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Impetigo

Impetigo is a common, contagious childhood bacterial skin infection commonly caused by Staphylococcus aureus (S.aureus) and sometimes concomitant with group A Streptococcus pyogenes (S.pyogenes). Response to Student Post

Transmission can be by direct and indirect contact through minor breaks in the skin’s surface or secondary infection of a preexisting disease, infection, or infestation (McCance & Huether, 2019). Impetigo is particularly in the setting with poor sanitary, crowded conditions such as daycare facilities (McCance & Huether, 2019). Response to Student Post

Clinical Characteristics

There are two types of impetigo infections vesicular and bullous. Vesicular impetigo, caused by both bacterias S.aureus and S.pyogenes, presents with small vesicles with a honey-colored serum with yellow to white-brown crusts (hallmark sign) formed over the vesicles that have ruptured that extend radially around the nose and mouth; but can be on hands and other exposed skin surfaces on the body (McCance & Huether, 2019).

Bullous impetigo is caused by S.aureus alone that causes a bacterial toxin to be produced causing blistering vesicles and/or lesions that enlarge to form superficial bullae; and as bullae rupture, a thin, flat, honey-colored crust appears that too, like vesicular impetigo, can be seen around the nose, mouth, hands, and other bodily surfaces (McCance & Huether, 2019).

Diagnostics

Diagnosis of impetigo is usually based on the patient’s medical history, social history, and physical exam if it is localized to one area (uncomplicated). However, if complicated or for recurrent infections, bacterial cultures are the diagnostics of choice, especially if MRSA is suspected. A gram stain would show gram-positive cocci. A bacterial culture would reveal Group A strep. Response to Student Post

Recommended Plan

If the impetigo is non-complicated, meaning localized to one area, then topical antibiotics such as mupirocin can be used for both isolates of S.aureus and S.pyogenes. For complicated impetigo that extends largely to other surfaces of the skin, systemic antibiotics such as first-generation cephalosporins like Cephalexin is used.

If MRSA is suspected, beta-lactam antibiotics (ex. penicillins/cephalosporins) should be avoided, the use of macrolides (the “mycins”) should be considered; and chlorhexidine 2% washes and mupirocin topical ointment should be used in the multicombination treatment (Hollier, 2021).

References

Hollier, A. (2021). Clinical guidelines in primary care. Fourth edition ISBN 978-892418-27-2

McCance, K.L., & Huether, S.E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier.

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