Clinicoepidemiologic profile and the cutaneous and nasal colonization with methicillin-resistant Staphylococcus aureus in children with atopic dermatitis from North India

Abstract

Background: There is a paucity of literature about the atypical clinical manifestations in children with atopic dermatitis (AD) in Asian setting, and colonization with methicillin-resistant Staphylococcus aureus (MRSA), and its association with disease severity, if any. Objective: To elucidate atypical clinical patterns of AD in children and to determine the MRSA isolation and its association with disease severity. Methods: We studied 55 pediatric patients from 2 months to 10 years of age, of either sex, diagnosed with AD based on the diagnostic criteria of Hanifin and Rajka. History, clinical examination (including atypical features), and severity score using SCORing Atopic Dermatitis (SCORAD) severity index were recorded. Swabs from the cutaneous lesion and anterior nares were collected from each case and processed. Statistical analysis was done by SPSS (V 17). Observations and Results: Atypical clinical features were seen in 52.7% of cases. Retroauricular fissures (among atypical features), oozing, crusting, darkening, early age at onset, and nipple eczema were found to be significantly associated with disease severity (P < 0.05). The majority of the cases (56.4%) fell in the moderate disease severity (mean SCORAD 32.02). MRSA showed an isolation frequency of 7.27% from the skin swabs and 10.90% from the nares. No significant association was found between Staphylococcus aureus isolates (including MRSA) and disease severity in our study. A high degree of fluoroquinolone resistance was noted in MRSA isolates. Limitation: Further characterization of S. aureus by superantigen profiling was not done. Conclusion: Patients with AD need to be evaluated for atypical features which may serve as markers of severe disease.