Impetigo Disease

BASICS

DESCRIPTION

A superficial, intraepidermal, unilocular, vesiculopustular infection. Typically begins as erythematous tender papule that rapidly progresses through a vesicular to a honey-crusted stage. Still debated as to relative importance of staphylococci versus streptococci. Cultures now give over 80% with Staphylococcus aureus alone or combined with group A beta-hemolytic streptococci. Change over past 15 years to predominately Staph. aureus.

Bullous impetigo: Staphylococci impetigo that progress rapidly to small to large flaccid bulla. No lymphadenopathy; <30% of cases.
Folliculitis: Considered by some to be Staph aureus impetigo of hair follicle
Ecthyma: A deeper, ulcerated, impetigo infection often with lymphadenitis
System(s) affected: Skin/Exocrine
Genetics: N/A
Incidence/Prevalence in USA: Unreported
Predominant age: 2-5 years
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

May be slow and indolent or rapidly spreading
Tender red macule or papule as early lesion
Thin roofed vesicle to bullae - usually nontender
Pustules
Weeping shallow red ulcer
Honey-colored crusts
Most frequent on face around mouth and nose, or at site of trauma
Satellite lesions
Often multiple sites
Bullae on buttocks, trunk, face

CAUSES

Coagulase positive staphylococci - pure culture about 50–90%. More contagious via contact.
Beta-hemolytic streptococci - pure culture only about 10% of the time
Mixed infections of streptococci and staphylococci common. Data suggest increasing importance of staphylococci over past 15 years.
Direct contact or insect vector
Can be contamination at trauma site
Regional lymphadenopathy

RISK FACTORS

Warm, humid environment
Tropical or subtropical climate
Summer or fall season
Minor trauma, insect bites, etc.
Poor hygiene, epidemics, during war, etc.
Familial spread
Poor health with anemia and malnutrition
Complication to pediculosis, scabies, chickenpox, eczema
Contact dermatitis (Rhus)
Burns
Atopic dermatitis
Contact sports
Children in day care

DIAGNOSIS

LABORATORY

None usually required

Culture - taken from the base of lesion after removal of crust. Blood agar grows both staphylococci and group A streptococci
ASO titer - can be weak positive for streptococci (not usually done)
Streptozyme - positive for streptococci (not usually done)

Drugs that may alter lab results: N/A
Disorders that may alter lab results: Streptococci pharyngitis will alter streptococci enzyme tests

PATHOLOGICAL FINDINGS

N/A

SPECIAL TESTS

Cultures as listed under Laboratory

IMAGING

N/A

DIAGNOSTIC PROCEDURES

N/A

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Removal of crusts, cleanliness with gentle washing 2-3 times daily. Clean with antibacterial soap, chlorhexidine or betadine.

SURGICAL MEASURES

N/A

ACTIVITY

No restrictions

DIET

No special diet

PATIENT EDUCATION

Good hygiene important to prevent possible spread

FOLLOW UP

PREVENTION/AVOIDANCE

Close attention to family hygiene, particularly hand washing. Avoid crowding. Treat atopic dermatitis.

POSSIBLE COMPLICATIONS

Ecthyma
Erysipelas
Post-streptococcal acute glomerulonephritis
Deep cellulitis
Bacteremia
Osteomyelitis
Septic arthritis
Pneumonia
Lymphadenitis

EXPECTED COURSE AND PROGNOSIS

Complete resolution in 7–10 days with treatment
Antibiotic treatment will not prevent or halt glomerulonephritis as it will with rheumatic fever
If not clear within 7–10 days, culture is necessary to find resistant organism

MISCELLANEOUS

ASSOCIATED CONDITIONS

Malnutrition and anemia
Crowded living conditions
Poor hygiene
Neglected minor trauma
Any chronic dermatitis

AGE-RELATED FACTORS

Pediatric: Impetigo neonatorum may occur by nursery contamination
Geriatric: N/A
Others: N/A

PREGNANCY

Only if < 50,000 platelet count, may consider C-section
Patient in labor should receive intravenous gamma globulin due to risk to the infant
Platelet autoantibodies cross the placenta and may cause neonatal thrombocytopenia. Consider prednisone 10–20 mg/day for 10–14 days prior to delivery.
Preeclampsia or gestational thrombocytopenia may cause thrombocytopenia unrelated to ITP

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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