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[Microbiology of streptococcal infections].

Since the discovery of streptococci by the surgeon of Vienna, Theodor Billroth, more than 100 years ago, they have proved to be a bacterial group of great medical and epidemiological importance. The classification in growth-characteristics on blood culture mediums (alpha-, beta- and gamma-hemolysis) has been detached by the evidence of group specific cell wall antigens. The antigene extraction described by Lancefield can distinguish at least 21 serogroups (A-T). They have also taken over the historical names (S. pyogenes, S. agalactiae etc.). In addition to group relationship the antigen structure of the streptococci cell wall (carbohydrates, peptidoglycanes, M-T-R-proteins and others) is responsible for antigenetic and pathogenetic conditions. Some species of streptococci do also excrete exotoxines (streptolysin, hyaluronidase, bacteriocines, erythrogenic toxins) with antigenetic and pathogenetic significance. Infections with streptococci of the serogroup A, B, D and H are numerously and medically significant. There is a great interest in infections due to A streptococci (pharygitis, impetigo, erysipel, scarlatin fever). The known non-purulent diseases following A streptococci infections (acute rheumatoid fever, acute glomerulonephritis) are streptococcal specific reactions for the individual. Some antigens of the cell wall and also some exotoxines react in human beings as autoantigenes. Human beings are the most important reservoir for streptococci. Nearly 20% of a population have A streptococci in their upper respiratory tract.(ABSTRACT TRUNCATED AT 250 WORDS)

Antigens, Bacterial↗
PubMed1984

Pregnancy's effects on the skin. Common and uncommon changes.

The skin almost always shows changes during pregnancy. Some of these alterations are so predictable as to be considered normal. Not nearly so common are a host of pruritic dermatoses, including pruritus gravidarum, herpes gestationis, pruritic urticarial papules and plaques of pregnancy, Spangler 's papular dermatitis of pregnancy, and impetigo herpetiformis. Some of these conditions can cause maternal and/or fetal complications and even death; others, although benign and transient, add to the stress of pregnancy. Physician adeptness at diagnosing and treating skin diseases specific to or affected by pregnancy is thus of vital importance in caring for pregnant women.

Female↗
PubMed1986

Blistering diseases in children. How to recognize and treat the most common.

The most common blistering diseases encountered in children are impetigo, burns, acute dermatitis, friction blisters, viral blisters, insect bite reactions, and linear IgA dermatosis. Diagnosis should be based on specific clinical manifestations and, when necessary, results of a Tzanck test or skin biopsy. A search for an intact blister is always warranted when erosions, oozing, or crusts are noted.

Acute Disease↗
PubMed2002

Clonal spread among Swedish children of a Staphylococcus aureus strain resistant to fusidic acid.

An increased incidence of fusidic acid-resistant Staphylococcus aureus strains causing superficial infections among children in Sweden has been noted since the mid-1990s. Based on routine susceptibility testing data from 10 laboratories representing 8/21 Swedish counties during 1990-2001, the increase was first demonstrated in southern Sweden and subsequently became apparent throughout the country. Epidemiological typing using pulsed-field gel electrophoresis of recent isolates of fusidic acid-resistant S. aureus from 11 laboratories representing 8/21 Swedish counties revealed a high degree of similarity of band patterns, indicating a clonal relationship. Data from 1 of the laboratories demonstrated a close connection between this clone and impetigo. Sales statistics showed a pronounced increase in the use of fusidic acid ointments in the 0-12 y age group from 1998 onwards. There was, however, no statistically significant correlation between sales of fusidic acid ointments and resistance among S. aureus strains to fusidic acid.

Administration, Topical↗
PubMed2000

Contrasting molecular epidemiology of group A streptococci causing tropical and nontropical infections of the skin and throat.

Disease caused by group A streptococci (GAS) in tropical regions often takes the form of impetigo, whereas pharyngitis tends to predominate in temperate zones. GAS derived from asymptomatic throat infections and pyoderma lesions of rural Aboriginal Australians were evaluated for phylogenetic distant emm genes, which represent ecological markers for tissue site preference. On the basis of the percentage of total isolates from a given tissue, emm pattern A-C organisms exhibited a stronger predilection for the throat, whereas pattern D organisms preferred the skin. Only 16% of isolates collected by active surveillance displayed pattern A-C, which reflects the low incidence of oropharyngeal infection. Importantly, most (70%) pattern A-C organisms were isolated from skin sores, despite their innate tendency to infect the throat. Combined with findings from nontropical populations, analysis of the data supports the hypothesis that GAS tissue preferences are genetically predetermined and that host risk factors for infection strongly influence the differential reproduction of individual clones.

Adult↗
PubMed1996

Genetic correlates of throat and skin isolates of group A streptococci.

The existence of discrete populations of throat and skin strains of group A streptococci has long been recognized; however, a molecular basis for this distinction is not known. The emm gene structure was analyzed for 105 isolates obtained from patients with well-defined group A streptococcal diseases: uncomplicated pharyngitis, impetigo, and acute rheumatic fever. Four emm gene sub-family forms, defined by nucleotide sequence differences in regions encoding the peptidoglycan-spanning domain of M and M-like surface proteins, were found to exist in five different chromosomal patterns among naturally occurring isolates. Strong correlations were made between disease and the number and arrangement of emm subfamily genes. These findings provide a genetic basis for the historical references to "throat," "skin," and "rheumatogenic" types.

Bacterial Outer Membrane Proteins↗
PubMed2003

Staphylococcal epidermolysins.

PURPOSE OF REVIEW: Staphylococcal epidermolysins are the major causative toxins of bullous impetigo and staphylococcal scalded skin syndrome. This disease is characterized by the splitting of the epidermis between two cell layers resulting in exfoliation. It predominantly affects newborn babies and exposes them to secondary infections. This leads to the risk of epidemics, especially in nurseries. With only an experimental model which consists of skin injections in newborn mice and the recent determination of three-dimensional structures, the essential function of these toxins remained controversial, split between that of specific proteases and that of superantigens. RECENT FINDINGS: Staphylococcal epidermolysins now constitute a family of toxins, with the recent characterizations of two new serotypes: ETC and ETD. They may be secreted by sensitive or methicillin-resistant strains. Four molecules were also identified in Staphylococcus hyicus responsible for exudative epidermitis in swine. While different observations suggested a proteolytic action to these toxins, the histological parallel made with pemphigus foliaceus greatly helped in the characterization of the targets for epidermolysins ETA, ETB, ETD: desmoglein-1, a desmosome-constitutive protein, and incidentally melanocyte-stimulating hormones, which accounts for the blisters observed clinically. SUMMARY: The growing complexity in staphylococcal toxins has to be taken into account both for their association with diseases and for diagnosis purposes. Even though cases of staphylococcal scalded skin syndrome in adults are rare, they raise further questions about the pathogenic features of the disease such as individual sensitivity and distribution of the toxins into the body.

Adult↗
PubMed1988

Microbiologic characteristics of exfoliative toxin-producing Staphylococcus aureus.

Exfoliative toxin (ET) production, phage types and antibiotic susceptibilities of 74 strains of Staphylococcus aureus isolated from patients with generalized staphylococcal scalded skin syndrome or bullous impetigo were studied. Of 74 staphylococcal isolates, 61 strains were found to produce ET by the newborn mouse assay method and the latex agglutination method. Fifteen strains were positive for ET-A, 32 for ET-B and 14 for both ET-A and ET-B. Among 61 ET-producing strains 27 (44%) were classified as Phage Group II, 16 (26%) as Group III, and 14 (23%) as Groups I and III. Of 27 Phage Group II strains 14 produced ET-A and 13 produced both ET-A and ET-B, but no strain was positive solely for ET-B. On the other hand 15 of 16 Phage Group III strains and all 14 Phage Group I and III strains produced only ET-B. It was demonstrated that the phage types of staphylococci were closely related to ET types. Characteristically the minimal inhibitory concentrations of penicillin G against ET-producing strains were less than 2 micrograms/ml, in contrast to other pathogenic staphylococci, 60 to 70% of which are highly penicillin G-resistant.

Adolescent↗
PubMed1975

Enumeration of beta-haemolytic streptococci on normal skin by direct agar contact.

Normal skin sites in children from a population in which streptococcal impetigo is endemic were examined for the presence of beta-haemolytic streptococci by a direct agar-contact technique. Ninety-eight of 554 samples (18%) were positive for these organisms. Penicillin prophylaxis reduced the frequency of isolation of streptococci from the normal skin for a period of 3 weeks, perhaps accounting in part for the lower isolation rate in this than in earlier studies. Numbers of streptococcal colony-forming units in positive samples were generally low, both in terms of absolute numbers isolated from the surface area sampled and in comparison with numbers of other aerobic flora recovered. The presence of streptococcal pyoderma at the time of agar contact was not necessarily associated with the presence of or with increased numbers of streptococci on samples obtained from normal skin sites. Low counts were consistently found in early summer and higher counts in some samples in late summer. In a simultaneous comparison of paired samples taken from adjacent sites, the frequency of detection of streptococci by direct agar contact compared favourably with that obtained with a moist-swab method. The increased frequency of detection by the agar-contact method appeared to be related to an increased sensitivity for the detection of low numbers of streptococcal colony-forming units on the normal skin.

Adolescent↗
PubMed1976

Clinical and bacteriological evaluation of a twice daily regimen of epicillin capsules for the treatment of skin infections.

Fifty-five patients with impetigo, ecthyma, or folliculitis caused by epicillin-sensitive strains of Streptococcus pyogenes or Staphylococcus aureus were treated with 500 mg epicillin capsules twice daily for an average duration of 9 days. Bacteriological and clinical examinations were performed at 2-day intervals. Favourable clinical responses (excellent or good) were obtained in 95% of the patients. No side effects were observed.

Administration, Oral↗
PubMed1979

Pemphigus-like antibodies: a report of two cases.

Two patients with high titres of circulating intercellular antibodies are described. One had bullous mycosis fungoides and the other had bullous impetigo. In each case, as the underlying disease responded to treatment, the titre of antibodies fell.

Adult↗
PubMed1986

Early warning skin signs in AIDS and persistent generalized lymphadenopathy.

Distinctive patterns of skin disease other than Kaposi's sarcoma have been in patients with AIDS, in others with persistent generalized lymphadenopathy (PGL) and in a group at high risk of developing AIDS. We found a chronic acneiform folliculitis on the face, back, chest and buttocks, extensive cutaneous fungal infections and a striking neck and beard impetigo. These skin diseases were not present in asymptomatic male homosexual control subjects, 32% of whom were found to have antibodies to human T cell lymphotropic virus type III (HTLV-III). We regard these dermatoses as early warning signs of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Developmental, behavioural and somatic factors in pervasive developmental disorders: preliminary analysis.

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.

Asperger Syndrome↗
PubMed1993

Recurrent impetiginized eczema as a presenting manifestation of cyclic neutropenia.

A patient is described with a persistent, impetiginized dermatitis that worsened periodically, which was preceded by neutropenic episodes during which her circulating neutrophil count fell to 500-600/ml. Each episode lasted 24 h and had a 7-11 day periodicity. The importance of this case depends on the frequency and brevity of the neutrophil trough levels that made the dermatitis appear to be continuous. Similar cases may be more common than expected as isolated abnormal leukocyte counts may be disregarded as laboratory artefacts. Dermatologists should be cautious in managing patients with persistent atypical impetigo.

Adult↗
PubMed1988

Incidence of skin disease in rural Jamaica.

The incidence of skin disease in people seeking health care in rural Jamaica during the period January to December 1985 has been studied. Results indicate that of 14,179 clinic visits reviewed, 6% involved a primary dermatologic diagnosis. Infectious and parasitic diseases predominated, with scabies, impetigo, and tinea being the most common diagnoses. Of these, scabies accounted for nearly one third of all dermatologic visits. Noninfectious skin disease accounted for less than 10% of dermatologic diagnoses, with unclassified eczema making up the majority. Undiagnosed skin conditions contributed one third of dermatologic visits, with an incidence inversely related to the incidence of scabies visits. This relationship suggests that many evaluations of skin conditions were based on the exclusion of scabies with no alternative diagnosis.

Dermatitis↗
PubMed1985

Practical aspects of bacterial skin infections in children.

Bacterial skin infections are a common reason for children to be examined by a pediatrician. Streptococci and staphylococci are responsible for the great majority of the infections. Because of the variety of lesions produced by these bacteria, there is support for dividing impetigo into "traditional" crusted and bullous forms. Two important forms of cellulitis--facial and periorbital--have potential for serious systemic consequences. The bacterial etiology and treatment of cellulitis, animal bites, and puncture wounds of the foot require special attention for successful outcome.

Animals↗
PubMed1995

The frequency of erythromycin-resistant Staphylococcus aureus in impetiginized dermatoses.

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.

Adolescent↗
PubMed1993

Distribution of presumptive pathogenicity factors among beta-hemolytic streptococci isolated from Ethiopia.

Beta-hemolytic streptococci are known to bind several mammalian proteins, which are presumed to be important in pathogenicity. The distribution of such binding structures was examined for mouse albumin, human serum IgA, human IgG, human fibrinogen, and human plasminogen. A total of 218 group A beta-hemolytic streptococci (GAS) were studied: 5 isolates from children with acute rheumatic fever (ARF), 18 from acute post-streptococcal glomerulonephritis (APSGN), 57 from tonsillitis, 52 from skin infections, and 86 from healthy carriers. Sixty-eight Streptococcus equisimilis and 20 group G streptococci were also included. Most of the S. equisimilis (60/68) and group G (14/20) were obtained from apparently healthy carriers. The results were evaluated with respect to T type, serum opacity reaction (SOR), site of isolation, and disease type. No direct correlation was detected between the protein-binding structures studied. There was no apparent correlation between any particular protein-binding structure and specific T type. Albumin-binding and IgA-binding activities were inversely correlated among skin and nephritis GAS isolates. A strong correlation was demonstrated between IgA-binding activity and SOR production, while albumin-binding activity correlated with SOR-negative strains. Albumin-binding levels in isolates from ARF, APSGN and tonsillitis were significantly higher than in isolates from healthy carriers (P < 0.001). A higher albumin-binding capacity was shown in skin isolates from APSGN than in isolates from impetigo (P < 0.001).

Animals↗