Lymphedema and Impetigo
This page has been updated, please see:
Our Home Page: Lymphedema people
page is included on this skin infection
because with lymphedema
it can rapidly progress into erysiplas or cellulitis. Many years back, my daughter and I swam in an immaculate private pool. She came down with impetigo, while mine developed into a severe cellulitis infection.
Related words: impetigo contagiosa, group A beta-hemolytic streptococci, GABHS, Staphylococcus aureus, bullous impetigo, impetigo bullosa, common impetigo, folliculitis, follicular impetigo, ecthyma (1) strep throat, scarlet fever, cellulitis, lymphedema
Highly contagious superficial skin infection, generally found in children. The infection is caused by the bacterium staphylococcus aureus, it also however, may be caused by group A beta-hemolytic streptococci.
Impetigo forms round, crusted, oozing spots that continue to grow unless treated. The infection is rapidly and easily spread to others by contact and spreads through the skin by scratching.
For lymphedema patients, it also can easily become cellulitis or erysipelas, if left untreated or allowed to progress.
General symptoms include a skin lesions, itching blister, rash, single or multiple blisters filled with pus and possible lymphadenopathy (swollen lymph nodes) at the infected spot.
The are four ways impetigo may express itself:
1.) Bullous impetigo - This form usually begins with blister type sores (bullae) on the trunk or extremeties.
2.) Impetigo contagiosa begin with small to medium size rose-colored patched on the skin (erythematous macule) that will rapidly change into a pustule. Generally occurs on the face, corners of the mouth, or ears or nose.
3.) Impetigo also can present as folliculitis, which is considered to be impetigo of the hair follicles caused by Staph aureus. (1)
4.) Ecthyma is a deeper, ulcerated impetigo infection, often occurring with lymphadenitis. (1)
General complications may include skin damage and scarring. More serious complications include meningitis, sepsis, ecthyma, erysipelas, cellulitis, bacteremia, lymphadenitis.
Diagnosis is usually made fom simple observation and examination. However, cultures may be taken to determine the specific bacteria involved.
Simple superficial impetigo is treated with topical antibiotic ointment. For more difficult cases oral antibiotics such as flucloxacillin or erythromycin may be used.
Before the application of topical ointments, the crust should also be removed as the causative bacteria lives underneath the crusts.
Crusts should be removed before the ointment is applied. Soak a soft, clean cloth in a mixture of one-half cup of white vinegar and a quart of lukewarm water. Press this cloth on the crusts for 10-15 minutes three or four times daily. Then gently wipe off the crusts and apply a little antibiotic ointment. (2)
What Is it?
American Medical Association - MedLine Plus
Impetigo is a skin infection caused by bacteria. It may affect skin anywhere on the body but usually attacks the area around the nose and mouth. Impetigo is generally caused by Group A streptococci bacteria or Staphylococcus aureus.
Impetigo typically affects school-age children, most often during the hot, humid summer months. It has a special preference for skin that has already been injured by other types of skin problems, including eczema, poison ivy, or an allergy to soap or makeup.
Impetigo is contagious, and it can be spread from one area of skin to another by scratching. On the face, the infection usually spreads along the edges of an affected area, but it may also spread to more distant parts of the body on contaminated fingers.
Impetigo is contagious from person to person. When someone in a household has impetigo, the infection can be passed to other family members on clothing, towels, and bed linens that have touched the infected person's skin.
What are the symptoms?
Although impetigo can affect skin anywhere on the body, it most often attacks the face. Look for areas of itchy skin with tiny blisters, especially around your child's mouth and nose. Blisters will eventually burst to reveal areas of red skin that may weep fluid. Gradually, a tan or yellowish-brown crust will cover the affected area, making it look as if it's been coated with honey or brown sugar.
How is it treated?
Impetigo is usually treated with antibiotics, which may be given by mouth. In very mild cases, a topical (on the skin) antibiotic cream or ointment may be used.
At home, follow your doctor's orders for giving oral antibiotics or applying antibiotic creams or ointments. Wash areas of infected skin twice a day using antiseptic soap. Scrub the skin gently with a piece of clean gauze. If an area of skin is crusted, soak it in warm, soapy water before washing.
To keep your child from spreading impetigo to other parts of his body, cover infected areas of skin with gauze and tape, or use other protective methods as directed by your doctor. Cut your child's fingernails short.
When is it over?
With antibiotic treatment, healing should begin within three days. A child with impetigo may return to school once his infection cannot be spread to classmates, usually about 48 hours after treatment begins.
How can I keep my kids from getting it?
You can help prevent impetigo by following good general hygiene practices in caring for your child's skin. This includes either a daily bath or a shower with soap and water. Pay special attention to areas of the skin that have been injured, including cuts, scrapes, areas of eczema, and rashes caused by allergic reactions or poison ivy. Keep these areas clean and covered.
If someone in your family has impetigo, make sure that his fingernails are cut short and that the impetigo sores are covered with gauze and tape to prevent him from scratching and spreading the infection to other areas. Prevent infection from spreading to other family members by using antibacterial soap and by making sure that each family member uses a separate towel. If necessary, substitute paper towels for cloth ones for a while.
When should I call my doctor?
Call your pediatrician if your child has signs of impetigo, especially if the child has been exposed to a family member or classmate with the infection. If your child is already being treated for impetigo, call your doctor if a fever develops or if your child's skin doesn't begin to heal after three days of treatment.
Related Group A Streptoccal Infections
Group A streptococcal infections are caused by group A streptococcus, a bacterium responsible for a variety of health problems. These infections can range from mild skin infection or sore throat to invasive, life-threatening conditions such as toxic shock syndrome and necrotizing fasciitis. Most people are familiar with strep throat, which along with minor skin infection, is the most common form of the disease. Experts estimate that more than 10 million mild infections like these occur every year.
In addition to step throat and superficial skin infections, group A strep bacteria can cause infections in tissues at specific body sites, including lungs, bones, spinal cord, and the abdominal cavity.
STREP THROATWhat is strep throat and what are the symptoms?
Your health care provider may call it acute streptococcal pharyngitis. People with strep throat infections have a red and painful sore throat with white patches on their tonsils. A person may also have swollen lymph nodes in the neck, run a fever, and have a headache. Nausea, vomiting, and abdominal pain can occur but are more common in children than in adults.
How does Group A strep spread to others?
Group A strep infections can spread from person to person by direct contact with saliva or nasal discharge. Most people do not get group A strep infections from casual contact with others, but a crowded environment like a dormitory, school, or an institutional setting can make it easier for the bacteria to spread. There have also been reports of contaminated food, especially milk and milk products, causing infection. A person becomes sick within 3 days after being exposed to the germ. Once people become infected, they can pass the infection to others for up to 2 to 3 weeks even if they don't have symptoms. After 24 hours of antibiotic treatment, a person will no longer spread the bacteria to others.
How is strep throat diagnosed?
Your health care provider will take a sample from your throat. This will be used for a culture or a rapid strep test, which only takes 10 to 20 minutes. If the result of the rapid test is negative, your provider may do a follow-up culture to confirm the results, which takes 24 to 48 hours. If the culture test is also negative, your health care provider may suspect you do not have strep, but rather another type of infection. The results of these throat cultures will affect what your health care provider decides to be the best treatment. Most sore throats are caused by viral infections, however, and antibiotics are useless against them.
What is the treatment for strep throat?
If your health care provider confirms you have a strep infection, he or she will prescribe antibiotics. This will help reduce symptoms, and after 24 hours of taking the medicine, you can no longer spread the disease to others. Treatment will also reduce the likelihood of complications.
Penicillin is considered the medicine of choice for treating strep throat because it has been proven to be effective, safe, and inexpensive. Your health care provider may have you take pills for 10 days or give you a shot. Health care providers often prefer to give amoxicillin to children with strep throat. If you are allergic to penicillin there are other antibiotics your health care provider can give you to clear up the illness.
During treatment, you may start to feel better within 4 days. This can happen even without treatment. Still it is very important to finish all the medicine in order to prevent complications.
What are the complications of strep throat?
Untreated group A strep infection can result in rheumatic fever and post-streptococcal glomerulonephritis (PSGN). Rheumatic fever develops about 18 days after a bout of strep throat and causes joint pain and heart disease. It can be followed months later by a jerky movement disorder called Sydenham chorea. PSGN is an inflammation of the kidneys that may follow an untreated strep throat but more often comes after a strep skin infection. Both disorders are rarely seen in the United States.
What is impetigo?
Impetigo is an infection of the top layers of the skin and is most common among children ages 2 to 6. It usually starts when the bacteria get into a cut, scratch, or insect bite. Impetigo is usually caused by staphylococcus, a different bacterium, but can be caused by group A streptococcus. Skin infections are usually caused by different types of streptococci than those that cause strep throat. Therefore, the types of streptococci that cause impetigo are usually different from those that cause strep throat.
What are the symptoms of impetigo?
Symptoms start with red sores or pimple-like lesions (sores) surrounded by reddened skin These lesions can be anywhere on the body, but are found mostly on the face, arms, and legs. Lesions fill with pus, then break open after a few days and form a thick crust. Itching is common. The health care provider can diagnose the infection by looking at the skin lesions.
How is impetigo spread?
The infection is spread by direct contact with wounds or sores or nasal discharge from an infected person. Scratching may spread the lesions. From the time of infection until a person shows symptoms is usually a period of 1 to 3 days. Dried streptococci in the air are not infectious to skin with no breaks.
What is the treatment for impetigo?
Your health care provider will prescribe antibiotics, as with strep throat. He or she may also prescribe an antibiotic ointment.
What are cellulitis and erysipelas?
Cellulitis is inflammation of the skin and deep underlying tissues. Erysipelas is an inflammatory disease of the upper layers of the skin. Group A streptococcus is the most common cause of both conditions.
What are the symptoms of cellulitis and erysipelas?
People with cellulitis may experience fever and chills and swollen "glands" or lymph nodes. Their skin will be painful, red, and tender. The skin may blister and then scab over. Perianal (around the anus) cellulitis may also occur with itching and painful bowel movements.
With erysipelas, a fiery red rash with raised borders may occur on the face, arms, or legs. Skin will be hot, red, and have sharply defined raised areas. The infection may come back, causing chronic swelling of arms or legs (lymphedema).
How does a person get cellulitis or erysipelas?
Both cellulitis and erysipelas begin with minor trauma, such as a bruise. It can also begin at the site of a burn, surgical incision, or wound, and usually affects an arm or leg. When the rash appears on the trunk, arms, or legs, however, it is usually at the site of a surgical incision or wound. People who have no symptoms, but carry the germ on their skin or in their nasal passages, can transmit the disease.
How are these skin infections diagnosed and what is the treatment?
A health care provider may take a sample or culture from skin lesions to identify the bacteria causing infection. He or she may also recover the bacteria from the infected person's blood. Depending on how severe the infection is, treatment involves either oral or intravenous antibiotics.
What is scarlet fever?
Scarlet fever is another form of group A streptococcal disease that can follow strep throat. It is usually self-limited.
What are the symptoms of scarlet fever?
In addition to the symptoms of strep throat, a red rash appears on the sides of the chest and the abdomen. It may spread to cover most of the body. This rash appears as tiny, red pinpoints and has a rough texture like sandpaper. When pressed on, the rash loses color or turns white. There may also be dark red lines in the folds of skin. People with scarlet fever may get a bright strawberry-red tongue, and their faces are flushed while the area around the mouth remains pale. The skin often peels after recovery usually on tips of fingers and toes. In severe cases, a patient may have a high fever, nausea and vomiting.
How does a person get scarlet fever?
A person can get scarlet fever the same way they get strep throat - through direct person-to- person contact with throat mucus, nasal discharge, and saliva of an infected person.
What is the treatment for scarlet fever?
Like strep throat, a health care provider treats scarlet fever with antibiotics.
SEVERE STREP INFECTIONS
What are the more severe streptococcal infections?
Some types of group A streptococcus bacteria cause severe infections. These include
According to the Centers for Disease Control and Prevention (CDC), 9,000 cases of severe group A streptococcal disease were reported in 2002.
All severe group A strep infections may lead to shock, organ failure, and death. Health care providers must recognize and treat such infections quickly.
Health care providers diagnose these infections by looking at blood counts and doing urine tests as well as cultures of blood or fluid from a wound site. Antibiotics include penicillin, erythromycin, and clindamycin. If tissue damage is severe, a health care provider may need to remove the tissue surgically or amputate the limb.
Who is at greatest risk for severe infection?
Severe group A strep disease may also occur in healthy persons with no known risk factors.
Through research, health
experts have learned that
there are more than 120 different strains of group A streptococci, each
producing its own unique proteins. Some of these proteins are
specific group A streptococcal diseases. With the support of the
Institute of Allergy and Infectious Diseases (NIAID), scientists have
the genetic sequence, or DNA code, for three different strains of the
By studying an organism's genes, scientists learn which proteins are responsible for virulence, crucial information that will lead to new and improved drugs and vaccines. NIAID funds are supporting research for developing a group A streptococcus vaccine. An effective vaccine will prevent not only strep throat and impetigo, but more serious invasive disease and post-infectious complications like rheumatic fever.
Two different vaccine approaches are being evaluated in clinical trials in the NIAID Vaccine and Treatment Evaluation Units. More information is available at the following NIAID Web site:
National Library of Medicine
8600 Rockville Pike
Bethesda, MD 20894
Information on post-streptococcal glomerulonephritis (PSGN)
National Institute of Diabetes, Digestive, and Kidney Diseases
31 Center Drive, MSC 2560,
Bethesda, MD 20892-2560
Information on Sydenham chorea
National Institute of Neurological Disorders and Stroke
Office of Communications and Public Liaison
P.O. Box 5801
Bethesda, MD 20824
Information on group A streptococcal disease, including diagnosis and prevention, guidelines for healthcare and laboratory workers, and statistics.
Centers for Disease Control and Prevention
1600 Clifton Road
Atlanta, GA 30333
1-800-311-3435 or 404-639-3534
FOR FURTHER INFORMATION:
Author: Randy Park, MD, Chair, Associate Professor, Department of Emergency Medicine, Denton Regional Medical Center
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