phenylephrine-hydrochloride and Impetigo

Impetigo is caused by both Streptococcus pyogenes and Staphylococcus aureus; the relative contributions of each have been reported to fluctuate with time and region. While S. aureus is reportedly on the increase in most industrialised settings, S. pyogenes is still thought to drive impetigo in endemic, tropical regions. However, few studies have utilised high quality microbiological culture methods to confirm this assumption. We report the prevalence and antimicrobial resistance of impetigo pathogens recovered in a randomised, controlled trial of impetigo treatment conducted in remote Indigenous communities of northern Australia.. Each child had one or two sores, and the anterior nares, swabbed. All swabs were transported in skim milk tryptone glucose glycogen broth and frozen at -70°C, until plated on horse blood agar. S. aureus and S. pyogenes were confirmed with latex agglutination.. From 508 children, we collected 872 swabs of sores and 504 swabs from the anterior nares prior to commencement of antibiotic therapy. S. pyogenes and S. aureus were identified together in 503/872 (58%) of sores; with an additional 207/872 (24%) sores having S. pyogenes and 81/872 (9%) S. aureus, in isolation. Skin sore swabs taken during episodes with a concurrent diagnosis of scabies were more likely to culture S. pyogenes (OR 2.2, 95% CI 1.1 - 4.4, p = 0.03). Eighteen percent of children had nasal carriage of skin pathogens. There was no association between the presence of S. aureus in the nose and skin. Methicillin-resistance was detected in 15% of children who cultured S. aureus from either a sore or their nose. There was no association found between the severity of impetigo and the detection of a skin pathogen.. S. pyogenes remains the principal pathogen in tropical impetigo; the relatively high contribution of S. aureus as a co-pathogen has also been confirmed. Children with scabies were more likely to have S. pyogenes detected. While clearance of S. pyogenes is the key determinant of treatment efficacy, co-infection with S. aureus warrants consideration of treatment options that are effective against both pathogens where impetigo is severe and prevalent.. This trial is registered; ACTRN12609000858291 .

Topics: Adolescent; Australia; Carrier State; Child; Child, Preschool; Coinfection; Female; Humans; Impetigo; Infant; Male; Methicillin Resistance; Nose; Population Groups; Prevalence; Respiratory Tract Infections; Scabies; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus pyogenes; Treatment Outcome

Nonbullous impetigo is a common skin infection in children and is frequently caused by Staphylococcus aureus. Staphylococcal toxins and especially exfoliative toxin A are known mediators of bullous impetigo in children. It is not known whether this is also true for nonbullous impetigo. We set out to analyze clonality among clinical isolates of S. aureus from children with nonbullous impetigo living in a restricted geographical area in The Netherlands. We investigated whether staphylococcal nasal carriage and the nature of the staphylococcal strains were associated with the severity and course of impetigo. Bacterial isolates were obtained from the noses and wounds of children suffering from impetigo. Strains were genetically characterized by pulsed-field gel electrophoresis-mediated typing and binary typing, which was also used to assess toxin gene content. In addition, a detailed clinical questionnaire was filled in by each of the participating patients. Staphylococcal nasal carriage seems to predispose the patients to the development of impetigo, and 34% of infections diagnosed in the Rotterdam area are caused by one clonal type of S. aureus. The S. aureus strains harbor the exfoliative toxin B (ETB) gene as a specific virulence factor. In particular, the numbers (P = 0.002) and sizes (P < 0.001) of the lesions were increased in patients infected with an ETB-positive strain. Additional predictors of disease severity and development could be identified. The presence of a staphylococcal plasmid encoding multiple antibiotic resistance traits, as detected by binary typing, was associated with a reduction in the cure rate. Our results recognize that a combination of staphylococcal virulence and resistance genes rather than a single gene determines the development and course of nonbullous impetigo. The identification of these microbial genetic markers, which are predictive of the severity and the course of the disease, will facilitate guided individualized antimicrobial therapy in the future.

Topics: Anti-Bacterial Agents; Bacterial Toxins; Child; Child, Preschool; Drug Resistance, Multiple, Bacterial; Exfoliatins; Exotoxins; Fusidic Acid; Genetic Markers; Humans; Impetigo; Leukocidins; Nose; Plasmids; Severity of Illness Index; Staphylococcal Infections; Staphylococcus aureus; Virulence

Topics: Adolescent; Carrier State; Child, Institutionalized; Disease Outbreaks; Drug Resistance, Microbial; Humans; Impetigo; Intellectual Disability; Male; Nose; Staphylococcal Infections; Staphylococcus; Tetracycline; Virulence

Topics: Child; Child, Preschool; Diagnosis, Differential; Exanthema; Female; Humans; Impetigo; Infant; Male; Mouth; Nose; Skin Diseases

Topics: Adult; Cellulitis; Cosmetic Techniques; Ear, External; Female; Granuloma; Humans; Impetigo; Keloid; Male; Nose; Wounds, Penetrating

Contrasting data are reported in the literature on the percent positivity rates (13.5%-100%) of exfoliative toxin (ET) production by S. aureus strains isolated from impetigo patients in Japan and in France. In the present study, by means of a recently available latex-test, toxin-A (ETA) or toxin-B (ETB) production was found in 67.6% of the 34 S. aureus strains isolated from 19 lesional (63.2%) and 15 non-lesional (nose or pharynx, 73.3%) areas of patients with impetigo (with no significant difference between the lesional and non-lesional isolates). ETA + ETB were produced by 44.1% of the strains, while 32.4% were non-producers. In contrast, the percent positivity rate observed in 40 [20 lesional and 20 non-lesional (nose or pharynx)] strains isolated in patients with atopic dermatitis was 15.0% (p < 0.001 both for the lesional and non-lesional strains versus impetigo, with no significant difference between lesional and non lesional strains). Finally, 26 strains from other types of specimens (abscesses, hemocultures, urine, central venous catheters, bronchoalveolar lavages) showed an 11.5% production rate of ETA or ETB (p < 0.001 versus impetigo strains, no significance versus atopic dermatitis). These data point to a significant association between exfoliative toxin production and S. aureus strains isolated in impetigo, both in lesional areas and in nasal/pharyngeal reservoirs. An attempt to correlate SmaI pulsed-field gel electrophoresis (PFGE) restriction patterns and exfoliative toxin production showed no significant association in either group.

Topics: Adolescent; Adult; Aged; Bacterial Typing Techniques; Child; Child, Preschool; Deoxyribonucleases, Type II Site-Specific; Dermatitis, Atopic; Electrophoresis, Gel, Pulsed-Field; Exfoliatins; Female; Humans; Impetigo; Infant; Male; Middle Aged; Nose; Pharynx; Staphylococcal Infections; Staphylococcus aureus

PFGE has been extensively used to obtain a reliable intra-species differentiation, although this technique has not been completely standardized. In this study, PFGE was applied to analyze in detail the patterns of 19 lesional S. aureus strains isolated from patients with impetigo, compared with 15 non-lesional strains isolated from nasal or pharyngeal swabs of the same patients. The strain DNA was extracted and processed as previously reported, using the strictest protocol to limit the variations between different analytical sets. To obtain maximum sensitivity and comparability, the electrophoresis patterns were analyzed by an automated and computerized reader (GelDoc1000). The DNA fragments (range 12-15 bands) obtained for each individual strain were then divided into 39 zones including from 1 to 4 bands for a total of at least 91 possible different gel positions. The positivity for each zone (and/or the positivity for the individual bands contained) was associated with the lesional/non-lesional origin and with the face localization of the strains.

Topics: DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Humans; Impetigo; Nose; Pharynx; Staphylococcal Infections; Staphylococcus aureus

EPIDEMIC: Following the notification of an unusual number of scarlet fever cases within the same primary school, the epidemiological and clinical features of the outbreak were investigated. Questionnaire information about the cases was collected from parents and general practitioners per telephone. Throat specimens were taken, before and after treatment, for culturing and specific typing of streptococci was performed to determine transmission. Within a period of one month, 21 schoolchildren in a class of 29 pupils, with a mean age of 5 years, presented with symptoms caused by streptococcal infection (attack rate: 72%). Eight had scarlet fever, 5 suffered from impetigo and 8 had pharyngitis. A further 6 children, outside of this class, had complaints of scarlet fever, impetigo or pharyngitis. For 90% (26/29) of the schoolchildren a throat culture was established. Twelve positive cultures of the same strain of beta-haemolytic group A streptococcus, T4M4 exotoxin C gene positive, were found. The advice given was to treat all positive children for 3 days with azithromycin to prevent complications and further spreading of the disease. After two weeks only one child, that had not taken the antibiotics, still had a positive throat culture. No further cases or complications were reported.. The pattern of the outbreak was typical of a person-to-person transmission. This was confirmed by typing of the isolates. The results of this study demonstrate the importance of mandatory notification of infectious clusters by institutions, such as schools, as introduced in the new Dutch Infectious Disease Act. On the one hand, the notification gives the municipal health authority the opportunity to analyse source and transmission dynamics and on the other to prevent disease and complications.

Topics: Bacterial Typing Techniques; Carrier State; Child; Child, Preschool; Disease Notification; Disease Outbreaks; Disease Transmission, Infectious; Female; Humans; Impetigo; Incidence; Male; Netherlands; Nose; Pharyngitis; Pharynx; Scarlet Fever; Schools; Streptococcal Infections; Streptococcus pyogenes

Topics: Anti-Bacterial Agents; Drug Resistance, Microbial; Humans; Impetigo; Malaysia; Nose; Staphylococcal Skin Infections; Staphylococcus aureus

Serial observations including cultures of the upper respiratory tract and of infected skin lesions and streptococcal antibody determinations were made over a two-year period in a semi-closed population of children between 10 months and 15 years of age. There was a high prevalence of group A streptococci in nose and throat cultures and of skin lesions containing these organisms. Almost 90% of the study population developed streptococcal impetigo during the study period. A slightly higher proportion of males than females developed skin infection but there was no relationship to age. Impetigo was observed throughout the calendar year, exceeding 12% of child-visits in one winter month, but was generally more common in the summer and fall. Conversely, group A streptococci were more often isolated from nose and throat cultures in the winter months. The increase in recovery of streptococci from nose and throat cultures lagged behind the increase in streptococcal impetigo and continued into the winter months, when the prevalence of impetigo had declined. Calculation of ratios for individual streptococcal serotypes isolated from different body sites revealed a clear cut distinction between "respiratory" and "impetigo" serotypes, with respect to both prevalence and acquisition rates. Respiratory serotypes were more commonly isolated in the winter and impetigo serotypes in the summer and fall. Significant antibody responses to extracellular antigens of the streptococcus were documented for pharyngeal acquisitions of both impetigo and respiratory serotypes and for skin lesions associated with impetigo serotypes. Group A streptococcal serotypes may be divided into three categories on the basis of their human pathogenicity for body sites: some with the potential for respiratory infection, others with the potential for skin infection and a few unusual serotypes with the potential for infecting both sites.

Topics: Age Factors; Antibodies, Bacterial; Child; Child, Preschool; Female; Humans; Impetigo; Indians, North American; Male; Minnesota; Nose; Pharynx; Respiratory Tract Infections; Seasons; Serotyping; Sex Factors; Streptococcal Infections; Streptococcus pyogenes

200 patients with primary impetigo were studied. Staphylococcus aureus was the only organism isolated in 72.5%, beta-hemolytic streptococci, group A, in 10%, and both pathogens in 15%. 17 of the 50 streptococcal isolates were typed serologically; 11 of these belonged to potentially nephritogenic types. A majority of these cases had identical strains in the nose and throat. Hence, the primary source of skin streptococcal in this study may be the nasopharynx. Uncomplicated cases were treated with topical antibiotics, and oral antibiotics were added in 22 cases with extensive lesions, fever or a concurrent throat infection. None of the 200 patients developed acute glomerulonephritis and urinary analyses were normal at follow-up after 3 weeks.

Topics: Adolescent; Adult; Child; Child, Preschool; Female; Humans; Impetigo; Infant; Male; Nose; Pharynx; Staphylococcus; Streptococcus pyogenes; Sweden

Topics: Cross Infection; Disease Outbreaks; Disease Reservoirs; Humans; Impetigo; Indiana; Infant, Newborn; Infant, Newborn, Diseases; Nose; Nurseries, Hospital; Staphylococcus; Umbilicus

The appearance on and spread of Group A streptococci among different body sites in relationship to the development of impetigo were studied prospectively in 31 children in five families. During July and August 1969 intensive clinical, bacteriological, and serological observations were made, including cultures taken at least every other day. In individual children, site sequence of spread of Group A streptococci was from normal skin to lesions and finally to respiratory tract. Streptococci were recovered from normal skin before development of lesions (mean interval of 10 days) in 74% of episodes. Recovery of streptococci from nose and throat followed (by means of 14 and 20 days, respectively) skin acquisition of streptococci (97% of episodes) and lesions (74% of episodes).Distribution of positive normal skin sites among wrist, ankle, and back was similar (28-37%) although 62% of lesions were on the legs. Recovery of a serotype from normal skin was associated with a high risk (76%) of subsequent development of lesions due to that type. New streptococcal serotypes usually entered a family during the peak or decline of a preceding serotoype with a tendency of one to predominate. Among family members the mean interval from index to secondary skin acquisition of streptococci was 4.8 days, but 21 days elapsed from first appearance to last acquisition of skin disease. In the population as a whole, streptococci were recovered in high frequency from normal skin before the increase in prevalence of lesions and also later in the fall when cutaneous infections were absent.

Topics: Adolescent; Antibodies, Bacterial; Child; Child, Preschool; Humans; Impetigo; Infant; Nose; Pharynx; Seasons; Serotyping; Skin; Streptococcus; Time Factors

Topics: Animals; Biology; Cross Infection; Fatty Acids; Humans; Impetigo; Infant, Newborn; Lipase; Mice; Nose; Skin; Staphylococcal Infections; Staphylococcus; Toxins, Biological

Topics: Adolescent; Alabama; Bacteriological Techniques; Black or African American; Child; Child, Preschool; Female; Humans; Impetigo; Infant; Lymph Nodes; Lymphatic Diseases; Male; Nose; Pharyngitis; Pharynx; Prospective Studies; Seasons; Staphylococcus; Streptococcus; White People