Impetigo contagiosa

• Children between 2-5 years of age are particularly affected
• Most common bacterial disease in children
• Can cause endemics in schools and kindergartens
• Predisposing factors:
  • Atopic eczema
  • Scabies
  • Wind pox
  • Warm, humid climate
  • Poverty
  • Living with many people
  • Poor hygiene

• Staphylococci produce exfoliative toxins which act as serine proteases attacking desmoglein 1. This causes acantholysis of the str. granulosum (also called localised staphylococcal scalded skin syndrome or staphylogenic Lyell syndrome)

• Division
  • Non-bullous form
  • Bullous form

• Primary infections: Infestation of healthy skin
• Secondary infections (impetiginisation): infestation of previously damaged skin (injuries, atopic eczema, scabies etc.)

• Incubation period: 2-10 days

Aetiopathogenesis

• Transmission occurs through smear infection or direct body contact. In rare cases, objects may also serve as a source of infection. Continuous sniffing can damage the skin and facilitate infection

• Clinic
• Bact. smear
• ASL titer, ASO titer
• U status (e.g. of glomerulonephritis), follow-up after 2-4 weeks recommended
• In adults, HIV infection should be excluded

• Post-infectious glomerulonephritis
• Rheumatic fever
• Purulent conjunctivitis
• Otitis media

Remediate nasal vestibule, strengthen personal hygiene

Healing after 1-2 weeks.

1. Bukowski M, Wladyka B, Dubin G. Exfoliative toxins of Staphylococcus aureus. Toxins (Basel) 2010;2:1148-65.
2. Hartman-Adams H, Banvard C, Juckett G. Impetigo: diagnosis and treatment. Am Fam Physician 2014;90:229-35.
3. Romani L, Steer AC, Whitfeld MJ, Kaldor JM. Prevalence of scabies and impetigo worldwide: a systematic review. Lancet Infect Dis 2015;15:960-7. 
4. Pereira LB. Impetigo - review. An Bras Dermatol 2014;89:293-9. 
5. Koning S, van der Sande R, Verhagen AP, et al. Interventions for impetigo. Cochrane Database Syst Rev 2012;1:CD003261. 
6. George A, Rubin G. A systematic review and meta-analysis of treatments for impetigo. Br J Gen Pract 2003;53:480 
7. Liu Y, Kong F, Zhang X, Brown M, Ma L , Yang Y. Antimicrobial susceptibility of Staphylococcus aureus isolated from children with impetigo in China from 2003 to 2007 shows community-associated methicillin-resistant Staphylococcus aureus to be uncommon and heterogeneous. Br J Dermatol 2009;161:1347-50.
8. Kikuta H, Shibata M, Nakata S, Yamanaka T, Sakata H, Akizawa K et al. Predominant Dissemination of PVL-Negative CC89 MRSA with SCCmec Type II in Children with Impetigo in Japan. Int J Pediatr 2011;2011:143872. 
9. Amagai M, Matsuyoshi N, Wang ZH, Andl C , Stanley JR. Toxin in bullous impetigo and staphylococcal scalded-skin syndrome targets desmoglein 1. Nat Med 2000;6:1275-7.