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PubMed2005

Facial and perioral primary impetigo: a clinical study.

Impetigo is the most common skin infection in children. The face, especially the perioral region, is one of the most frequently involved areas. Impetigo is a disease that interests the pediatric dentist, as it poses significant problems in its differential diagnosis from other conditions. Sixteen otherwise healthy children were examined suffering from facial and perioral impetigo. The typical clinical appearance was scattered, painless, slightly pruritic erosions covered by "honey-colored" crusts. In 4 children impetigo was localized in the facial and perioral area, whereas in all other cases lesions were diffused in perioral area and several regions throughout the body. Four children exhibited neck lymphadenopathy and one had mild fever. The treatment of impetigo included the application of topical measures with the systemic antibiotic chemotherapy.

Child↗
PubMed2000

Association between lesional or non lesional S. aureus strains from patients with impetigo and exfoliative toxin production. No association with SmaI PFGE patterns.

Contrasting data are reported in the literature on the percent positivity rates (13.5%-100%) of exfoliative toxin (ET) production by S. aureus strains isolated from impetigo patients in Japan and in France. In the present study, by means of a recently available latex-test, toxin-A (ETA) or toxin-B (ETB) production was found in 67.6% of the 34 S. aureus strains isolated from 19 lesional (63.2%) and 15 non-lesional (nose or pharynx, 73.3%) areas of patients with impetigo (with no significant difference between the lesional and non-lesional isolates). ETA + ETB were produced by 44.1% of the strains, while 32.4% were non-producers. In contrast, the percent positivity rate observed in 40 [20 lesional and 20 non-lesional (nose or pharynx)] strains isolated in patients with atopic dermatitis was 15.0% (p < 0.001 both for the lesional and non-lesional strains versus impetigo, with no significant difference between lesional and non lesional strains). Finally, 26 strains from other types of specimens (abscesses, hemocultures, urine, central venous catheters, bronchoalveolar lavages) showed an 11.5% production rate of ETA or ETB (p < 0.001 versus impetigo strains, no significance versus atopic dermatitis). These data point to a significant association between exfoliative toxin production and S. aureus strains isolated in impetigo, both in lesional areas and in nasal/pharyngeal reservoirs. An attempt to correlate SmaI pulsed-field gel electrophoresis (PFGE) restriction patterns and exfoliative toxin production showed no significant association in either group.

Adolescent↗
PubMed1990

Group A streptococcal pharyngeal carriage, pharyngitis, and impetigo in two northern Canadian native communities.

The prevalence of pharyngeal carriage of group A streptococci, streptococcal pharyngitis, and impetigo was determined in schoolchildren in two northern communities, one Inuit (mean number of schoolchildren surveyed, 233) and one native Indian (mean number of schoolchildren surveyed, 349). At three surveys from November 1984 to May 1985, pharyngeal group A streptococcal carriage was 5.3%, 22%, and 34% in the Inuit community and 5.3%, 5.1% and 10% in the native Indian, with impetigo prevalence 1.6%, 3.8% and 1.0%, and 2.4%, 4.2% and 0.6%, respectively. Increased pharyngeal carriage correlated with the increasing number of household residents and the lower school grade. In 12 months of observation the incidence of group A streptococcal pharyngitis was 49/100 schoolchildren for the Inuit and 9.4/100 for the native Indian community, with impetigo 13/100 and 11/100 respectively. The maximal incidence of pharyngitis was late winter in the Inuit community and midsummer in the native Indian. The incidence of impetigo peaked in January for both communities. M and T typing showed consecutive outbreaks of different serotypes in the Inuit community, but a persistent low level of endemic infection in the Indian community. These observations suggest a seasonal prevalence of group A streptococcal pharyngeal carriage consistent with other North American populations, but marked inter-community variation in pharyngeal carriage and disease. The midwinter peak of impetigo appears unique to these populations.

Adolescent↗
PubMed1998

[A case of corneal abscess with impetigo contagiosa].

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.

Abscess↗
PubMed2003

Confocal laser scanning microscopic observation of glycocalyx production by Staphylococcus aureus in skin lesions of bullous impetigo, atopic dermatitis and pemphigus foliaceus.

BACKGROUND: Glycocalyx collapses during dehydration to produce electron-dense accretions. Confocal laser scanning microscopy (CLSM) may be used to visualize fully hydrated microbial biofilms. OBJECTIVES: Using CLSM, to analyse glycocalyx production by Staphylococcus aureus cells in skin lesions of bullous impetigo, atopic dermatitis and pemphigus foliaceus. A second objective was to compare numbers of S. aureus cells in tissue sections prepared by different methods for routine light microscopy. METHODS: S. aureus cells in skin lesions of impetigo, atopic dermatitis and pemphigus were stained with safranin, and positive staining with fluorescein isothiocyanate-conjugated concanavalin A was considered to indicate the presence of glycocalyx. RESULTS: All S. aureus cells tested in skin lesions of impetigo, atopic dermatitis and pemphigus were covered with glycocalyx and formed microcolonies. The numbers of S. aureus cells in a routine light microscopy section were significantly lower than those in a frozen section that had not been dehydrated with ethanol. CONCLUSIONS: S. aureus cells generally produce glycocalyx in skin lesions of bullous impetigo, atopic dermatitis and pemphigus foliaceus, which accounts for the difficulty of removing S. aureus cells from these skin lesions. The glycocalyx may collapse during dehydration and most of the S. aureus cells may be carried away during preparation of routine light microscope sections.

Acetic Acid↗
PubMed1984

Impetigo herpetiformis as a cause of postpartum fever.

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.

Abdomen↗
PubMedDate not supplied

Treatment of impetigo: a review.

A number of well-designed comparison studies have shown the superiority of oral or injectable antibiotics over typical treatment in the treatment of impetigo contagiosa. Erythromycin, phenoxymethyl penicillin, intramuscular benzathine penicillin G as well as clindamycin, cefaclor and amoxicillin with clavulanic acid have been shown to be extremely effective. Because of significant differences in study design, it is difficult to compare drugs investigated in different studies. Intramuscular benzathine penicillin G consistently has been associated with the highest cure rates, especially in studies specifically of streptococcal impetigo. It is unclear whether these high cure rates reflect superior efficacy or are the result of lesser compliance with oral medication, but the latter explanation is quite likely. This information generally translates into daily practice as a recommendation of a penicillin or an erythromycin preparation for streptococcal impetigo unless the lesions are small and few in number, in which case topical therapy is probably sufficient. If oral antibiotics are prescribed they should be given for 10 days. Systemic as opposed to topical antibiotics should be considered more strongly in situations where the incidence of impetigo is high, since these drugs are clearly superior in sterilizing the lesions quickly to prevent transmission. Other situations that favor the use of systemic as opposed to topical antibiotics include the presence of nephritogenic strains in the population, whether endemic or epidemic, more severe or spreading lesions and a population with poor hygiene.

Administration, Oral↗
PubMed1988

Treatment of impetigo and ecthyma. A comparison of sulconazole with miconazole.

In a randomized, double-blind, parallel comparative study of 80 patients, impetigo and ecthyma were treated effectively by sulconazole nitrate 1% cream and miconazole nitrate 2% cream applied to lesions twice daily for 14 days. When treatment began, bacterial cultures from all pyodermal lesions yielded Group A beta-hemolytic streptococci or pathogenic staphylococci. Among the 32 sulconazole-treated impetigo patients, bacterial cultures from 26 (69%) were negative by treatment day 4, and those from all 32 (100%) were negative by treatment day 7; among the 34 miconazole-treated impetigo patients, cultures from 17 (50%) were negative by treatment day 4, cultures from 32 (94.1%) were negative by treatment day 7, and cultures from 29 (97%) were negative by treatment day 14. Each treatment promptly relieved the pyodermal signs (crusts, vesicles, pustules, bullae, and exudate). Both agents were considered to be safe and effective medications for treating impetigo and ecthyma.

Double-Blind Method↗
PubMed1997

[Antibacterial sensitivity, phage group and coagulase type of Staphylococcus aureus isolated from bullous impetigo].

Bullous Impetigo caused mainly by S. aureus is seen in high incidence in children. Three decades ago CEMs were much more effective for bullous impetigo than today. Recently, the causative S. aureus obtained resistance against not only PCs but multiple antibacterial drugs except a few agents. Therefore the therapy for the disease has become difficult, especially the first choice effective antibacterial drugs for general use. Sensitivity of antibacterial drugs against S. auresu isolated from skin lesions, including some MRSA was studied in 113 patients with bullous impetigo. The agents with high sensitivity against all strains were VCM (100%), MINO (100%), CLDM (96.5%), FMOX (96.3%) and against 39 MRSA strains were VCM (100%), MINO (100%), OFLX (92.3%), CLDM (87.2%) and FOM (82.1%). Clinically available antibacterial drugs for children are MINO granules and FOM drysyrup. Phage group and coagulase type of the S. aureus were simultaneously examined to elucidate which strains were causative or secondary infectious agents of the bullous impetigo.

Adult↗
PubMed2002

Fusidic acid cream in the treatment of impetigo in general practice: double blind randomised placebo controlled trial.

OBJECTIVE: To test the hypothesis that fusidic acid would not increase the treatment effect of disinfecting with povidone-iodine alone in children with impetigo. DESIGN: Randomised placebo controlled trial. SETTING: General practices in Greater Rotterdam. PARTICIPANTS: 184 children aged 0-12 years with impetigo. MAIN OUTCOME MEASURES: Clinical cure and bacterial cure after one week. RESULTS: After one week of treatment 55% of the patients in the fusidic acid group were clinically cured compared with 13% in the placebo group (odds ratio 12.6, 95% confidence interval 5.0 to 31.5, number needed to treat 2.3). After two weeks and four weeks the differences in cure rates between the two groups had become smaller. More children in the placebo group were non-compliant (12 v 5) and received extra antibiotic treatment (11 v 3), and more children in the placebo group reported adverse effects (19 v 7). Staphylococcus aureus was found in 96% of the positive cultures; no strains were resistant to fusidic acid. CONCLUSIONS: Fusidic acid is much more effective than placebo (when both are given in combination with povidone-iodine shampoo) in the treatment of impetigo. Because of the low rate of cure and high rate of adverse events in the placebo group, the value of povidone-iodine in impetigo can be questioned.

Anti-Bacterial Agents↗
PubMed2004

Treatment of bullous impetigo and the staphylococcal scalded skin syndrome in infants.

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.

Anti-Infective Agents↗
PubMed1976

Streptococcal types in impetigo and acute glomerulonephritis among children in Addis Ababa.

Studies on the streptococcal epidemiology of impetigo in children below 12 years of age in Addis Ababa indicated that most streptococci isolated belonged to the classic serological impetigo strains. Streptococcal type 9 seemed to be a new impetigo strain. Several cases of severe acute glomerulonephritis on impetigo basis were observed during the study.

Acute Disease↗
PubMed2002

The effect of antibacterial soap on impetigo incidence, Karachi, Pakistan.

We conducted a study to determine if soap containing 1.2% triclocarban would be effective in reducing the incidence of impetigo. We randomized 162 households in a low-income neighborhood of Karachi, Pakistan, to receive a regular supply of 1.2% triclocarban-containing soap (n = 81) or an identically appearing placebo (n = 81); 79 households in a nearby neighborhood were enrolled as standard practice controls. After adjustment for household clustering and covariates, the incidence of impetigo among children living in households receiving triclocarban-containing soap (1.10 episodes per 100 person-weeks) was 23% lower than in households receiving placebo soap (P = 0.28) and 43% lower than the standard habit and practice controls (P = 0.02). The routine use of triclocarban-containing soap by children living in a community with a high incidence of impetigo was associated with a reduced incidence of impetigo.

Anti-Infective Agents↗
PubMedDate not supplied

Impetigo: aetiology, complications and treatment options.

This article describes impetigo, and outlines differential diagnoses, likely complications associated with impetigo and signs and symptoms. Main treatments for impetigo are highlighted, with explanations of when these treatments are useful and when they may not be the best choice. Anxieties that accompany impetigo in a family context and ways in which an appreciation of these anxieties may enhance the care provided are examined.

Administration, Oral↗
PubMed2004

[Non bullous impetigo: streptococcal or staphylococcal?].

Non bullous impetigo is very common among the pediatric population. It is caused by bacteria. For twenty years, Staphylococcus aureus has been the most frequently isolated organism (present in 80 % of non bullous impetigo lesions, it is the only pathogen cultured in 50 % of patients). The group A beta-haemolytic streptococcus is at the moment isolated alone in 3% of lesions and in association with S. Aureus in 30 % of patients. An epidemiologic change seems to have occurred. Until the early 1980s, group A beta-haemolytic streptococcus was indeed the most predominant etiologic agent causing non bullous impetigo. Unfortunately, the rate of resistance among staphylococci responsible of non bullous impetigo is increasing. As serious complications can follow this skin infection, an appropriate treatment is necessary combining local care, topical antibiotics and sometimes adjunction of systemic antibiotics.

Humans↗
PubMed1996

[Erysipelas and impetigo].

Erysipela is a dermal or hypodermal infection of the skin, which predominantly involves the leg and is associated with high fever. Erysipela is most often caused by Streptococcus pyogenes. Venous insufficiency or lymphoedema are important local factors for the development of this infection which spreads from intertrigo, local wound or leg ulcer. Treatment is essentially based on parenteral penicillin G. Impetigo is a superficial infection of the skin due to Staphylococcus aureus or to Streptococcus pyogenes, and is frequent in children. Classical impetigo is made of yellow-brown crusts located around the mouth and nose, whereas bullous impetigo involves frequently the trunk and limbs. Secondary impetigo occurring in pediculosis or scabiosis is frequent. It is a contagious disease which is more frequent in patients with poor hygiene. It can be treated by general antibiotics, mainly macrolides, penicillin M or cephalosporins.

Adult↗
PubMed1990

Impetigo. Current etiology and comparison of penicillin, erythromycin, and cephalexin therapies.

We attempted to determine the causative bacterial pathogens of impetigo in children in our area, to compare the effectiveness of three frequently used oral antimicrobial treatment regimens, and to correlate the antimicrobial sensitivity of the bacterial isolates with clinical responses to treatment. Seventy-three children with impetigo were randomly assigned to receive penicillin V potassium or cephalexin monohydrate, both administered in dosages of 40 to 50 mg/kg per day, or erythromycin estolate administered in a dosage of 30 to 40 mg/kg per day. All drugs were given in three divided doses for 10 days. Treatment failure was defined as persistence of lesions 8 to 10 days after initiation of drug therapy as determined by examiners blinded to the treatment therapies. Forty-five (62%) cultures showed Staphylococcus aureus only, 14 (19%) showed S aureus and group A beta-hemolytic streptococci, six (8%) showed group A beta-hemolytic streptococci only, and eight (11%) showed no growth or other organisms. Treatment failure occurred in six (24%) of 25 patients treated with penicillin V, one (4%) of 25 patients treated with erythromycin estolate, and no patients treated with cephalexin. We conclude that S aureus is the most common cause of impetigo in children in our study population, that cephalexin is the most effective treatment, that erythromycin estolate is nearly equally effective and may be preferred on a cost-effectiveness basis, and that penicillin V is inadequate for treatment of this infection.

Adolescent↗
PubMed1992

Production of experimental staphylococcal impetigo in mice.

We produced a staphylococcal impetigo model by epicutaneous inoculation in mature mice. A strain isolated from a human impetigo was used. Five-week-old female mice (ddy-strain) were used with and without pre-treatment by cyclophosphamide (Cy) (2 mg/mouse) for 5 days. The back skin of mice was shaved by a razor blade and slightly abraded by sand paper. Bacterial suspension (1.4 x 10(7) CFU/0.05 ml) was applied on the abraded areas which were then occluded under sterile plastic plaster. Although intraepidermal blisters developed in non-Cy-treated mice, massive neutrophil infiltration obscured the changes there. Development of subcorneal bullae in Cy-treated mice inoculated with Staphylococcus aureus was first observed at 3h and enlargement of bullae was apparent at 12 h after inoculation. The bullae produced in Cy-treated mice contained numerous S. aureus bacilli. Electronmicroscopically, S. aureus cells invaded the horny layer at 1/4 h. A clear halo was seen between S. aureus cells and horny cells. S. aureus cells attached to surrounding horny cells by fibril-like structures. The halo-like spaces became larger, coalesced and then developed into an intraepidermal blister. Our new method to produce human impetigo-like blister in Cy-treated adult mice may contribute to disclosing the mechanisms of blister formation in epidermis by S. aureus. Due to the thin structure of mouse epidermis, only specimens taken earlier than 24 h after inoculation were considered appropriate.

Animals↗