Bacterial Infections

  • Catalina MatizEmail author
  • Emily Osier


Cutaneous manifestations of bacterial infections of pediatric patients can provide critical diagnostic information. Bacterial infections may cause significant morbidity and mortality in the pediatric population. Although often recognized by pediatricians, input from dermatologists may be helpful in assessing bullae, erosions, petechia, purpura, and morbilliform eruptions in systemically unwell children. In this chapter, we discuss the clinical presentation, differential diagnosis, and treatment of ecthyma gangrenosum, toxic shock syndrome, staphylococcal scalded skin syndrome, meningococcemia, and methicillin-resistant Staphylococcus aureus skin and soft tissue infections.


Community acquired methicillin-resistant Staphylococcus aureus Skin infections in children Ecthyma gangrenosum Pseudomona aeruginosa Toxic shock syndrome Neisseria meningitidis Meningococcemia 


  1. 1.
    Long SS, Pickering LK, Charles G. Principles and practice of pediatric infectious diseases. 4th ed. Philadelphia: Elsevier; 2012. p. 550.Google Scholar
  2. 2.
    Pathak A, Singh P, Yadav Y, Dhaneria M. Ecthyma gangrenosum in a neonate: not always pseudomonas. BMJ Case Rep. 2013; doi: 10.1136/bcr-2013-009287 Google Scholar
  3. 3.
    Cohen N, Capua T, Bilavsky E, Dias-Polak H, Levin D, Grisaru-Soen G. Ecthyma gangrenosum skin lesions in previously healthy children. Acta Paediatr. 2015;104(3):e134–8.CrossRefPubMedGoogle Scholar
  4. 4.
    Vaiman M, Lazarovitch T, Heller L, Lotan G. Ecthyma gangrenosum and ecthyma-like lesions: review article. Eur J Clin Microbiol Infect Dis. 2015;34(4):633–9.CrossRefPubMedGoogle Scholar
  5. 5.
    Long SS, Pickering LK, Charles G. Principles and practice of pediatric infectious diseases. 4th ed. Philadelphia: Elsevier; 2012. p. 845.Google Scholar
  6. 6.
    Curtis N. Toxic shock syndrome: under-recognised and under-treated? Arch Dis Child. 2014;99(12):1062–4.CrossRefPubMedGoogle Scholar
  7. 7.
    Low DE. Toxic shock syndrome: major advances in pathogenesis, but not treatment. Crit Care Clin. 2013;29(3):651–75.CrossRefPubMedGoogle Scholar
  8. 8.
    Chi C-Y, Wang S-M, Lin H-C, Liu C-C. A clinical and microbiological comparison of Staphylococcus aureus toxic shock and scalded skin syndromes in children. Clin Infect Dis. 2006;42(2):181–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Kulhankova K, King J, Salgado-Pabon W. Staphylococcal toxic shock syndrome: superantigen-mediated enhancement of endotoxin shock and adaptive immune suppression. Immunol Res. 2014;59(1–3):182–7.CrossRefPubMedGoogle Scholar
  10. 10.
    Wharton M, Chorba TL, Vogt RL, Morse DL, Buehler JW. Case definitions for public health surveillance. MMWR Recomm Rep. 1990;39:1–43.PubMedGoogle Scholar
  11. 11.
    Reingold AL, Hargrett NT, Shands KN, Dan BB, Schmid GP, Stickland BY. Toxic shock syndrome surveillance in the United States, 1980–1981. Ann Intern Med. 1982;96:875–80.CrossRefPubMedGoogle Scholar
  12. 12.
    Adalat S, Dawson T, Hackett SJ, Clark JE. Toxic shock syndrome surveillance in UK children. Arch Dis Child. 2014;99(12):1078–82.CrossRefPubMedGoogle Scholar
  13. 13.
    Smit MA, Nyquist AC, Todd JK. Infectious shock and toxic shock syndrome diagnoses in hospitals, Colorado, USA. Emerg Infect Dis. 2013;19(11):1855–8.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Lin YJ, Cheng MC, Lo MH, Chien SJ. Early differentiation of Kawasaki disease shock syndrome and toxic shock syndrome in a pediatric intensive care unit. Pediatr Infect Dis J. 2015;34(11):1163–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Linner A, Darenberg J, Sjolin J, Henriques-Normark B, Norrby-Teglund A. Clinical efficacy of polyspecific intravenous immunoglobulin therapy in patients with streptococcal toxic shock syndrome: a comparative observational study. Clin Infect Dis. 2014;59(6):851–7.CrossRefPubMedGoogle Scholar
  16. 16.
    DeVries AS, Lesher L, Schlievert PM, Rogers T, Villaume LG, Danila R, et al. Staphylococcal toxic shock syndrome 2000–2006: epidemiology, clinical features, and molecular characteristics. PLoS One. 2011;6(8), e22997.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Centers for Disease Control and Prevention. Nosocomial group A streptococcal infections associated with asymptomatic health-care workers—Maryland and California, 1997. Morb Mortal Wkly Rep. 1999;48(8):163–6.Google Scholar
  18. 18.
    Tremlett W, Michie C, Kenol B, van der Bijl S. Recurrent menstrual toxic shock syndrome with and without tampons in an adolescent. Pediatr Infect Dis J. 2014;33(7):783–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Oranje AP, de Waard-van der Spek FB. Recent developments in the management of common childhood skin infections. J Infect. 2015;71 Suppl 1:S76–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Handler MZ, Schwartz RA. Staphylococcal scalded skin syndrome: diagnosis and management in children and adults. J Eur Acad Dermatol Venereol. 2014;28(11):1418–23.CrossRefPubMedGoogle Scholar
  21. 21.
    Amagai M, Matsuyoshi N, Wang ZH, Andl C, Stanley JR. Toxin in bullous impetigo and staphylococcal scalded-skin syndrome targets desmoglein 1. Nat Med. 2000;6(11):1275–7.CrossRefPubMedGoogle Scholar
  22. 22.
    Avancini J, Maragno L, Santi CG, Criado PR. Drug reaction with eosinophilia and systemic symptoms/drug-induced hypersensitivity syndrome: clinical features of 27 patients. Clin Exp Dermatol. 2015;40(8):851–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Braunstein I, Wanat KA, Abuabara K, McGowan KL, Yan AC, Treat JR. Antibiotic sensitivity and resistance patterns in pediatric staphylococcal scalded skin syndrome. Pediatr Dermatol. 2014;31(3):305–8.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Paranthaman K, Bentley A, Milne LM, Kearns A, Loader S, Thomas A, et al. Nosocomial outbreak of staphyloccocal scalded skin syndrome in neonates in England, December 2012 to March 2013. Euro Surveill. 2014;19(33):pii: 20880.Google Scholar
  25. 25.
    Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):e10–52.CrossRefPubMedGoogle Scholar
  26. 26.
    Gianchecchi E, Torelli A, Piccini G, Piccirella S, Montomoli E. Neisseria meningitidis infection: who, when and where? Expert Rev Anti Infect Ther. 2015;24:1–15.Google Scholar
  27. 27.
    Folaranmi T, Rubin L, Martin SW, Patel M, MacNeil JR. Use of serogroup B meningococcal vaccines in persons aged ≥10 years at increased risk for serogroup B meningococcal disease: recommendations of the advisory committee on immunization practices, 2015. MMWR Morb Mortal Wkly Rep. 2015;64(22):608–12.PubMedGoogle Scholar
  28. 28.
    Rosenstein NE, Perkins BA, Stephens DA, Popovic T, Hughes JM. Meningococcal disease. N Engl J Med. 2001;344(18):1378–88.CrossRefPubMedGoogle Scholar
  29. 29.
    Baselga E, Drolet BA, Esterly NB. Purpura in infants and children. J Am Acad Dermatol. 1997;37(5 Pt 1):673–705.CrossRefPubMedGoogle Scholar
  30. 30.
    Chalmers E, Cooper P, Forman K, Grimley C, Khair K, Minford A, et al. Purpura fulminans: recognition, diagnosis and management. Arch Dis Child. 2011;96:1066–71.CrossRefPubMedGoogle Scholar
  31. 31.
    Materna B, Harriman K, Rosenberg J, Shusterman D, Windham G, Atwell J, et al. Occupational Transmission of Neisseria meningitides, California, 2009. MMWR Morb Mortal Wkly Rep. 2010;59(45):1480–3.Google Scholar
  32. 32.
    Siegel JD, Rhinehart E, Jackson M, Chiarello L. Health Care Infection Control Practices Advisory Committee. 2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control. 2007;35(10 suppl 2):S65–164.CrossRefPubMedGoogle Scholar
  33. 33.
    Moet GJ, Jones RN, Biedenbach DJ, et al. Contemporary causes of skin and soft tissue infections in North America, Latin America, and Europe: report from the SENTRY Antimicrobial Surveillance Program (1998–2004). Diagn Microbiol Infect Dis. 2007;57(1):7–13.CrossRefPubMedGoogle Scholar
  34. 34.
    Britton PN, Andresen DN. Paediatric community-associated Staphylococcus aureus: a retrospective cohort study. J Paediatr Child Health. 2013;49(9):754–9.CrossRefPubMedGoogle Scholar
  35. 35.
    Shallcross LJ, Fragaszy E, Johnson AM, et al. The role of the Panton-Valentine leucocidin toxin in staphylococcal disease: a systematic review and meta-analysis. Lancet Infect Dis. 2012;13(1):43–54.CrossRefPubMedGoogle Scholar
  36. 36.
    Jahamy H, Ganga R, Al Raiy B, et al. Staphylococcus aureus skin/soft-tissue infections: the impact of SCCmec type and Panton-Valentine leukocidin. Scand J Infect Dis. 2008;40:601–6.CrossRefPubMedGoogle Scholar
  37. 37.
    Fenster DB, Renny MH, Ng C, Roskind CG. Scratching the surface: a review of skin and soft tissue infections in children. Curr Opin Pediatr. 2015;27(3):303–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Long SS, Pickering LK, Charles G. Principles and practice of pediatric infectious diseases. Philadelphia: Elsevier; 2012. p. 454–62.Google Scholar
  39. 39.
    Trenchs V, Hernandez-Bou S, Bianchi C, Arnan M, Gene A, Luaces C. Blood cultures are not useful in the evaluation of children with uncomplicated superficial skin and soft tissue infections. Pediatr Infect Dis J. 2015;34(9):924–7.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Division of Pediatric and Adolescent Dermatology, Department of DermatologyUniversity of CaliforniaSan DiegoUSA
  2. 2.Division of Pediatric and Adolescent Dermatology, Department of DermatologyRady Children’s HospitalSan DiegoUSA

Personalised recommendations