title: Varicella infection in a neonate with subsequent staphylococcal scalded skin syndrome and fatal shock.
abstract: A male term neonate, at day 23 of life, presented with vesicular lesions over the trunk, which spread to allover the body on the next day. Five days later, he started developing blistering of the skin over the trunk and extremities, which subsequently ruptured, leaving erythematous, tender raw areas with peeling of the skin. The mother had vesicular eruptions, which started on the second day of delivery and progressed over the next 3 days. Subsequently, similar eruptions were noticed in two of the siblings before affecting the neonate. On the basis of the exposure history and clinical picture, a diagnosis was made of varicella infection with staphylococcal scalded skin syndrome (SSSS). The blood culture and the wound surface culture grew Staphylococcus aureus. Treatment included intravenous fluid, antibiotics, acyclovir and wound care. However, after 72 h of hospitalisation, the neonate first developed shock, refractory to fluid boluses, vasopressors and catecholamine along with other supports; and he then succumbed. In all neonates, staphylococcal infection with varicella can be fatal due to SSSS, the toxic shock syndrome or septicaemia.
authors.affiliation: Department of Paediatrics, Chhatrapati Shahuji Maharaj Medical University (formerly King George's Medical College), Lucknow, Uttar Pradesh, India. drsn.singh@rediffmail.com
authors.forename: Shakal Narayan
authors.initials: SN
authors.lastname: Singh
authors.forename: Mohammad
authors.initials: M
authors.lastname: Tahazzul
authors.forename: Anita
authors.initials: A
authors.lastname: Singh
authors.forename: Surabhi
authors.initials: S
authors.lastname: Chandra
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D002644:Chickenpox / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009035:Mothers; D012772:Shock, Septic / Q000209:etiology* / Q000382:microbiology / Q000473:pathology / Q000821:virology; D012867:Skin / Q000473:pathology*; D013206:Staphylococcal Scalded Skin Syndrome / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D013211:Staphylococcus aureus / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D000998:Antiviral Agents; D000212:Acyclovir