Impetigo Research Articles

Modern approaches to treatment of superficial pyoderma

Impetigo is the most common bacterial skin infection in children. The disease has two forms: nonbullous and bullous, of which nonbullous is the most common (70 %). Impetigo is caused by Staphylococcus aureus, Streptococcus pyogenes, or their combinations. In nonbullous impetigo, methicillin­resistant strains (MRSA) of S. aureus are most often detected. For the colonization of staphylococcus and streptococcus, the necessary conditions are damage to the integrity of the skin and violation of the composition of the usual microflora of the skin. Patients with inflammatory skin diseases are most often colonized by S. aureus and are at high risk for developing MRSA infections. In bullous impetigo, the rash elements are represented by bullae which quickly burst with the formation of surface erosion and a yellow crust. Nonbullous impetigo is manifested by vesicles, pustules, crusts. Typically, impetigo is clinically diagnosed. Suspicion of MRSA occurs in cases of spontaneous abscess or cellulitis, or if lesions are not eliminated by the recommended initial treatment with antibiotics. Topical therapy is the first line of treatment for uncomplicated nonbullous and bullous impetigo. If the lesion is limited to a small area (up to 6 cm2), the treatment involves soaking the crusts, exfoliating them and applying antimicrobial ointments (fusidic acid or a combination of neomycin and bacitracin) (EBM Guidelines, 2018). With more diffuse lesions, systemic antibiotic therapy is prescribed. In treatment of patients with eczema, topical and systemic antimicrobials with topical steroids are used. The combination of the aminoglycoside antibiotic neomycin and the polypeptide antibiotic bacitracin is presented at the Ukrainian pharmaceutical market as Baneocin drug. This combination has a pronounced synergistic effect on S. aureus, S. pyogenes and P. aeryginosa. An important advantage of Baneocin is its availability in two forms (powder and ointment), which allows the use of this drug at different stages of the infection process.

A nursing consultation for children with impetigo

A nursing consultation for children with impetigo

Impetigo/Staphylococcal Scalded Skin Disease.

1. Lorena C. Dollani, MD*,†,‡ 2. Kalyani S. Marathe, MD* 1. *Children’s National Medical Center, Washington, DC 2. †Washington Hospital Center, Washington, DC 3. ‡Georgetown University Hospital, Washington, DC Bacterial skin infections are among the most common skin diseases in children. These encompass a range of cutaneous manifestations from localized (bullous impetigo) to systemic (staphylococcal scalded skin disease [SSSS]). The most common pathogen in both nonbullous and bullous impetigo is Staphylococcus aureus . Another important pathogen causing nonbullous impetigo is group A β-hemolytic Streptococcus. SSSS specifically refers to a spectrum of skin diseases induced by the exfoliative toxins of S aureus. The most common pathogen implicated in their pathophysiology is S aureus, which is a gram-positive coccus and can commonly colonize the nose, perineum, eyes, axillae, umbilicus, and wound sites. Impetigo frequently involves children younger than 6 years, accounting for approximately 10% of skin problems observed in pediatric clinics. SSSS is a rare blistering manifestation affecting mainly neonates and young children. Impetigo is an extremely contagious infection that can spread quickly via direct person-to-person contact or through fomites, and its peak incidence is in the summer months. Primary impetigo can result from direct bacterial involvement of the previously normal skin, whereas secondary impetigo is caused by a disruption in the skin barrier that allows the bacteria to adhere, invade, and establish an infection. Causes of secondary impetigo include minor skin trauma secondary to abrasions, cuts, or insect bites or skin infections due to herpes simplex virus or varicella zoster virus. Colonization of the nasopharynx, axillae, and perineal skin with S aureus increases the risk of developing staphylococcal infections. Impetigo is classified as nonbullous or bullous. Whereas nonbullous impetigo …

Where in the World Did You Get That Rash?

1. Panteha Eshtiaghi, HBSc* 2. Miriam Weinstein, MD, FRCPC† 1. *Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada 2. †Hospital for Sick Children, Toronto, Ontario, Canada * Abbreviations: ACD: : allergic contact dermatitis CD: : cercarial dermatitis CL: : cutaneous leishmaniasis CLM: : cutaneous larva migrans DF: : dengue fever HFMD: : hand, foot, and mouth disease HSV: : herpes simplex virus KD: : Kawasaki disease PCR: : polymerase chain reaction PR: : pityriasis rosea RT-PCR: : reverse transcriptase polymerase chain reaction The challenge to diagnose cutaneous eruptions and lesions in patients who have spent time in foreign countries is increasingly common. With the advent of increased global travel, foreign adoptions, immigration, and refugee seekers, rashes that were once relegated to the realm of the exotic and likely to show up in a tropical diseases clinic may now present to a general pediatrician. Furthermore, the pediatric traveler is at increased risk for dermatoses. (1) It behooves the practitioner to be aware of these skin findings, to be able to recognize them and distinguish them from other skin conditions. After completing this article, readers should be able to: 1. Identify and classify rashes by main morphologic patterns. 2. Develop a broad differential diagnosis and diagnostic approach for a rash in a returned pediatric traveler based on initial morphology, history, epidemiology, and other clinical features. 3. Consider both infectious and noninfectious causes of skin disorders presenting in a patient with a travel history. 4. Outline the basic investigations and principles of management for travel-acquired and non–travel-acquired dermatologic illnesses. 5. Discuss …

Safety and Efficacy of Mupirocin Gel in Children With Impetigo

Safety and Efficacy of Mupirocin Gel in Children With Impetigo

Clinical study of curative effect of compound Qinjiao Pill on palmoplantar pustulosis and its effect on neutrophil/lymphocyte ratio (NLR)

Objective To evaluate the efficacy of compound Qinjiao Pill in the treatment of pustulosis palmaris and plantaris and the effect on the neutrophil-to-lymphocyte ratio (NLR). Methods A total of 100 patients with palmoplantar pustulosis who met the inclusion criteria from June 2017 to June 2018 were randomly divided into two groups, 50 in each group. The control group was treated with 308 nm excimer laser twice a week, and the treatment group was treated with one compound Qinjiao Pill once and twice a day. Both groups were treated for 8 weeks and followed up for 3 months. The disease severity was evaluated by the Palmoplantar pustulosis area and severity index (PPPASI), the quality of life was evaluated by the dermatology life quality index (DLQI), the changes of serum NLR were observed, and the clinical efficacy was evaluated. Results The total effective rate was 88.0% (44/50) in the treatment group and 70.0% (35/50) in the control group. The PPPASI scores (t=6.813, 3.091, 3.582, 5.622) and DLQI scores (t=5.713, 4.616, 6.262, 1.824) in the treatment group were significantly lower than those in the control group (P<0.01). After treatment, NEU (4.13 ± 1.42 ×109/L vs. 6.56 ± 1.65 ×109/L, t=7.893), NLR (1.75 ± 0.98 vs. 2.60 ± 0.87, t=4.592). During the treatment, the incidence of adverse reactions was 20.0% (10/50) in the treatment group and 18.0% (9/50) in the control group (χ2=1.680, P=0.089). The recurrence rate of the treatment group was 9.1% (4/44) and that of the control group was 20.0% (7/35). The difference between the two groups was statistically significant (χ2=2.893, P=0.003). Conclusions Compound Qinjiao Pill combined with 308 nm excimer laser can reduce the NLR in peripheral blood, improve the clinical efficacy and reduce the risk of recurrence. Key words: Impetigo; Qinjiao Pill; Lasers, excimer; Neutrophil-to-lymphocyte ratio

Ozenoxacin, a New Effective and Safe Topical Treatment for Impetigo in Children and Adolescents

Background: Ozenoxacin is a topical antibiotic approved in Europe to treat non-bullous impetigo in adults and children aged ≥6 months. This analysis evaluated the efficacy and safety of ozenoxacin in paediatric patients by age group. Methods: Pooled data for patients aged 6 months to <18 years who had participated in a phase I or in two phase III clinical trials of ozenoxacin 1% cream were analysed by age group: 0.5–<2, 2–<6, 6–<12, and 12–<18 years. Results: The combined population comprised 529 patients with non-bullous impetigo treated with ozenoxacin (n = 239), vehicle (n = 201), or retapamulin as internal validation control (n = 89). Studies were well matched for extent and severity of impetigo and therapeutic schedule (twice daily application for 5 days). The clinical success rate after 5 days’ treatment (day 6–7, end of therapy), and microbiological success rates after 3–4 days’ treatment and at the end of therapy, were significantly higher with ozenoxacin than vehicle (p < 0.0001 for all comparisons). Clinical and bacterial eradication rates were higher with ozenoxacin than vehicle in each age group. No safety concerns were identified with ozenoxacin. One (0.3%) of 327 plasma samples exceeded the lower limit of quantification for ozenoxacin, but the low concentration indicated negligible systemic absorption. Conclusion: This combined analysis supports the efficacy and safety of ozenoxacin administered twice daily for 5 days. Ozenoxacin 1% cream is a new option to consider for treatment of non-bullous impetigo in children aged 6 months to <18 years.

Role and place of macrolides in complex therapy of patients with suppurative lesions of skin and its appendages

Objective — to improvе the effectiveness of therapy of patients with suppurative lesions of the skin and its appendages by including the antibacterial drug Doramycin (spiramycin) in the complex treatment of pyoderma.Materials and methods. 24 patients with pyoderma aged from 24 to 61 years were under observation. Among them there were 11 (45.8 %) women and 13 (54.2 %) men whose disease duration ranged from 2 months to 25 years. Treatment of patients with pyoderma involved the prescription of the antibacterial drug Doramycin, 2 pills 2 times a day together with the basic therapy.Results and discussion. Patients were diagnosed with various nosological forms of pyoderma: staphylococcal impetigo (common form), multiple folliculitis, vulgaris sycosis, furunculosis, hydradenitis, chronic ulcerative pyoderma. Patients with secondary bacterial complications of foot mycosis and infectious eczema were also included in the study.The dynamics of the regression of the objective and subjective manifestations of the disease were evaluated on the basis of elimination or reduction of the severity of erythema, pustulation, infiltration and area of the affected zone of the skin. The rate of disappearance or reduction of itching, pain, burning in the lesions were taken into account.The result of treatment in the form of clinical recovery was observed in 100 % of patients with superficial pyoderma. In patients with deep forms of pyoderma, the disease regressed slower, with most of them experiencing clinical recovery and significant improvement. Clinical improvement was diagnosed in 2 patients with severe recurrent pyoderma.No adverse reactions and complications during treatment were observed. No disease recurrences were fixed during the next 6 months.Conclusions. Complex therapy with the inclusion of the antibacterial drug Doramycin is effective and safe and may be recommended for the treatment of patients with deep and superficial (widespread) forms of pyoderma.

Therapeutic Potential of an Endolysin Derived from Kayvirus S25-3 for Staphylococcal Impetigo

Impetigo is a contagious skin infection predominantly caused by Staphylococcus aureus. Decontamination of S. aureus from the skin is becoming more difficult because of the emergence of antibiotic-resistant strains. Bacteriophage endolysins are less likely to invoke resistance and can eliminate the target bacteria without disturbance of the normal microflora. In this study, we investigated the therapeutic potential of a recombinant endolysin derived from kayvirus S25-3 against staphylococcal impetigo in an experimental setting. First, the recombinant S25-3 endolysin required an incubation period of over 15 minutes to exhibit efficient bactericidal effects against S. aureus. Second, topical application of the recombinant S25-3 endolysin decreased the number of intraepidermal staphylococci and the size of pustules in an experimental mouse model of impetigo. Third, treatment with the recombinant S25-3 endolysin increased the diversity of the skin microbiota in the same mice. Finally, we revealed the genus-specific bacteriolytic effect of recombinant S25-3 endolysin against staphylococci, particularly S. aureus, among human skin commensal bacteria. Therefore, topical treatment with recombinant S25-3 endolysin can be a promising disease management procedure for staphylococcal impetigo by efficient bacteriolysis of S. aureus while improving the cutaneous bacterial microflora.

AKT answer relating to impetigo

AKT answer relating to impetigo

AKT question relating to impetigo

AKT question relating to impetigo

Factors related to neonatal skin infection in community

Total 1 452 newborns were home visited within 28 d after birth during January 2016 to December 2016, and 27 cases of skin infections were found. Umbilical inflammation was more common (11 cases), followed by folliculitis (9 cases) and impetigo (7 cases). Samples were collected for bacterial culture and identification from the skin of infected newborns, the hands and nasal cavity of family baby caretakers, and household articles, including faucets, mobile phones, toilet buttons and so on. The pathogens identified were Staphylococcus aureus in 20 cases (including 2 methicillin-resistant strains) and Escherichia coli in 7 cases. The isolation of Staphylococcus aureus in household articles was significantly correlated with newborns infected with Staphylococcus aureus (χ2=678.808, P<0.01); and the isolation of Staphylococcus aureus from family baby caretakers was also significantly associated with neonatal Staphylococcus aureus infection (χ2=820.396, P<0.01). In 7 cases of Escherichia coli infection, the Escherichia coli were detected from samples of baby caretakers or household articles. The study suggests that the awareness of baby caretakers and home hygiene are important to reduce neonatal skin infections. Key words: Newborn; Skin infection; Family environment; Home care workers

The functional status of peripheral blood supply in patients with acute pyodermias

Objective — the evaluation of functional status of some aspects of peripheral circulation in patients with pyodermia.Materials and methods. 22 patients with acute pyodermias (staphylococcal impetigo and furunculosis) of upper extremi­ties localization were observed. The parameters of Vps, Ved, S/D, RI and PI in axillary, brachial, ulnar and radial arteries were calculated by Duplex ultrasound method. Results and discussion. Segmental disturbance of functional status of peripheral circulation was fixed. Normal phy­siological vascularization in axillary artery was accompanied by its inhibition in ulnar, brachial and radial arteries. The obtained data testify to the inhibited state of resistance and pulsatile inertness of vessels and, as a consequence, to certain therapy.Conclusions. Patients with pyodermias were characterized by segmental disturbance of functional status of peripheral circulation, which was manifested by depression of resistance and pulsatile inertness of vessels in the middle and distal segments. Vps, Ved, S/D, RI and PI can be used for evaluation of fuctional status of peripheral circulation in patients with pyodermias and can be used as criteria of treatment efficacy. Some medications which influence the functional status of peripheral circulation should be used in complex treatment.

Ozenoxacin: A Novel Topical Quinolone for Impetigo.

To review the data supporting Food and Drug Administration (FDA) labeling of ozenoxacin and evaluate its place in therapy for impetigo. A literature search was conducted using PubMed (1966 to May 2018) and Google Scholar (2000 to May 2018) with the search terms ozenoxacin, T-3912, and GF-001001-00. Other resources included clinicaltrials.gov , the manufacturing product label, and the FDA website. All relevant English-language data from abstracts, phase 1 to 4 studies, and review articles were included. FDA labeling of ozenoxacin was based on 2 phase 3 studies conducted in patients 2 months of age and older. Ozenoxacin demonstrated efficacy and safety for use in bullous or nonbullous impetigo from Staphylococcus aureus or Streptococcus pyogenes as compared with placebo. The lack of systemic absorption results in minimal adverse drug reactions. Studies did not detect possible adverse events commonly associated with other quinolone antibiotics. Relevance to Patient Care and Clinical Practice: This topical quinolone has bactericidal activity against Gram-positive organisms, including methicillin-resistant Staphylococcus aureus. Ozenoxacin may have an expanded clinical role for the treatment of localized impetigo if resistance to current therapies increases significantly. However, ozenoxacin is unlikely to play a significant role in the treatment of impetigo in the foreseeable future, because of lack of direct comparative clinical efficacy data with currently recommended therapies and likely high cost. Ozenoxacin, the first nonfluorinated quinolone, is a safe, topical treatment for impetigo in patients 2 months of age and older. Although clinical trials demonstrate efficacy compared with placebo, comparative trials to current treatment options are needed to identify its therapeutic use.

Novel topical antibiotic approved for impetigo

Novel topical antibiotic approved for impetigo

A Randomized Vehicle-Controlled Trial to Assess the Efficacy, Safety, and Tolerability of Ozenoxacin 1% Cream in 465 Patients 2 Years and Older with Impetigo

Abstract Not Available

Ozenoxacin, a Novel, Topical Antibacterial Agent for Treatment of Adult and Pediatric Patients with Impetigo: Phase III Clinical Trials Pooled Analysis Results

Abstract Not Available

A Randomized Vehicle-Controlled Trial to Assess the Efficacy, Safety, and Tolerability of Ozenoxacin 1% Cream in 412 Patients 2 Months and Older with Impetigo

Abstract Not Available

Bullous Impetigo Case Series: An Updated Review

Impetigo also known as pyoderma is a common paediatric skin infection presenting to clinics and hospitals in summer season. The illness is acquired from close skin contact with the victim and is highly contagious. The lesions are fluid filled vesicles that leave crust after rupture and usually heal without treatment. The infection is classified as bullous and non-bullous impetigo, the latter one having the least occurrence and is most commonly associated with complications, therefore prompt treatment is necessary.&#x0D; The case series holds a brief literature review of bullous impetigo, its clinical course, treatment op- tions and complications. The author reports two cases presenting with bullous impetigo in the month of June. A five-year old boy and fifteen months old girl; both presenting with similar rashes involving limbs, trunk and neck with slight differences in the clinical symptoms. Both were treated with fluids, oral and topical antibiotics. The climatic conditions of Karachi favours the incidence of impetigo. Also, poor sanitation and overcrowded areas have further more increased the incidence of the disease. Families are unaware of these types of skin infections and hence do not isolate the victim which, in case of highly contagious illnesses like impetigo, is of great importance. Furthermore, not getting prompt treatment is another factor that cannot be ignored and results in complications in case of bullous impetigo. The most important conclusions which can be drawn from our case series are the lack of paediatric centres that treat dermatological conditions promptly and effectively. Lack of proper guidance convinces families to switch to self-medication and sometimes neglect. The role of a paediatrician is vital when creating understanding with the patient's attendant by explaining them the clinical features and course of treatment of bullous impetigo to avoid self-medication while dealing with skin diseases in children.

The Prevalence, Molecular Characterization and Antimicrobial Susceptibility of S. aureus Isolated from Impetigo Cases in Duhok, Iraq

Background:Staphylococcus aureusis one of the most important opportunistic pathogens. Impetigo is the common contagious bacterial infection of the skin caused byS. aureus.Method:Samples were taken from 204 patients with impetigo disease.S. aureusisolates were tested for their antimicrobial susceptibility. Genomic DNA ofS. aureuswas used to transformE. coliHB101 strain and expression capability ofS. aureusplasmids in transformedE. coliwas investigated. 68.62% (140/204) of the specimens were nonbullous impetigo and 31.38% (64/204) were bullous impetigo.S. aureusstrains were isolated from 41.66% (85/204) of impetigo cases (82.35% from nonbullous and 17.65% from the bullous impetigo). There was an inverse relationship between the incidence ofS. aureusisolated and age.Result:Three biotypes ofS. aureuswere identified based on their fermentation of different sugars. All isolates were resistant to penicillin and most isolates were resistant to ampicillin (95.3%), amoxicillin, (94.11%) and cephalexin (90.95%). Most isolates were sensitive against vancomycin and rifampicin (98.83%). 5.88% (5/85) ofS. aureusisolates were identified as MRSA. A maximum of 5 markers fromS. aureusisolates were capable to be expressed in transformedE. coliHB101 strains. The incidence of impetigo caused byS. aureusis comparable with reports from elsewhere.S. aureusisolates showed multidrug resistance against antibiotics.Conclusion:Plasmids ofS. aureusare capable to show its expression inE. coliHB101. Molecular study is needed to investigate the role of plasmids in different patterns of multi drug resistance.