Clinico-bacteriological study of pyodermas in children.

Abstract

One hundred cases of pyodermas in children were investigated clinically and bacteriologically. Nasal and throat swabs from all cases were subjected to bacteriological examination. Most of the children (42%) were in the 1-4 year age group. The majority (58%) belonged to lower socio-economic groups with poor standards of hygiene. A history of over-crowding was obtained from 87% of cases, 82% were undernourished. Most of the children (68%) reported during the hot and humid months of June, July, August, and September. Primary pyodermas were observed in 72% of the children, and secondary pyodermas in 28%. Impetigo was the commonest primary pyoderma (48.61%); among secondary pyodermas, infected scabies was noted predominantly (42.86%). The face and legs were more commonly involved. Bacteriological cultures from pyoderma lesions revealed a single microorganism in the majority of the patients (84%). Staphylococcus aureus was isolated in pure culture from 48% and pure beta-hemolytic streptococci from 36%. A combination of both was obtained from 16%. No other organism was isolated from any case. A similar pattern was also observed in cultures from the nose and throat. Only 46 out of the 64 strains (84.3%) of Staphylococcus aureus isolated from pyoderma were typable. The majority (39.1%) showed a mixed pattern of phages; the second commonest was the non-allocated phage type (30.4%). Nasal flora had more of the non-allocated phage type (50%); two out of the three strains (66.6%) isolated from the throat showed a mixed pattern. All the strains of beta hemolytic streptococci, isolated either from lesions of pyoderma, nose, or throat belonged to group A. Staphylococcus aureus and showed a high sensitivity to netilmycin (100%), ofloxacin (98.4%), amoxycillin/clavulanic acid (96.9%), ciprofloxacin (89.1%) and gentamycin (84.4%) but a high resistance to penicillin (85.9%). A greater correlation was noted between nasal flora and organisms causing pyodermas. A change in the pattern of organisms causing pyodermas in children and their antibiotic sensitivities in this part of the globe has been observed in this study. The role of endogenous nasal and throat flora in the causation of pyodermas has also been highlighted.