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At least 109 records · Page 6Linked to original sources
PubMed2003

Impetigo herpetiformis unresponsive to therapy in a pregnant adolescent.

Impetigo herpetiformis is a rare pustular disorder affecting mainly pregnant women. We report a 16-yr-old adolescent primigravida, who presented with impetigo herpetiformis at 27 weeks gestation. She had a pustular erythroderma covering her entire body, except face, scalp, and palmoplantar regions, with severe pruritus and pain. After unsuccessful attempts of treatment with systemic corticosteroids, intravenous fluids, and antibiotics, treatment was switched to cyclosporine, but no therapeutic effect could be achieved. Because of the deteriorating condition of the patient, an early delivery decision was made. Her symptoms resolved after delivery, and at day 20 postpartum her skin lesions were completely resolved.

Adolescent↗
PubMed1989

Two sisters with impetigo herpetiformis.

Two sisters (non-twins) had impetigo herpetiformis triggered by their first pregnancy. One sister treated with etretinate had good resolution of skin disease. Impetigo herpetiformis is probably a variant of pustular psoriasis and may be provoked or precipitated by factors, such as pregnancy. Both patients shared common HLA antigens (All, AW24, BW44, BW54 and DR6Y).

Adult↗
PubMedDate not supplied

Impetigo herpetiformis in a primigravida: successful treatment with etretinate.

Impetigo herpetiformis (IH) is a rare dermatosis which usually occurs during the third trimester of pregnancy. It is characterized by acute erythematosquamous plaques covered with tiny superficial pustules in a herpetiform distribution with less likely mucus membranes involvement. It can be associated with constitutional symptom s such as fever, chills, nausea, vomiting and diarrhea. Impetigo herpetiformis can cause serious complications to the mother and fetus which include: maternal hypocalcemia leading to delirium, convulsions, and tetany in the mother, and placental insufficiency leading to still birth, neonatal death or fetal abnormalities. Lesions are expected to disappear after birth but may recur during subsequent pregnancies at an earlier gestational age. Presented here is a case of IH occurring during the 37th week of gestation in a primigravida who failed to respond to oral steroid but successfully cleared with oral etretinate.

Dermatitis Herpetiformis↗
PubMed2005

Impetigo herpetiformis--a rare dermatosis of pregnancy associated with prenatal complications.

INTRODUCTION: We describe a patient who developed an acute generalised pustular eruption associated with pyrexia at 33 weeks of gestation. CLINICAL PICTURE: Her condition was complicated by preterm labour, requiring an emergency caesarean section delivery. A diagnosis of impetigo herpetiformis was made on clinicopathological grounds. TREATMENT: Initial treatment with topical and systemic corticosteroids failed and oral methotrexate was added. OUTCOME: She responded well to this therapy and required only 2 doses of weekly methotrexate. CONCLUSION: Impetigo herpetiformis is a rare dermatosis of pregnancy that requires early recognition and treatment to prevent maternal and fetal morbidity. Combination therapy using oral corticosteroids and short-term methotrexate is effective.

Adult↗
PubMed1991

Impetigo herpetiformis associated with hypocalcemia of congenital rickets.

A 30-year-old woman with congenital rickets and autosomal recessive ichthyosis developed impetigo herpetiformis in the second trimester of her first pregnancy. This condition was temporally related to her discontinuation of vitamin D supplements and subsequent hypocalcemia. No associated systemic symptoms were observed, and a healthy baby was delivered prematurely at 34 weeks' gestation. This report supports the association between hypocalcemia and impetigo herpetiformis and raises theoretical questions regarding a relationship between vitamin D metabolism and various epidermal hyperproliferative states.

Adult↗
PubMed1996

Impetigo herpetiformis and RhE isoimmunization: a case report.

Impetigo herpetiformis is a rare acute eruption associated with severe systemic disturbances, typically occurring in pregnant women. We describe the case of a 33-year-old woman who presented with impetigo herpetiformis during her third pregnancy, the appearance of which coincided with an increase in the titer of E antigen antibodies.

Adult↗
PubMedDate not supplied

Mupirocin: a new topical therapy for impetigo.

Mupirocin is a new, topical antibiotic effective for the treatment of impetigo. It has a unique structure, mechanism of action, and water-miscible formulation. When it is applied to an infected area three times daily, clinical improvement should be seen in 85% to 100% of patients within 3 to 5 days. It is associated with a low incidence of adverse effects and cross-resistance. Further studies are necessary to define the exact role of mupirocin in treating other primary and secondary cutaneous infections.

Administration, Topical↗
PubMed2004

Desmosomes and disease: pemphigus and bullous impetigo.

Desmosomal cadherins are the pathophysiologic targets of autoimmune or toxin-mediated disruption in the human diseases pemphigus and bullous impetigo (including its generalized form, called staphylococcal scalded skin syndrome). Experiments exploiting the production of both pathogenic and nonpathogenic antidesmoglein antibodies in pemphigus patients' sera have afforded data that make an invaluable contribution towards identifying the functional domains of the desmogleins involved in intercellular adhesion. Conformational epitopes of antidesmoglein autoantibodies in pemphigus patients' sera and the specific cleavage site of desmoglein 1 by exfoliative toxin have been identified, implicating the N-terminal extracellular domains of the desmogleins as critical regions for controlling intercellular adhesion. Furthermore, the development of active autoimmune mouse models for pemphigus allows in vivo characterization of the disease and its pathogenesis. These studies offer new insight into the potential mechanisms of acantholysis in pemphigus and staphylococcal-associated blistering disease, with implications for the role of desmogleins in desmosomal structure and function.

Acantholysis↗
PubMed1987

Diagnosis and treatment of impetigo.

Sixty patients with impetigo were seen in a private practice. Cultures of specimens from all but one patient grew coagulase-positive Staphylococcus aureus. The culture of one patient grew pure group A beta-hemolytic streptococcus. The cultures of six patients were mixed, having streptococci and S. aureus. In all but one instance the staphylococci were resistant to penicillin and ampicillin. We recommend that all centers treating patients with superficial skin infections have a method of screening or spot checking their patient population to determine antibiotic sensitivities and the frequency and distribution of these infections. Then, if bacteriologic and antibiotic sensitivity studies mandate, a switch in antibiotics should be contemplated.

Administration, Oral↗
PubMed1997

Biofilm formation of Staphylococcus aureus strains isolated from impetigo and furuncle: role of fibrinogen and fibrin.

The formation of membranous structure (thickness from the plastic tissue-culture coverslip (hematoxylin-eosin) > 1 mm; periodic acid-Schiff-positive) was more prominent with Staphylococcus aureus (S. aureus) strains isolated from impetigo (coagulase types I.V origin) than with S. aureus strains isolated from furuncle (coagulase type IV origin) (P < 0.05) in the plastic tissue-culture coverslip in human plasma after 72 h. Attachment of S. aureus cells to a plastic tissue-culture coverslip was more marked in 0-3% fibrinogen/tryptic soy broth (TSB) than in plasma (P < 0.05). The formation of the membranous structure was observed on the plastic tissue-culture coverslip with 0.3% fibrinogen/human serum but not with 0.3% fibrinogen + 5% glucose/TSB. Electron microscopy revealed abundant fibrin around S. aureus cells at 4 h and Ruthenium red-positive materials increased at 24 and 72 h in plasma. Staphylococcus aureus cell attachment to the plastic tissue-culture coverslip in plasma decreased by addition of levofloxacin (LVFX) at 1/2 minimum inhibitory concentration (MIC) and clarithromycin (CAM) at 1/4 MIC. Polysaccharide production of S. aureus cells on the plastic tissue-culture coverslip in plasma decreased with the addition of CAM at 1/4 MIC. Fibrinogen is closely related to initiation of infection but biofilm formation requires the conversion of fibrinogen to fibrin. Thus, attachment of S. aureus cells to the plastic tissue-culture coverslip, conversion of fibrinogen to fibrin by coagulase-prothrombin complex, and production of abundant glycocalyx by S. aureus cells are at least required for the production of biofilm in staphylococcal skin infection.

Anti-Bacterial Agents↗
PubMed2000

[Contagious impetigo--pathogen spectrum and therapeutic consequences].

OBJECTIVE: The aim of this prospective study was to compare the clinical picture of contagious impetigo (C.I.) with the causative organism and to generate data of the susceptibility of bacteria as the basis for adequate therapy. PATIENTS AND METHODS: In 126 patients with C.I. (86 children, 66 of them younger than 10 years) bacterial swabs were taken and antibiotic sensitivity testing for isolated organisms was tested. RESULTS: In all cases in which contents of vesicles or pustules were analysed, Staphylococcus aureus was the only pathogen isolated. In non-bullous variants of C.I. Staphylococcus aureus was the most often isolated organism as well. Both staphylococci and streptococci were isolated in 12 cases, whereas in just 9 cases streptococci were the only pathogen detected. All Staphylococcus aureus isolates were sensitive to flucloxacillin and cefotaxime. Erythromycin-resistance amounted to more than 20 percent. The percentage of resistant staphylococci against the predominantly topically applied antibiotics fusidinic acid and mupirocin was 2 and 0 per cent, respectively. CONCLUSION: For all manifestations of C.I. Staphylococcus aureus is at present the leading organism which has to be taken into consideration for treatment. If oral antibiotic therapy is indicated, penicillinase-stable penicillins or cephalosporins, preferably of the cefalexin-type, are the drugs of choice. Macrolides are no longer recommended for initiating of C.I. treatment.

Adult↗
PubMed1971

Experimental infection of the skin in the hamster simulating human impetigo. III. Interaction between staphylococci and group A streptococci.

The interaction between staphylococci and Group A beta hemolytic streptococci in mixed lesions was investigated in an experimental impetigo model. A strain of staphylococcus of phage Type 71, which has been shown in vitro to produce a bacteriocin for streptococci and other Gram-positive organisms, eliminates or reduces Group A streptococci in mixed lesions. In contrast, staphylococcal strains of phage Types 75 and 81, which do not produce a demonstrable bacteriocin in vitro, exhibit no such effect. Some variation was noted in the in vivo response of two different streptococcal M Types to the bactericidal effect of phage Type 71 staphylococci. Bacterial antagonism is more pronounced when staphylococci and streptococci are injected simultaneously into animals than when staphylococci are superimposed on preexisting streptococcal lesions. Marked variations were found in the numbers of viable streptococci (colony-forming units) recovered from individual lesions containing identical mixtures of streptococci and phage Type 71 staphylococci. The frequency of a demonstrable bactericidal effect was related to the number of streptococci injected. With small inocula of streptococci, the tendency towards an all-or-none effect was particularly striking. No evidence of selection of streptococcal or staphylococcal mutants which might explain this phenomenon was obtained. These observations suggest that the bactericidal effect of phage Type 71 staphylococci on other Gram-positive organisms, previously demonstrated in vitro, appears to operate also in vivo.

Animals↗
PubMed2002

A fusidic acid-resistant clone of Staphylococcus aureus associated with impetigo bullosa is spreading in Norway.

OBJECTIVE: To investigate the possibility that the increased prevalence of fusidic acid-resistant Staphylococcus aureus in Norway is caused by clonal spread. METHODS: Fusidic acid-resistant and -susceptible clinical isolates of S. aureus from patients with skin infections in the Norwegian county of Telemark and fusidic acid-resistant isolates from other parts of Scandinavia were compared. MICs of fusidic acid for bacterial isolates and pulsed-field gel electrophoresis (PFGE) patterns were investigated. Prevalence data for fusidic acid-resistant S. aureus for the period 1992-2001 were obtained. RESULTS: The prevalence of fusidic acid resistance in S. aureus increased from 1992 to 2001. Eighty per cent of the resistant isolates investigated shared an identical PFGE pattern. The same pattern was found in fusidic acid-resistant isolates from other parts of Scandinavia. Fusidic acid-resistant S. aureus was typically found in impetigo bullosa-like skin disease in children mostly in the summer months. CONCLUSIONS: Fusidic acid resistance among S. aureus is increasing in Norway and is predominantly caused by one clone of S. aureus. The clone may spread further to other countries, and dissemination may be facilitated by extensive use of topical fusidic acid.

Clone Cells↗
PubMed1976

Orthotic collar in the treatment of intertriginous impetigo.

This article illustrates a manner in which physical therapy can provide adjunctive treatment management of an infant with intertriginous impetigo. This treatment program was an interdisciplinary approach to a difficult clinical problem. The medical staff concluded that implementation of the cervical orthosis expedited the patient's recovery and reduced the potential complications of the disease process.

Humans↗
PubMed1978

The epidermolytic toxin of Staphylococcus aureus: its failure to bind to cells and its detection in blister fluids of patients with bullous impetigo.

Radioiodinated staphylococcal epidermolytic toxin was found not to bind to erythrocytes, blood leukocytes, trypsin-dispersed keratinocytes, epidermis or whole skin. Moreover the toxin could not be found to bind to murine epithelia by indirect immunofluorescence methods. However, the toxin, measured by radioimmunoassay, could be eluted from the skin of mice undergoing epidermolysis following intraperitoneal injection of toxinogenic Staphylococcus aureus. Furthermore, epidemolysin was measured in the blister fluid of 3 of 5 children with bullous impetigo but not in blister fluid from control patients with other blistering eruptions. Thus epidermolysin has been demonstrated to be present in lesions of the staphylococcal epidermolytic toxin syndrome but its mechanism of action does not involve binding to cells.

Animals↗
PubMedDate not supplied

Microbiology of nonbullous impetigo.

Our objective was to establish the aerobic and anaerobic microbiology of nonbullous impetigo (NI) in children. We used a retrospective review of clinical microbiology laboratory and patients' records. Specimens were obtained from 40 patients with NI lesions and showed bacterial growth. Aerobic or facultative anaerobic bacteria only were present in 24 patients (60%), strict anaerobic bacteria only in 5 patients (12.5%), and mixed anaerobic-aerobic flora was present in 11 patients (27.5%). Sixty-four isolates were recovered (1.6 per specimen): 43 aerobic or facultative, and 21 anaerobic. The predominant aerobic and facultative bacteria were Staphylococcus aureus (29 isolates), Group A beta hemolytic streptococcus (GABHS) (13 isolates), and Escherichia coli (1 isolate). The predominant anaerobes were Peptostreptococcus spp. (12), pigmented Prevotella spp. (5), Fusobacterium spp. (2), and Bacteroides fragilis (1). Single bacterial isolates were recovered in 17 patients (42.5%), 13 of which were S. aureus. S. aureus alone or mixed with GABHS or Peptostreptococcus spp. were isolated from all body sites. Mixed flora of Peptostreptococcus spp. with Prevotella spp. or Fusobacterium spp. was mostly found in infections of the head and neck, while E. coli mixed with B. fragilis and Peptostreptococcus spp. were isolated from one infection of the buttocks area. Thirty-three organisms isolated from 32 patients (80%) produced the enzyme beta-lactamase. This study demonstrates the polymicrobial aerobic-anaerobic microbiology of NI lesions.

Adolescent↗
PubMedDate not supplied

Impetigo herpetiformis and Staphylococcus aureus lymphadenitis in a pregnant adolescent.

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.

Adolescent↗