SSSS and what does SSSS stand for?

Staphylococcal Scalded Skin Syndrome
-It's cause by Staphylococcus aureus and a previous systemic infection

2

What does a typical SSSS case involve?

Ill child for the past few weeks, runny nose, not eating well, generalized rash, red eyes, red tounge, slightly inflamed throat, a few large cervical lymph nodes
-General erythematous rash present with exfoliation on the face, back of the neck, ears and feet (red, flaking skin)
-Do a skin culture to confirm your diagnosis

3

What is childhood exanthema?

A skin rash accompanying a disease or fever

4

What are possible causes of Childhood Exanthema?

1. Viral Exanthemas
2. Scarlet fever
3. Thermal burns
4. Pemphigus
5. Kawasaki disease
6. SSSS

5

What is associated with the chicken pox virus?

Varicella zoster - prodrome of fever and malaise
-Rash with blisters followed by scabs on body and head
Diagnosis: can culture lesions but most diagnosis made by history and exam

6

What causes fifths disease?

This is also "slapped cheeks" syndrome caused by Parvovirus B19.
-It is associated with fever and joint pain.
Diagnosis is done by history and exam, no lab.

7

What is pemphigus? What does this disease create antibodies against?

-Blistering, autoimmune disease
-Autoantibodies against desmoglein, which glues epidermal cells together
Diagnosis: Skin punch biopsy

8

What organism causes scarlet fever and how does the disease progress?

Group A strep
-Begins with fever and sore throat
-Rash begins on neck and chest
-Red tongue with white patch on back of tongue
Diagnosis: throat swab for strep antigen

9

What does Kawasaki disease cause and how is it diagnosed?

-Autoimmune vasculitis
-Affects skin, mucous membrane, blood vessels and heart
-High fever and rash, red eyes, enlarged lymph nodes
Diagnosis: history and physical only, no lab that helps

10

SSSS - what does the gram stain look like?

Gram +, purple, cocci in clusters/clumps
Staphylococcus aureus

11

What is a diagnostic test to determine if an organism is SSSS? What toxins does SSSS produce?

The staph should be coagulase positive.
Releases exfoliatin (epidermolysin), an extracellular toxin

12

What is the typical presentation of SSSS?

-Erythematous rash near eyes and mouth, red eyes (conjunctiva), exfoliation of skin
-Can occur in newborns or babies
-Starts as skin redness followed by exfoliation of skin 2-5 days later
-Typically associated with fever
Diagnosis: based on history and appearance
Lab test: CRP increased, platelet count normal, Grams stain positive, blood or tissue cultures will confirm the diagnosis later

13

What does the exfoliatin toxin do?

It splits the upper epidermis below the granular cell layer.

14

How to treat SSSS?

-Beta-lactamase resistant Penicillin (ampicillin/sulbactam) or Penicillinase-resistant penicillin (Nafcillin)
-Isolate the child - easily transmitted

15

What is the mortality for SSSS?

50% in adults
3-10% in children