Zuzana Chaloupková

Staphylococcal scalded skin syndrome in the Czech Republic: an epidemiological study

OBJECTIVE To identify the basic epidemiological characteristics of children hospitalized with diagnosis of Staphylococcal scalded skin syndrome in the Czech Republic in the years 1994-2009. INTRODUCTION Staphylococcal scalded skin syndrome (SSSS) is a relatively rare disease in childhood. This syndrome was first defined in 1878 by Baron Gottfried Ritter von Rittershainem and belongs to the group of diseases called Burn-like syndromes. It is a bullous skin disease caused by exfoliative toxins which are produced by certain types of Staphyloccocus aureus. Typical structures affected by these toxins are desmosome proteins called Desmoglein-1 located in the stratum granulosum of epidermis. Unlike in Lyells syndrome or Stevens-Johnsons syndrome, the exfoliation is caused by loss of adhesivity particularly in the stratum granulosum and not by induction of apoptosis in the dermo-epidermal junction. MATERIAL AND METHODS This retrospective study was conducted on patients hospitalized in the Czech Republic in the period from 1.1.1994 to 31.12.2009. The basic condition for the inclusion in the retrospective study was age under 1 year and hospitalization due to SSSS. A total of 399 children (177 girls) fulfilled the criteria for inclusion into the study. Information was obtained from a central data depository, the Department of Health Information and Statistics, Czech Republic. RESULTS A total of 399 children under 1 year were hospitalized for the diagnosis of SSSS in the study period. The group included 177 girls and 222 boys. M:F ratio was 1.25:1. The average incidence of SSSS in the Czech Republic was 25.11 cases per 100,000 children under 1 year of age. The highest recorded incidence in the followed period was in 1994, when a total of 57 cases of SSSS was reported, namely 53.47 per 100,000 children. By contrast, in 2003, there were reported only 12 cases and the incidence of 12.81 per 100,000 children. The average length of hospitalization was 6.39 days. In 1995, the highest average length of hospitalization was reported, which was 8.1 days, and then in 2007, the lowest average length of hospitalization, 4.4 days. There was no significant difference in the length of hospitalization in boys and girls. None of the 399 children in the population died. CONCLUSION In our retrospective study, we established basic epidemiological characteristics of a group of children aged under 1 year with diagnosis of SSSS. As epidemiological data show, the occurrence of this syndrome is not sporadic, but steady.

Effect of timing of tracheostomy on changes in bacterial colonisation of the lower respiratory tract in burned children

OBJECTIVE The study aims to evaluate the impact of early and late tracheostomy on microbiological changes in the airways in severely burned children. MATERIALS AND METHODS Early tracheostomy is sometimes performed within 3 days after the start of mechanical ventilation regular microbiological surveillance of the respiratory tract was done in all patients. From each sputum, tracheobronchial aspirate and bronchoalveolar lavage (BAL), a microscopic slide was made and the material was seeded in a culture medium. The standard culture media used for the growth of respiratory pathogens are blood agar, McConkey agar, VL agar and chocolate agar. The obtained values were statistically analysed. RESULTS In the observed period, a total of 68 children underwent mechanical ventilation in our department. A total of 31 (45.59%) children had undergone surgical tracheostomy (18 patients with early tracheostomy and 13 patients with late tracheostomy). The most common bacterium isolated from the lower respiratory tract in patients with early and late tracheostomy was Acinetobacter baumannii (31.53% resp. 44.30% of all bacterial strains). In patients with early tracheostomy, the ratio of G+/G- during the 6-7th day of mechanical ventilation was 1.29:1 and during the 8-10th day, 1:1.43. In patients with late tracheostomy the G+/G- ratio was 1:2.25 and during the 8-10th day, 1:2.25. There was not any statistically significant deviation in the G+/G- ratio in patients with early and late tracheostomy in any of the monitored periods. CONCLUSION The main reasons for performing early tracheostomy are: extent, localisation and depth of the burn. Difficult weaning in an uncooperative patient, failure of extubation with subsequent reintubation and other complications may be an indication for late tracheostomy. The study confirms that the use of appropriately indicated early tracheostomy provides a microbiological benefit for burned children.

Severe bullous diseases in the Czech Republic

Aim: The study is to establish basic epidemiological characteristics of patients hospitalized in the Czech Republic with a diagnosis of toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS). Material and methods: This is a retrospective multicenter study including hospitalized patients in the Czech Republic in the period from 1st January 1994 to 31st December 2010. The basic condition for inclusion in the study is TEN (L512) or SJS (L511) as the primary diagnosis according to International Classification of Diseases 10th version (ICD–10). The two diseases have similar clinical presentations, but have different nosological codes, which were retrieved from our database. Information was obtained from a central data depository-Department of Health Information and Statistics (National Registry of hospitalized patients). Results: A total of 626 patients were hospitalized in our followed period. Of these, 163 patients were hospitalized with toxic epidermal necrolysis and 463 patients with Stevens-Johnson syndrome. The overall M:F ratio in the sample was 1:1.15. In the group of patients with TEN M:F ratio was 1:1.31 and in the SJS group M:F ratio was 1:1.11. The mean incidence in the period in patients with TEN was 0.93 cases/million inhabitants per year. In patients with SJS, the average incidence was 2.64 cases/million inhabitants per year. The average age was 39.2 years, in patients with TEN it was 40.1 years (SD±21.5) and in patients with SJS 38.4 years (SD±11.98). The average length of hospitalization was 11.3 days. In patients with TEN, the average length of hospitalization was slightly higher (11.8 days (SD±3.11)) when compared with SJS group (10.7 days (SD±6.48)). From the total of 626 patients, 54 patients died. Of these, it was 47 patients with TEN and 7 patients with SJS. Conclusion: In a retrospective study confirms that SJS and TEN are rare diseases and their incidence in the Czech Republic closer to the results of most large epidemiological studies.