Pediatric emergency medicine trisk 1323 1323
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (130.28 KB, 1 trang )
Transient Neonatal Pustular Melanosis
Transient Neonatal Pustular Melanosis or TNPM is usually present at delivery.
TNPM is characterized by small pustules (0.3 to 0.5 cm) on a nonerythematous
base. These pustules rupture easily, and pigmented macules develop with
surrounding collarettes of scales that may persist for weeks to months. The
pustules are mostly located over the forehead, neck, and lower back, but
occasionally, palms and soles may be involved ( Fig. 69.3 ). No systemic
manifestations have been reported.
Staphylococcal Pustulosis
If a neonate presents after 48 hours of life with new pustules, it is important to
consider infection with staphylococcus or candida. Staphylococcal pustulosis is
relatively common and can occur in the setting of infection of the umbilicus or
circumcision site. Community-acquired S. aureus is common, and a history of
staph infection in close contacts may aid in diagnosis. Simple bacterial swabs are
the primary diagnostic tool. Pustules on the lower abdomen and in the diaper area
are common. A small number of pustules, in an otherwise healthy neonate, can
often be treated with oral and/or topical antibiotics. Providers should look for
peeling in the folds of the skin and very red or hot skin because this can be a sign
of staphylococcal scalded skin ( Fig. 69.4 ).
Neonatal Candida
Congenital candidiasis usually presents within 12 hours of birth as redness on the
affected area and then later with pustules with desquamation. Candida albicans
and Candida psiloparis are the most common causes of neonatal candida
infections. In full-term healthy infants, congenital candida can often be treated
topically and is usually not a worrisome infection. In preterm infants, or other
medically complex infants, candida can be invasive and can cause late-onset
neonatal sepsis. Therefore, in the appropriate setting, blood cultures, urine
cultures, evaluation of the CSF, ophthalmologic examination, echocardiogram,
renal ultrasound, and systemic antifungal therapy are needed.
Candidal Diaper Dermatitis
See Chapter 66 Rash: Bacterial and Fungal Infections/Rash: Maculopapular .
Candidal diaper dermatitis is the most characteristic of the diaper rashes (see
below for a more detailed discussion of diaper dermatitis). The skin in the diaper
area has clusters of erythematous papules and pustules that coalesce into an
intensely red confluent rash with sharp borders ( Fig. 69.5 ). Beyond these
