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Key Features

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  • Diseases caused by staphylococci include, but are not limited to, furuncles, carbuncles, scalded skin syndrome, osteomyelitis, pyomyositis, septic arthritis, pneumonia, bacteremia, endocarditis, meningitis, and toxic shock syndrome (TSS)

  • Staphylococci are the major cause of osteomyelitis and septic arthritis and are an uncommon but important cause of bacterial pneumonia

  • Two toxins are recognized as playing a central role in specific diseases

    • Exfoliatin, largely responsible for scalded skin syndrome

    • Enterotoxin causes staphylococcal food poisoning

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Clinical Findings

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  • Staphylococcal skin diseases

    • Dermal infection with S aureus causes pustules, furuncles, carbuncles, or cellulitis.

    • Skin lesions can be seen anywhere on the body but are commonly seen on the buttocks in infants and young children

    • Factors that facilitate transmission of methicillin-resistant S aureus (MRSA) or methicillin-susceptible S aureus (MSSA) include

      • Crowding

      • Compromised skin (eg, eczema)

      • Participation on contact sports teams

      • Day care attendance

      • Bare skin contact with surfaces used by others (exercise mats, sauna benches)

      • Sharing towels or other personal items

  • Scalded skin syndrome

    • Skin erythema, often beginning around the mouth, is accompanied by fever and irritability

    • Involved skin becomes tender to touch

    • A day or so later, exfoliation begins, usually around the mouth

    • Inside of the mouth is red, and a peeling rash is present around the lips, often in a radial pattern

    • If erythematous but unpeeled skin is rubbed, superficial epidermal layers separate from deeper ones and slough (Nikolsky sign)

    • In the newborn, the disease is termed Ritter disease and may be fulminant

  • Staphylococcal pneumonia

    • Characterized by abdominal distention, high fever, respiratory distress, and toxemia in infants

    • May occur without predisposing factors or after minor skin infections

    • Organism is necrotizing, producing bronchoalveolar destruction

    • Pneumatoceles, pyopneumothorax, and empyema are frequently encountered

    • Frequent chest radiographs to monitor the progress of disease are indicated

    • MRSA or MSSA pneumonias are rapidly progressive, severe, and often devastating

  • Staphylococcal food poisoning

    • Characterized by vomiting, prostration, and diarrhea occurring 2–6 hours after ingestion of contaminated foods

  • Staphylococcal endocarditis

    • Presenting symptoms are fever, weight loss, weakness, muscle pain or diffuse skeletal pain, poor feeding, pallor, and cardiac decompensation

    • Signs include splenomegaly, cardiomegaly, petechiae, hematuria, and a new or changing murmur

    • Course of S aureus endocarditis is rapid, although subacute disease occurs occasionally

  • Toxic shock syndrome

    • Characterized by fever, blanching erythroderma, diarrhea, vomiting, myalgia, prostration, hypotension, and multiorgan dysfunction

    • Additional clinical features include sudden onset; conjunctival suffusion; mucosal hyperemia; desquamation of skin on the palms, soles, fingers, and toes during convalescence; DIC in severe cases; renal and hepatic functional abnormalities; and myolysis

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Diagnosis

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  • Moderate leukocytosis (15,000–20,000/μL) with a shift to the left is occasionally found, although normal counts are common, particularly in infants

  • Erythrocyte sedimentation rate is elevated

  • Blood cultures are frequently positive in systemic staphylococcal disease and should always be obtained when it is suspected

  • Similarly, pus from sites of infection should always be aspirated or obtained surgically, examined with Gram stain, and cultured both aerobically and anaerobically

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