Prévention repose sur :
5) Antibiotiques & Vaccination
L'antibiothérapie prophylactique n'est généralement pas efficace, elle active le développement de bactéries résistantes et altère l'équilibre de la flore normale du nouveau-né. Cependant, au cours d'une épidémie de maternité confirmée, les antibiotiques contre les agents pathogènes spécifiques peuvent être envisagés.
Les vaccins inactivés doivent être administrés selon le calendrier systématique (Tableau n : Calendrier national de vaccination recommandé de 0 à 5 ans) à tout nourrisson hospitalisé à ce moment-là.
X. Conclusion : (102)
Une desquamation généralisée et systémique est le plus souvent un syndrome d'épidermolyse aigue staphylococcique chez le nourrisson et le jeune enfant (et parfois chez l'adulte immunodéprimé).
Effectuer une biopsie et une culture de la conjonctive, du nasopharynx, des hémocultures, un ECBU et une culture des zones de possible infection primaire, comme l'ombilic et les lésions cutanées suspectes.
Traiter par des antibiotiques antistaphylococciques et si la maladie est diffuse dans un service de brûlés, si possible.
Surveiller et traiter les complications semblables à celles qui se produisent dans les brûlures (p. ex., déséquilibre hydro-électrolytique,le sepsis).
RÉSUMÉ
Titre :Epidermolyse aiguë staphylococcique chez l’enfant Auteur : KALLIDA Zaineb
Rapporteur : Professeur. JABOUIRIK.Fatima
Mots clés : Staphylococcus Aureus- Peau-Desmogleine -1- ;Antibiotiques.
L’épidermolyse aiguë staphylococcique (EAS) nommée aussi le syndrome de
la peau ébouillantée chez les jeunes enfants (Staphylococcal Scalded Skin Syndrome) est provoquée par la diffusion d’exfoliatines (ETA et/ou ETB) à partir d’un foyer initial qui peut être ORL, conjonctival ou cutané.
Le syndrome d’exfoliation généralisée se caractérise par une érythrodermie douloureuse, rapidement suivie d’un décollement bulleux généralisé régressant en 2 à 4 jours sous antibiotiques (ATB), avec respect des surfaces muqueuses, les bulles sont stériles.
Le diagnostic positif repose sur l'examen clinique et sur la biopsie cutanée.
Le diagnostic différentiel comprend essentiellement le syndrome de Lyell et de Stevens-johnson, la nécrolyse épidermique toxique,les exanthèmes viraux, la scarlatine, les brûlures thermiques et chimiques, les maladies bulleuses génétiques, des maladies bulleuses acquises,le syndrome d’ébouillantement staphylococcique atypique ,les manifestations dermatologiques de la maladie de Kawazaki.
L’évolution est bénigne, favorisée par un traitement anti-staphylococcique associée à des soins locaux, cependant le risque d’évolution mortelle est estimé à environ 4% en cas de retard de traitement antibiotique. (102) ; (103)
SUMMARY
Title :Staphylococcal scalded skin syndrome(SSSS) Author : KALLIDA Zaineb
Reporter : Professor JABOUIRIK Fatima
Keywords: Staphylococcus Aureus- Skin-Desmoglein -1-Antibiotics.
Staphylococcal scalded skin syndrome (SSSS) is caused by toxigenic strains of Staphylococcus aureus, a gram-positive, catalase-positive bacterium. The specific toxigenic strains usually belong to phage group 2 (types ETA/ETB).
Patients usually present with fever and pain associated with a generalized, macular, salmon-colored to bright-red rash. Within 24-48 hours, the rash progresses from a scarlatiniform rash to an edematous, blistering eruption. Periumbilical and perineal involvement is more common in infants. Extremity involvement is seen more often in older children. The Nikolsky sign, is present in staphylococcal scalded skin syndrome.
The diagnosis of staphylococcal scalded skin syndrome was reached on clinical grounds and culture report.
The differential Diagnoses: Dermatologic manfestations of Stevens-johnson Syndrome and Toxic Epidermal Necrolysis ; Epidermolysis bullosa, Impetigo,Pemphigus,Foliaceus; Dermatologic manifestations of Kawasaki , Scarlet Fever,Chemical Burns,Thermal Burns. Pediatric Toxic Shock Syndrome and child abuse.
The benign evolution favored by a penicillinase-resistant anti-staphylococcal antibiotic treatment combined with local care, should not make us forget the risk of fatal evolution estimated at about 4% in case of delayed antibiotic treatment.
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ناﻮﻨﻌﻟا ﺔﯾدﻮﻘﻨﻌﻟا تارﻮﻜﻤﻟا ﺔﻣزﻼﺘﻣ : ةدﺎﺤﻟا ﺔﻗوﺮﺤﻤﻟا لﺎﻔطﻷا ﺪﻨﻋ ﻒﻟﺆﻤﻟا : ﻗ ﺪﯿﻠ ة ﺐﻨﯾز فﺮﺸﻤﻟا : ذﺎﺘﺳأ ﺔﻤطﺎﻓ ﻚﯾﺮﯾﻮﺑﺎﺟ ة تﺎﻤﻠﻜﻟا ﺔﯿﺳﺎﺳﻷا : ﺔﯾدﻮﻘﻨﻌﻟا تارﻮﻜﻤﻟا – ﺪﻠﺠﻟا -ﺔﯾﻮﯿﺤﻟا تادﺎﻀﻤﻟا , ﻦﯿﻠﻏﻮﻤﺴﯾد -1 ﻔط ﻲھ ﺔﯿﺒھﺬﻟا ﺔﯾدﻮﻘﻨﻌﻟا تارﻮﻜﻤﻠﻟ قﺮﺘﺤﻤﻟا ﺪﻠﺠﻟا ﺔﻣزﻼﺘﻣ ﻰﻋﺪﺗ ﺎﯾﺮﯿﺘﻜﺑ ﮫﺒﺒﺴﺗ قﺎﻄﻨﻟا ﻊﺳاو ﻢﻟﺆﻣ يﺪﻠﺟ ﺢ ﺪﻠﺠﻟا ﻦﻣ ﺔﯿﺟرﺎﺨﻟا ﺔﻘﺒﻄﻟﺎﺑ رﺮﻀﻟا ﻖﺤﻠﺗ ﺔﻣﺎﺳ ةدﺎﻣ ﺞﺘﻨﺗ ﻲﺘﻟاو ،ﺔﯿﺒھﺬﻟا ﺔﯾدﻮﻘﻨﻌﻟا تارﻮﻜﻤﻟا . ا ﺔﯾدﻮﻘﻨﻌﻟا تارﻮﻜﻤﻟا تﻻﻼﺳ ﺐﺒﺴﺑ ﺔﯾدﻮﻘﻨﻌﻟا تارﻮﻜﻤﻟا ﺪﻠﺠﻟا ﺔﻣزﻼﺘﻣ ﺐﺒﺴﺘﺗ :ﺔﯿﺿﺮﻤﻟا ﺎﯿﺟﻮﻟﻮﯾﺰﯿﻔﻟ ﻐﻟا ﺔﯿﺑﺎﺠﯾإ ﺎﯾﺮﯿﺘﻜﺑ ﻲھو ، ﺔﯿﺒھﺬﻟا ﺔﻋﻮﻤﺠﻣ ﻰﻟإ ً ةدﺎﻋ ﺔﯿﻤﺴﻟا ةدﺪﺤﻤﻟا تﻻﻼﺴﻟا ﻲﻤﺘﻨﺗ .زﻻﺎﺗﺎﻜﻟا ﻦﻣ ﺔﯿﺑﺎﺠﯾإو ماﺮ ﺔﻤﮭﺘﻠﻤﻟا 2 عاﻮﻧﻷا) 3 A وأ 3 B ةﺮﺸﺒﻟا ﻢﻤﺴﺗ ، ﺔﯿﺟرﺎﺨﻟا مﻮﻤﺴﻟا ﻦﻣ ﻦﯿﻨﺛا .( A (ET-A) ةﺮﺸﺒﻟا ﻢﻤﺴﺗو B (ET-B) ﻲﻓ تﺪھﻮﺷ ﻲﺘﻟا ﺔﯿﺿﺮﻤﻟا تاﺮﯿﻐﺘﻟا ﻦﻋ ﺔﻟوﺆﺴﻤﻟا ﻲھ ، ﺐﺒﺴﺘﺗ .ﺔﯾدﻮﻘﻨﻌﻟا تارﻮﻜﻤﻟا ﺔﻣزﻼﺘﻣ ﻲﻓ مﻮﻤﺴﻟا هﺬھ ﻦﯿﻠﻏﻮﻤﺴﯾﺪﻠﻟ دﺪﺤﻣ قﺎﻘﺸﻧا ﻖﯾﺮط ﻦﻋ ، ةﺮﺸﺒﻠﻟ ﺔﯿﺒﯿﺒﺤﻟا ﺔﻘﺒﻄﻟا ﺮﺒﻋ ﺪﻠﺠﻟا ﻞﺧاد مﺎﺴﻘﻧﻻا 1 ﻲﻓ ﻊﺟاﺮﺘﯾ ﻢﻤﻌﻣ ﻲﻋﺎﻘﻓ لﺎﺼﻔﻧا رﻮﻔﻟا ﻰﻠﻋ ﺎﮭﯿﻠﺗ ، ﻢﻟﺆﻣ ﻲﻣﺎﻤﺣ راﺮﻤﺣﺎﺑ ﻢﻤﻌﻤﻟا ﺮﯿﺸﻘﺘﻟا ﺔﻣزﻼﺘﻣ ﺰﯿﻤﺗ نﻮﻀﻏ 2 ﻰﻟإ 4 ﯿطﺎﺨﻤﻟا ﺢﻄﺳﻷا ماﺮﺘﺣا ﻊﻣ ، ﺔﯾﻮﯿﺤﻟا تادﺎﻀﻤﻟا ﺖﺤﺗ مﺎﯾأ .ﺔﻤﻘﻌﻣ تﺎﻋﺎﻘﻔﻟا نﻮﻜﺗو ، ﺔ .ﺔﯾﺪﻠﺠﻟا ﺔﻋﺰﺨﻟاو يﺮﯾﺮﺴﻟا ﺺﺤﻔﻟا ﻰﻠﻋ ﻲﺑﺎﺠﯾﻹا ﺺﯿﺨﺸﺘﻟا ﺪﻤﺘﻌﯾ لﺎﺤﻄﻟا ،ﻲﻤﺴﻟا ةﺮﺸﺒﻟا ﺮﺨﻨﺗ ،نﻮﺴﻧﻮﺟ ﺰﻨﻔﯿﺘﺳو ﻞﯿﻟ ﺔﻣزﻼﺘﻣ ﻰﻠﻋ ﻲﺳﺎﺳأ ﻞﻜﺸﺑ ﻲﻘﯾﺮﻔﺘﻟا ﺺﯿﺨﺸﺘﻟا ﻞﻤﺘﺸﯾ ﻘﻔﻟا ﺔﯿﺛارﻮﻟا ضاﺮﻣﻷا ، ﺔﯿﺋﺎﯿﻤﯿﻜﻟاو ﺔﯾراﺮﺤﻟا قوﺮﺤﻟا ، ﺔﯾﺰﻣﺮﻘﻟا ﻰﻤﺤﻟا ، ﻲﺳوﺮﯿﻔﻟا ﺔﯿﻋﺎ , ﺔﯿﻋﺎﻘﻔﻟا ضاﺮﻣﻷا .ﻲﻛازاوﺎﻛ ضﺮﻤﻟ ﺔﯾﺪﻠﺠﻟا ﺮھﺎﻈﻤﻟا ، ﺔﯾﺪﯿﻠﻘﺘﻟا ﺮﯿﻏ ﺔﯾدﻮﻘﻨﻌﻟا تارﻮﻜﻤﻟا ﺔﻣزﻼﺘﻣ ، ﺔﺒﺴﺘﻜﻤﻟا ، ﺔﯾدﻮﻘﻨﻌﻟا تارﻮﻜﻤﻟا ﺰﯿﻛﺮﺗ ﻰﻠﻋ ءﺎﻀﻘﻟا ﻲﻓ ﺔﯾدﻮﻘﻨﻌﻟا تارﻮﻜﻤﻟا ﺔﻌﻘﺒﻤﻟا ﺪﻠﺠﻟا ﺔﻣزﻼﺘﻤﻟ جﻼﻌﻟا ﮫﯿﺟﻮﺗ ا ﺔﯾﻮﯿﺤﻟا تادﺎﻀﻤﻟاو ، ﺪﯾرﻮﻟا ﻖﯾﺮط ﻦﻋ ةدﺎﻋ ﺐﻠﻄﺘﺗ ﻲﺘﻟاو تﺎﺑوﺮﻜﯿﻤﻟا تادﺎﻀﻣو ، تﺎﻨﯿﻠﯿﺴﻨﺒﻠﻟ ةدﺎﻀﻤﻟ . ﻰﺴﻨﻧ ، زﺎﻨﯿﻠﯿﺴﻨﺒﻠﻟ ﺔﻣوﺎﻘﻤﻟا ﺔﯾﻮﯿﺤﻟا تادﺎﻀﻤﻟﺎﺑ جﻼﻌﻟا ﮫﻠﻀﻔﯾ يﺬﻟا ، ﺪﯿﻤﺤﻟا رﻮﻄﺘﻟا ﺎﻨﻠﻌﺠﯾ نأ ﻲﻐﺒﻨﯾ ﻻ ﻮﺤﻨﺑ رﺪﻘﯾ يﺬﻟا ﺖﯿﻤﻤﻟا رﻮﻄﺘﻟا ﺮﻄﺧ 4 .ﺔﯾﻮﯿﺤﻟا تادﺎﻀﻤﻟﺎﺑ جﻼﻌﻟا ﺮﺧﺄﺗ ﺔﻟﺎﺣ ﻲﻓ ٪[1] CEDEF ,Collège des enseignants en dermatologie de France ;Histologie de la peau et de ses annexes ,cours de sémiologie Mai 2011 .
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