Impetigo contagiosa

Last Updated: 2019-08-26

Author(s): -

  • Especially children between 2-5 years are affected.
  • Most common childhood bacterial disease.
  • May cause endemic diseases in schools and kindergartens.
  • Predisposition factors
    • Atopic Eczema
    • scabies
    • chickenpox
    • Warm, humid climate
    • penuriousness
    • Living together with a lot of people
    • Poor hygiene
  • Staphylococci form exfoliative toxins which attack desmoglein 1 as serine proteases. This leads to acantholysis of St. granulosum (also known as localized Staphylococcal Scalded Skin Syndrome or staphylogenic Lyell Syndrome).
  • Classification
    • Non-cop form.
    • Bullous form. 
  • Primary infections: Infestation of healthy skin.
  • Secondary infections (impetigination): Infestation of pre-damaged skin (injuries, atopic eczema, scabies, etc.).
  • Incubation period 
    • 2-10 days.

Etiopathogenesis 

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

Honey yellow encrusted erythematous maculae.

  • Clinic.
  • Bacterial smear.
  • ASL titre, ASO titre.
  • U-status (e.g. glomerulonephritis), follow-up examination recommended after 2-4 weeks.
  • HIV infection should be ruled out in adults [1607190].

Often face.

  • Postinfectious glomerulonephritis 
  • Rheumatic fever 
  • Purulent conjunctivitis 
  • Otitis media

Healing after 1-2 weeks.

Systemic Therapy 

  • Systemic therapy is indicated in case of disseminated infestation or general symptoms (fever, aching limbs, lymphadenopathy).
  • Augmentin p.o. 625 (500/125) mg 3x daily (adults and children > 40 kg)
  • Cefuroxime p.o. 250-500 mg 2x daily (> 12 year), 125 mg 2x daily (5-12 year and ≥ 15 kg); intravenously 750 mg-1.5 g 3-4x daily.
  • Erythromycin p.o. 500 mg 3x daily, maximum dose: 4 g/d (adult), 40-100 mg/kg bw/day (5-12 years).

     

               In case of relapse:

  • Possible chronic carrier of bacteria: bacterial smear (nose, perianal)!

     

               For itching:

  • Sedative antihistamines
  • Clemastine p.o. 1 tablet 1x daily
  • Dimetind p.o. 1 tablet 1x daily 
  • Non-sedative antihistamines:
  • Desloratadine p.o. 1 tablet 1x daily 
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  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.