Search

Impetigo is a common, superficial, bacterial infection of the skin characterized by an inflamed and infected epidermis. The rarer variant, bullous impetigo, is characterized by fragile fluid-filled vesicles and flaccid blisters and is invariably caused by pathogenic strains of Staphylococcus aureus. Bullous impetigo is at the mild end of a spectrum of blistering skin diseases caused by a staphylococcal exfoliative toxin that, at the other extreme, is represented by widespread painful blistering and superficial denudation (the staphylococcal scalded skin syndrome). In bullous impetigo, the exfoliative toxins are restricted to the area of infection, and bacteria can be cultured from the blister contents. In staphylococcal scalded skin syndrome the exfoliative toxins are spread hematogenously from a localized source causing widespread epidermal damage at distant sites. Both occur more commonly in children under 5 years of age and particularly in neonates. It is important to swab the skin for bacteriological confirmation and antibiotic sensitivities and, in the case of staphylococcal scalded skin syndrome, to identify the primary focus of infection. Topical therapy should constitute either fusidic acid (Fucidin, Leo Pharma Ltd) as a first-line treatment, or mupirocin (Bactroban, GlaxoSmithKline) in proven cases of bacterial resistance. First-line systemic therapy is oral or intravenous flucloxacillin (Floxapen, GlaxoSmithKline). Nasal swabs from the patient and immediate relatives should be performed to identify asymptomatic nasal carriers of Staphylococcus aureus. In the case of outbreaks on wards and in nurseries, healthcare professionals should also be swabbed.

Impetigo is a common skin infection in children. If not treated promptly, it can spread rapidly through a student population and become a significant health problem. Whereas uncomplicated, localized lesions typically are treated with topical mupirocin, widespread infections involving multiple pathogens require systemic treatment with a cephalosporin or a beta-lactamase-resistant antibiotic.

Objectives: To ascertain the frequency of parental reporting of selected variables related to development, behaviour and physiology in subgroups diagnosed with pervasive developmental disorders (PDDs) and identify any significant intragroup differences., Design: Retrospective cross-sectional analysis of records of patients (n = 512) held on a computerized database with a chronological age between 3 and 11 years resident in the UK/Republic of Ireland and with a formal diagnosis of autism, Asperger syndrome (AS) or autism spectrum disorder (ASD)., Methods: Non-parametric analysis (P > 0.01) of the frequency of specific variables for PDD subgroups reported by parents/primary caregiver. VARIABLES INCLUDED: timing of symptom onset, presence of skills acquired prior to symptom onset, indications of regression and regression events, current language, history of viral infections, history of ear problems, achievement of continence, current skin complaints, current bowel habits and adverse events at parturition., Results: Preliminary results showed general agreement with the principle diagnostic differences between the PDD subgroups with patients diagnosed with AS showing an increased frequency of skills acquired before symptom onset (two- to three-word phrase speech, toileting skills) and a decreased frequency of regression in acquired skills when compared with other PDD subgroups. Developmental milestones such as the achievement of bowel and bladder continence were also more frequently reported for the AS group. Infantile feeding problems defined as vomiting, reflux, colic and failure to feed were more frequently reported for the AS group as was a reported history of the bacterial skin infection impetigo. Results are discussed with reference to relationships between behavioural and somatic factors in PDD.

Rashes in the anogenital and buttock region are some of the commonest dermatological problems occurring in infancy. The most frequent causes seen in clinical practice are ulcerating haemangiomas, bullous impetigo and severe irritant contact dermatitis. Other causes include nutritional deficiencies, bullous diseases, trauma, Langerhans cell histiocytoses and inflammatory disorders such as pyoderma gangrenosum and Crohn's disease. This review presents a brief overview of these causes and outlines the recommended management strategies.

A 50-year-old Japanese woman visited our clinic, complaining of generalized erythema with painful erosions and bullae. The histopathological findings of the skin lesion suggested development of impetigo. Gentamycin-resistant Staphylococcus aureus was detected by the bacterial culture examination from the impetiginous bullae. A direct immunofluorescence study of the lesion showed an intercellular deposition of IgG and C3 in the upper epidermis. We diagnosed this case as pemphigus foliaceus associated with bullous impetigo. A combined oral administration of tetracycline (200 mg/day) and nicotinamide (1200 mg/day) for 3 weeks was successful. In Japan, patients with moderate to severe symptoms of pemphigus foliaceus are usually treated with oral steroid therapy. To our knowledge, however, there is no reported pemphigus case which has been successfully treated only with tetracycline and nicotinamide.

Anticardiolipin (aCL) antibodies have been described in diverse clinical situations, linked to the risk of thrombosis in different vascular locations. They have been rarely studied in renal diseases, and occasionally they have been associated with glomerular thrombosis. We analyzed the incidence of aCL (isotypes IgG, IgA, and IgM) in samples, taken during the acute phase of the disease, from 27 well-documented patients having acute poststreptococcal glomerulonephritis. Twelve cases were positive on IgG testing, 1 case on IgA testing only, and no one was positive on IgM testing. A serological follow-up was performed with a second sample taken about 7 months later, for the patients initially positive on IgG testing showing persistence in 9. Clinical variables during the acute phase and after a follow-up period of 25 (range 6-89) months were analyzed for possible associations with the presence of these antibodies, but non was significantly related. Renal histopathological investigation did not reveal particular findings in the aCL-positive patients, and glomerular thrombosis was not found in any case. In addition, serum samples from 12 streptococcal impetigo patients without renal involvement were analyzed, showing similar incidence (4 positive on IgG testing, 1 of them positive on IgM testing as well, and no one positive on IgA testing) and titers of aCL antibodies. We conclude that the presence of aCL antibodies in acute poststreptococcal glomerulonephritis may be a marginal immunological phenomenon unrelated to the glomerular disease, triggered by the streptococcal infection.

A 17-year-old woman had a sudden eruption of pustules in her intertriginous areas as well as of erythematosquamous plaques on the scalp, elbows, palms and soles in the third trimester of her first pregnancy. Histopathological evaluation of a biopsy revealed typical changes of pustular psoriasis with parakeratosis and abscesses of neutrophils (Kogoj's spongiform pustules). The diagnosis of pustular psoriasis was established by the typical clinical and histopathological findings. Laboratory parameters showed a highly elevated blood sedimentation rate, hypoferric anemia and decreased albumin levels. Serum concentrations of parathormone and its metabolites were normal. After systemic treatment with glucocorticosteroids and antibiotics, the lesions improved but did not clear. After delivery of a healthy boy, therapy was switched to retinoid photochemotherapy with isotretinoin and PUVA that resulted in rapid and complete clearing of the eruption. The coincidence of plaque-type psoriasis and a pustular eruption as described previously in impetigo herpetiformis supports the view that this dermatosis of pregnancy is a variant of generalized pustular psoriasis.

Impetigo contagiosa often occurs on the face of children. Although the eyelid and conjunctiva are frequently affected, no corneal involvement has been reported in Japan. We encountered a case of impetigo contagiosa with corneal abscess. The patient, an 8-year-old boy, complained of pain and presented with corneal abscess and iritis in the right eye as well as eruptions in the inferior eyelid and around the anterior nostrils. He was diagnosed as having impetigo contagiosa with corneal abscess. Because the corneal abscess and eruptions occurred at the same time and coagulase-positive Staphylococcus with identical drug sensitivity was isolated from both lesions, we considered the corneal lesion as a part of the impetigo contagiosa. When impetigo contagiosa occurs around the eye, especially on the eyelids, a careful examination of the anterior segment of the eye is needed.

Streptococcal impetigo associated with atopic dermatitis has dramatically increased from 1989 to 1994 in outpatients visiting our hospital, totalling 174 cases. The most frequent causative agents were group A streptococci (Streptococcus pyogenes, 70.7%) followed by group G (19.5%) and group B (9.8%). Streptococcus was isolated singly in 28.2% of cases and in concomitant with Staphylococcus aureus (S. aureus) in 71.8%. Major clinical features of streptococcal impetigo, especially caused by group A streptococci, were non-bullous pustules with thick crusted ceiling. Impetigo caused by group G or B streptococci generally formed smaller sized pustules of fewer numbers. Impetigo was usually present, associated with severe eczematous lesions. Various degrees of fever were noticed in 32.8% (group A, 39.8%; group G, 17.6%; group B, 11.8%) during active stages. The lesions on the face often resembled Kaposi's varicelliform eruption in any group. Systemic antimicrobial agents were administered in 71.3% of cases and the remainder were treated with topical antibiotics (oxytetracycline hydrochloride) or disinfectants (povidone-iodine). Recurrence occurred within a month in 38.0% of cases treated with topical agents only and in 17.7% treated with systemic antimicrobial agents. Antimicrobial susceptibility tests and the results of treatment seem to indicate that cephems, as well as penicillins, are the first choice of treatment for streptococcal impetigo.

We performed a retrospective study during 2 years in order to determine the clinical and epidemilogic characteristics of 144 cases of scabiosis with acute glomerulo-nephritis in Dakar. The 144 cases of scabiosis complicated with glomerulo-nephritis represented 56.6% of the whole 205 cases of scabiosis observed in the same period. The most important part of the cases was observed between November and January. Usually children came from poor and numerous family. The scabios lesions were mostly generalised and the infection was recent. The main features of the kidney disease were: oedemas(93.2%), high blood pressure (89.1%) and haematuria(54.70%). Cardiac and neurological involvement were the main complications. The global mortality was very low(1 case). The evolution was good in 97% of the case with complete cure.

We report a 15-year-old primagravida female with a history of chronic plaque psoriasis who developed impetigo herpetiformis at 28 weeks gestation. Culture of a needle aspirate from a tender, enlarged cervical lymph node grew Staphylococcus aureus. The patient improved rapidly on wet dressings, topical midpotency corticosteroids, and intravenous nafcillin. The remainder of her pregnancy was uncomplicated. We speculate that both pregnancy and infection led to this pustular flare of her psoriasis.

A 9-month-old infant was diagnosed as having impetigo of the central face. Her clinical condition deteriorated despite treatment with intravenous antibiotics. Viral and bacterial cultures grew herpes simplex virus type I and Staphylococcus aureus, respectively. The patient's condition improved rapidly with antiviral treatment in combination with antibiotics. Recognition of the possibility of a combined viral and bacterial infection is important so that adequate treatment is not delayed.

A trend toward increasing resistance of Staphylococcus aureus to standard antibiotic therapy has been reported. Specimens were taken from 98 patients in our outpatient staff clinic who had clinical signs of superficial skin infections. Patients with erythromycin-resistant S. aureus were contacted by telephone or seen in clinic. The organism was found in 87% of patients. Twenty-two (26%) of the 85 cultures that grew S. aureus were resistant to erythromycin. Treatment failure occurred in one of these patients. We conclude that S. aureus is the most common causative organism in secondary skin infections and impetigo in our patient population. Despite significant erythromycin resistance, there was a low frequency of treatment failure in this group. Erythromycin may still be a reasonable agent in the treatment of uncomplicated superficial skin infections in our community at this time.

We report here a case of type 1 mesangiocapillary glomerulonephritis as well as a case of mesangial proliferative glomerulonephritis associated with streptococcal skin infection superimposed on atopic dermatitis. Both were endemic occurrences of postinfectious glomerulonephritis developed after repeated dirty-skin treatments for atopic dermatitis performed by unauthorized individuals under unsanitary conditions. Of 20 patients who were similarly treated and subsequently admitted to our hospital because of skin infection and fever, 8 (40%) showed urinary abnormalities. Four patients had renal dysfunction with acute nephritic onset. Almost all showed a decrease in CH50 values and an increase in levels of antistreptolysin O and IgE. In the 2 cases presented here, the disease eventually regressed in association with improvement of the skin infection. Although the occurrence of postinfectious glomerulonephritis has recently become uncommon, we must take care to note urinary abnormalities as early as possible in order to prevent the progression of glomerulonephritis.

This article reviews in detail the pathogenesis, clinical characteristics and management of impetigo in children. Impetigo is the most common bacterial skin infection of children. Most cases of nonbullous impetigo and all cases of bullous impetigo are caused by Staphylococcus aureus. The remainder of cases of nonbullous impetigo are due to group A beta hemolytic streptococci (GABHS). GABHS colonize the skin directly by binding to sites on fibronectin that are exposed by trauma. In contrast, S. aureus colonizes the nasal epithelium first; from this reservoir, colonization of the skin occurs. Patients with recurrent impetigo should be evaluated for carriage of S. aureus. Superficial, localized impetigo may be treated successfully in more than 90% of cases with topical application of mupirocin ointment. Impetigo that is widespread or involves deeper tissues should be treated with a beta-lactamase-resistant oral antibiotic. The choice of antibiotics is affected by the local prevalence of resistance to erythromycin among strains of S. aureus, antibiotic cost and availability, and issues of compliance.

A survey of five primary schools in the Njala area, Sierra Leone showed that Pediculus humanus capitis infestation is wide-spread. The overall prevalence was 6.8% among 1007 school children examined. Infestation rates varied between schools from 1.4% to 14.6% and the prevalence of infestation increased with age, from 3.1% among class I children to 10.2% among class IV and decreased to 4.9% among class VI children. Females had a higher infestation rate (8.3%) than their male counterparts (5.4%). The infestation rate was higher' in children whose fathers were Farmers (9.4%) followed by Traders (7.8%), Artisans (6.5%) and Professionals who had the lowest infestation rate of (5.8%). Sharing of beds, beddings and combs had a significant effect (P < 0.01) on the rate of infestation. The infestation was light, therefore, impetigo was minimal. Overcrowding at home is the main factor facilitating the transmission of the infestation from one head to another among these children.

Objective: To determine the incidence of bullous impetigo in a group of homosexual men at high risk of HIV-1 infection., Design: A longitudinal descriptive study (1984-9)., Setting: A private primary care and STD clinic in Sydney, Australia., Subjects: 88 homosexual men documented to seroconvert to HIV-1, and 37 homosexual controls who had practised unprotected anal intercourse with another man known to be HIV-1 positive but who remained HIV-1 negative., Main Outcome Measure: Incidence of bullous impetigo., Results: The crude annual incidence of bullous impetigo was 0.015 in subjects while they remained HIV-1 negative (10 cases) and 0.045 in early HIV-1 positive subjects (2 cases). Overall, 9% of the HIV-1 seroconverters and 9% of the HIV-1 negative controls were documented as suffering bullous impetigo over a mean of 29.2 and 39.3 months, respectively., Conclusions: Bullous impetigo in an adult could prove to be a clinical indication that a person is either infected with HIV-1 or is in close (possibly sexual) contact with a person with HIV-1 infection. If true, the recognition of bullous impetigo could provide an opportunity for behavioural intervention to limit the spread of HIV-1.

A patient with an unusual form of follicular impetigo, who later developed classical systemic lupus erythematosus (SLE) is described. When she had pyoderma, direct immunofluorescence and serology already suggested a connective tissue disease. Pyoderma could have been the presenting manifestation of SLE.

Systemic cloxacillin therapy of secondarily infected dermatitis cloxacillin therapy become apparent produces a significant increase in healing when compared to a placebo. The effects of systemic after five days of treatment. A single pretreatment culture was not helpful in directing therapy.

A 15 year old boy with scabies has been treated with local form of therapy for 3 month without effect. He was then admitted to our pediatric clinic with pyrexia and restricted movement of the right knee. The med. history, the consequent laboratory findings, positive bloodcultures, skin swabs and bone scintigraphy lead to diagnosis of acute haem. osteomyelitis. The early antibiotic therapy assured uneventful recovery.

In an attempt to further study the possible contribution of circulating immune complexes (CIC) in the pathogenesis of acute poststreptococcal glomerulonephritis, 61 patients with APSGN were studied during the first three weeks of the disease, and 13 patients with noncomplicated streptococcal impetigo as a control group. C1q solid phase ELISA and Conglutinin (K) solid phase ELISA were used to measure the levels of immune complexes. The incidence of CIC in a single serum sample from patients with APSGN was 48%. Elevated levels of immune complexes were found in 46% of the patients with streptococcal impetigo. The absolute levels of CIC were comparable in both groups of patients. No correlation was found among the presence of CIC and the clinical, immunoserological or pathological findings of the disease. Our results do not support the hypothesis that trapping of the circulating immune complexes play an important role on the renal injury poststreptococcal infection. Instead, we suggest that CIC are an epiphenomena present in APSGN, and may represent rather a systemic inflammatory immune response in patients with group A streptococcal infection.

Impetigo herpetiformis is a rare and often serious pustular dermatosis of pregnancy. The usual course of impetigo herpetiformis is one of continued progression throughout pregnancy with rapid resolution during the puerperium. This patient is the first reported case, to the authors' knowledge, of impetigo herpetiformis presenting during the puerperium, a time usually associated with the disease's remission. This suggests that impetigo herpetiformis should be included in the differential diagnosis of puerperal fever, particularly in those cases associated with dermatoses.

Pruritus occurs frequently during pregnancy; the reported incidence ranges from 3% to 14% of all pregnancies. Pruritus may occur with or without skin lesions, and may be an exaggerated response to a physiologic adaptation to pregnancy, a manifestation of a systemic disorder, or a primary skin disease. We review the most serious skin disorders associated with pregnancy and present an easy, logical approach to their diagnosis and management.

In an Australian Aboriginal community, 65% of all people examined had clinical evidence of pathology in the ear drum or middle ear, but active ear disease was found mainly in children. In most people, both ears showed similar clinical changes. Clinical nutritional status and hygienic factors did not correlate with the presence of ear disease. Some families had significantly more ear disease than did others, suggesting that there is some as yet unidentified familial factor.

We compared responses to amoxicillin combined with clavulanic acid (ACA) with a cefaclor regimen in children with skin and soft tissue infections (impetigo and cellulitis) due to Staphylococcus aureus, Streptococcus pyogenes, and Haemophilus species. All isolates from the 41 patients we were able to evaluate were susceptible to ACA by disk susceptibility testing at the onset of treatment. The 21 children receiving ACA and 18 (90%) of 20 taking cefaclor responded to therapy. Clinical cure was achieved in 18 (86%) of 21 and 18 (90%) of 20 in the two groups, respectively. Bacteriological failure occurred in 2 (10%) patients in the cefaclor group and none in the group receiving ACA; however, there were 2 (9%) relapses and 1 (5%) reinfection among the 21 children taking ACA. Adverse effects, although mild, occurred more commonly (9 of 21 versus 1 of 20; P = 0.005) with ACA than with cefaclor.

A 4 year-old girl presented with 2 episodes of acute glomerulonephritis with clinical and morphological recovery between them. Both episodes were preceded by impetigo. The first and third renal biopsies showed glomerulitis with diffuse dense deposits in the mesangium, segmentary intramembranous dense deposits, atypical "humps" and granular C3. The second biopsy, taken between episodes, was considered to be normal. Two years and 5 months after the second episode the clinical evaluation and laboratory tests were normal.

An unusual case of Chlamydia trachomatis (C. trachomatis) pneumonia, complicated by the development of a pneumothorax, is reported in an IgG2/IgG4 deficient infant delivered by caesarean section. C. trachomatis was isolated initially from a throat smear and subsequently from pleural effusions. Serological examinations using the complement fixation test were negative in sera of both mother and child. However, using immunofluorescence the presence of an acute or recent infection was confirmed by IgM-antibodies in the serum of the infant and IgA-antibodies in the serum of the mother. At the age of 7 months the girl suffered from impetigo contagiosa which was partially resistant to antibiotic treatment. IgG-subclass deficiency was diagnosed after the onset of this disease and the girl was then treated by immunoglobulin transfusion.

All of 68 renal transplant recipients (mean observation time 28.4 months after transplantation) showed skin complications. In these subjects fungal infection was found in 51, viral disease in 45 and bacterial infection in 36 cases. Of fungal manifestations candidiasis, onychomycosis, and dermatomycosis were most commonly observed. The most important viral disease was herpes simplex. The main part of bacterial infections was either caused by surgical complications or by super-infection (impetigo) of steroid acne. Non infectious dermatological disorders were usually due to immunosuppressive therapy.