Impetigo
Impetigo: Excerpt from Handbook of Diseases
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 the elderly.
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
Coagulase-positive Staphylococcus aureus and group A beta-hemolytic streptococci (or a combination of both) produce epidermal infections.
Signs and symptoms
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. Autoinoculation may cause satellite lesions. Other features include pruritus, burning, and regional lymphadenopathy.
A rare but serious complication of streptococcal impetigo is glomerulonephritis.
With bullous impetigo, a thin-walled vesicle opens and a thin, clear crust forms on the subsequent eruption. It commonly appears on exposed areas.
Diagnosis
Characteristic lesions suggest impetigo. (See Recognizing impetiginous vesicles, page 442.) 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.
Treatment
Treatment generally consists of a systemic antibiotic (usually a penicillinase-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 normal saline or a diluted soap solution.
Special considerations
❑ Urge the patient not to scratch because this spreads impetigo. Advise the parents to cut the child’s fingernails.
❑ Give medications as necessary; remember to check for penicillin allergy. Stress the need to continue prescribed medications as ordered, even after the lesions have healed.
❑ Teach the patient or his family how to care for impetiginous lesions. To prevent further spread of this highly contagious infection, encourage frequent bathing using an antibacterial soap.
❑ Tell the patient not to share towels, washcloths, or bed linens with family members. Emphasize the importance of following proper hand-washing technique.
Clinical tip Assess family members for impetigo. If the patient is school age, notify the school.
Pictures
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
More About Impetigo
More Medical Textbooks Online about Impetigo
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Medical Books Excerpts
- Impetigo
- "Professional Guide to Diseases (Eighth Edition)" (2005)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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