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Impetigo - Causes, Symptoms and Treatment


A contagious, superficial skin infection, impetigo (also known as impetigo contagiosa) occurs in nonbullous and bullous forms. This vesiculopustular eruptive disorder spreads most easily among infants, young children, and elderly people.

Predisposing factors such as poor hygiene, anemia, malnutrition, and a warm climate favor outbreaks of this infection, most of which occur during the late summer and early fall. Impetigo can complicate chickenpox, eczema, and other skin conditions marked by open lesions.

Causes of Impetigo

Coagulase-positive Staphylococcus aureus and, less commonly, group A beta­hemolytic streptococci usually produce nonbullous impetigo; S. aureus (especially of bacteriophage type 71) generally causes bullous impetigo.

Signs and Symptoms of Impetigo

Common nonbullous impetigo typically begins with a small red macule that turns into a vesicle, becoming pustular with a honey-colored crust within hours. When the vesicle breaks, a thick yellow crust forms from the exudate. Auto inoculation may cause satellite lesions. Other features include pruritus, burning, and regional lymphadenopathy. In bullous impetigo, a thin-walled vesicle opens and a thin, clear crust forms on the subsequent eruption. It commonly appears on exposed areas.

A rare but serious complication of streptococcal impetigo is glomerulonephritis.

Diagnosis for Impetigo

Characteristic lesions suggest impetigo. Microscopic visualization of the causative organism in a Gram stain of vesicle fluid usually confirms S. aureus infection and justifies antibiotic therapy. Culture and sensitivity testing of fluid or denuded skin may indicate the most appropriate antibiotic, but therapy shouldn't be delayed for laboratory results, which can take 3 days.

The differential diagnosis includes herpes simplex, infected eczema, varicella, and herpes zoster.

Treatment for Impetigo

Generally, treatment consists of systemic antibiotics (usually a pencillinase-resistant penicillin, cephalosporin, or erythromycin) for 10 days. A topical antibiotic such as mupirocin ointment may be used for minor infections.

Therapy also includes removal of the exudate by washing the lesions two or three times a day with soap and water or, for stubborn crusts, using warm soaks or compresses of nonnal saline or a diluted soap solution.

Special Considerations and Prevention Tips for Impetigo

  • Teach the patient or family how to care for the lesions. To prevent further spread of this highly contagious infection, encourage frequent bathing using a bactericidal soap.
  • Urge the patient not to scratch because this spreads impetigo. Advise parents to cut the child's fingernails.
  • Give medications as necessary; remember to check for penicillin allergy. Stress the need to continue prescribed medications for 7 10 10 days, even after the lesions have healed.
  • Check family members for impetigo. If this infection is present in a schoolchild, notify the school.
  • Tell the patient not to share towels, washcloths, or bed linens with family members.
  • Emphasize the importance of following proper hand-washing technique.

Mrsa Iinfection



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