Neonatal pemphigus is a highly contagious staphylococcal lesion of the skin of newborns, manifested by the appearance of small bubbles with purulent contents, which increase and burst with the formation of erosions. It may be accompanied by damage to the mucous membranes. The age of the sick, the typical clinic and the results of bacteriological studies of fluid from the bubbles and the discharge of erosions allow diagnosing neonatal pemphigus. Treatment includes the use of antibiotics, vitamins, albumin, baths with potassium permanganate, UFOs, bubble opening and erosion treatment. Taking into account the contagiousness of neonatal pemphigus, quarantine measures and disinfection are mandatory.
Neonatal pemphigus (pyococcal pemphigoid) is an acute staphyloderma that occurs with the formation of multiple pustules on the skin and a violation of the general condition of the baby. The disease is highly contagious and can spread rapidly among newborns, causing epidemic outbreaks in maternity hospitals. Before the beginning of the era of antibiotic therapy, the mortality rate of children from pyococcal pemphigoid reached 50-60%. Despite the achievements of modern pediatrics, the disease has not lost its relevance and epidemiological danger.
The causative agent of neonatal pemphigus is Staphylococcus aureus. Infection occurs from medical personnel or mothers who have had pyoderma or are carriers of Staphylococcus. The most predisposed to the development of the disease:
- children who have received a birth trauma;
- premature newborns;
- children whose mothers have suffered severe toxicosis of pregnant women.
The high contagiousness of the disease causes its rapid transmission from one child to another through the hands of medical staff, which can cause an outbreak of neonatal pemphigus in the maternity hospital.
Neonatal pemphigus occurs in the first 10 days of a child’s life. It begins with a rise in body temperature and anxiety of the newborn. Then rashes appear on the skin in the form of small bubbles containing a serous-yellowish liquid. Elements of rash in neonatal pemphigus are most often located in the umbilical region, on the abdomen, buttocks and back, as well as on the skin of the extremities. The most rare are rashes on the skin of the feet and palms. The bubbles grow rapidly in size, their contents become purulent and cloudy. The process spreads intensively through the child’s body and can capture the mucous membrane of the oral cavity, eyes, vestibule of the nose and genitals.
The opening of the bubbles is accompanied by the outpouring of purulent contents and the formation of bright erosive surfaces of red color. Erosions are covered with serous-purulent crusts and epithelized. It is characterized by a jolt-like course of the disease with rashes of new bubbles at short intervals. With an uncomplicated variant of neonatal pemphigus, the child’s recovery is observed after 3-5 weeks.
In weakened newborns, the disease proceeds with general symptoms (loss of appetite, anxiety, sleep disorder) and is accompanied by signs of inflammation in a clinical blood test. Possible addition of septic complications: phlegmon, otitis, pneumonia, pyelonephritis, etc. As a separate disease in dermatology, a severe clinical form of neonatal pemphigus is distinguished — Ritter’s exfoliative dermatitis.
The characteristic clinical picture and the development of the disease in the first days of a child’s life, as a rule, make it possible to immediately diagnose neonatal pemphigus. To identify the causative agent that caused it, back-seeding of the separated erosive surfaces is performed.
It is important to exclude syphilitic pemphigus, which is a manifestation of congenital syphilis. For this purpose, the dermatologist prescribes microscopy of the contents of the bubbles for pale treponema, conducting an RPR test and PCR diagnostics. Differential diagnosis is also carried out with congenital epidermolysis, other clinical forms of bullous dermatitis, herpes infection.
Staphylococci, which cause neonatal pemphigus, are usually resistant to penicillin. Therefore, treatment is carried out with penicillinase-resistant penicillins (amoxiclav, oxacillin, etc.) and cephalosporins (cephaloridin, cefazolin). Infusions of 5% albumin per kilogram of newborn body weight are used, as well as the introduction of B vitamins, retinol, ascorbic acid.
The skin around the blisters is treated with salicylic or boric alcohol. The bubbles are pierced and extinguished with solutions of aniline dyes. Synthomycin emulsion, aerosols and ointments with antibiotics are applied to dried erosive surfaces: gentamicin, neomycin, erythomycin, etc. In case of neonatal pemphigus, daily baths with a solution of potassium permanganate, general and local UVI are effective.
Neonatal pemphigus is able to spread rapidly using a contact transmission pathway. The pathogen is quite stable in the external environment and can persist on the skin of the hands of medical workers, underwear and care items. The main task of prevention is to prevent infection of healthy children. For this purpose, isolation of a sick child, detection of staphylococcal infection or carrier in the mother and medical personnel, sterilization of linen and disinfection of premises are necessarily carried out. The maternity hospital, where an outbreak of epidemic pemphigus was noted, is closed for complete sanitary and hygienic treatment.