Overview:

Etology
Pathogenesis
Diagnosis
Transmission
Treatment
Complications
Preventions

Roll No: 28

Etology

Skin disease, contagious

Causing agent: Staphylococcus aureus or
Streptococcus pyogenes
Incubation period: 1-3 days
Ways of infection:
Primary: bacteria invade the skin through a cut,

insect bite, or other lesion

Secondary: bacteria invade the skin through
lesions because another skin infection has
disrupted the skin barrier, such as eczema,
scabies or acne

Pathogenesis

Colonization of host tissues: surface proteins

Invasions (leukocidin, kinases, hyaluronidase)
Surface factors that inhibit phagocytic engulfment
(capsule, Protein A)
Biochemical properties that enhance their survival in
phagocytes (carotenoids, catalase production)
Membrane-damaging toxins that lyse eucaryotic cell
membranes (hemolysins, leukotoxin, leukocidin)
Exotoxins that damage host tissues or otherwise
provoke symptoms of disease (SEA-G, TSST, ET)
Inherent and acquired resistance to antimicrobial
agents

Symptoms
Bullous impetigo
Caused by Staphylococcus aereus
Mainly seen in children younger than 2 years and in

summer
Painless fluid filled blisters mostly on face, arms,
legs and trunk
Surrounded by red and itchy skin
Blisters break and form yellow scabs

Source: https://skitch-img.s3.amazonaws.com/20080204-k8miney8a2u3q8mat7dcg6fwxu.jpg

Diagnosis

Appearance of the skin lesion.

Appears as honey-colored scabs formed from dried serum
Often found on the arms, legs, or face

A culture of the skin or lesion

Gram stain method should give positive test
The isolate is cultured on mannitol salt agar, which is a selective

medium produces yellow-colored colonies as a result of mannitol

fermentation and subsequent drop in the medium's pH
For differentiation on the species level, following tests are done:

catalase (positive for Staphylococcus species)

coagulase(fibrin clot formation, positive for S. aureus)
DNAse (zone of clearance on DNase agar)
Lipase (a yellow color and rancid odor smell)
Phosphatase (a pink color) tests are done

Transmission
Incubation period: 110 days.
Dried staphylococci - not infectious to intact
skin
Could be transmitted in following ways:

Direct contact:
direct contact with fluid from the blisters, lesions or
nasal carriers
Indirect contact: by touching articles that are freshly

soiled with blister fluid e.g. face cloths, towels,

sharing toiletry items
auto re-infection, by touching own skin with hands
contaminated with fluid from the blisters
Scratching may spread the lesions

Treatment

Depending upon the infection level, treatment is done in three levels:

Mild infection:
Hygienic measures

Topical antibodies:
bactericidal ointment like mupirocin 3 4 times a day for one week
Remove scabs before ointment so that the antibiotic can get deeper
Wash affected areas of skin with warm, soapy water before applying the

topical antibiotic
If possible, use latex gloves when applying the cream. Afterwards wash
your hands thoroughly

The patient should respond to treatment within seven days .

More severe cases:
Oral antibiotics for 4 5 days
example: dicloxacillin, flucloxacillin, erythromycin
could also be amoxicillin combined with clavulanate potassium,
cephalosporin

Period of infectivity lasts few days after treatment

Complications

Many patches of impetigo (in children)

Permanent skin damage and scarring (very rare)
Spread of the infection to other parts of the body (common)
May develop different diseases like:
Cellulitis: similar to impetigo
Guttate psoriasis: a kind of skin infection
Scarlet fever/scarlatina bacterial skin infection along with

nausea, vomiting. Treatment includes antibiotic

Septicemia - bacterial infection of the blood. Fever, vomiting,
dizziness. Life threatening and requires immediate hospitalization
Post-streptococcal glomerulonephritis - rare fatal infection of the
small blood vessels in the kidneys. Dark colored urine
and hypertension
Scalded skin syndrome poisons produced by some MRSA
strains of impetigo

Prevention

Personalize your personal care products.

Immediately clean minor cuts and scrapes with soap
and clean water. Mild antibacterial soap can be
used. Cover the area with light gauze
Avoid touching the oozing lesions. Wash your hands
thoroughly after touching the skin lesions.
Keep the nails short to reduce scratching
Wear gloves while applying antibiotic ointment, and
wash hands thoroughly afterwards
Isolate the patient until you are sure he/she is not
contagious
To prevent recurrence, promptly treat any skin
conditions such as eczema

References

http://www.ncbi.nlm.nih.gov/pubmedheal
th/PMH0001863/
http://ww3.wandsworth.gov.uk/education
/infoforschools/NIC/adminhs/infectiousdi
sea_/impetigo/Impetigo.pdf
http://www.medicalnewstoday.com/articl
es/162945.php