Impetigo Essay

In today’s world, there are multiple skin infections and highly contagious viruses that may easily spread from person to person by direct interactions and daily contacts. Common types of bacteria such as Staphylococcus and Streptococcus can easily infect a person’s epidermis and lead to uncomfortable symptoms, painful feelings, itching, discomfort, and even serious health complications. As evidence shows, bacteria and viruses often weaken human immune system that may negatively affect the individual’s overall health, both physical and emotional. Most dermal infections can spread into the bloodstream and negatively contribute to the body systems (muscular, nervous, digestive, urinary, respiratory systems) and organs destroying the collaboration of the whole organism’s functional unite. Researchers state that bacterial skin infections often affect the most vulnerable populations that include people who live in warm humid environments, tropics, and hot climatic conditions.

Impetigo (Infantigo) is one of the most common and highly contagious bacterial dermal infections, especially in children, that affect the superficial layers of epidermis causing red sores, then form blisters that are usually about one or two cm across, and finally, create yellowish crusts on a person’s face, neck, arms, legs, or anywhere on the body. Due to either Staphylococcus aureus or Streptococcus pyogenes, impetigo infection can easily spread between people of any age, but it is diagnosed far more often in young children aged less than five. Bacteria can enter the epidermis through skin damaged by other conditions, such as eczema, scabies, head lice (secondary impetigo) and through dermal injuries or irritations, such as insects’ bites, cuts, burns (primarily impetigo). As evidence shows, “impetigo and scabies are correlated; people with scabies are at risk of secondary bacterial infection with impetigo and areas with a high prevalence of one condition often have a high prevalence of the other” (May, et al., 2016). Additionally, direct physical interactions with the infected individuals significantly contribute to the development of the disease, for example, by sharing personal items, towels, toys, clothing, and other skin-to-skin daily contacts with people who possess impetigo dermatosis. As evidence shows, impetigo is the most common bacterial skin infection in Northern America, Canada, and Northern Europe, which mostly affect young children aged two to six years.

According to recent statistics, approximate estimates of the global burden of impetigo are 111 million children from developing countries to 140 million people affected at any one time (Bowen et al., 2015). This common dermatosis is often seen in low socioeconomic regions, low-middle income countries, and resource-poor territories because of the lack of appropriate sanitation, poor nutrition, lack of access to clean-drinking water, poor-quality medicine, and inadequate treatment and poor medical interventions. From the beginning, impetigo infection does not cause any symptoms and only after five to ten days a person can notice small red sores that form fluid filled blisters, and finally, leave thick yellowish-brown golden crusts that soon dry and leave red spots that normally heal without scarring. Red spots usually occur around neck, nose, mouth, or lips, and then spread to other areas of the person’s body. In rare cases, impetigo may cause high temperature and swollen glands, but in most cases, the infection is easily treated with antibiotic drugs, ointments and creams. Some studies show that “natural therapies and traditional medicines such as tea tree oil and cocky apple tree poultices or suspensions are used by some populations” (May et al., 2016).

When it comes to impetigo diagnosis, the child’s pediatrician or dermatologist can easily diagnose the infection just by examining the patient’s skin and the infected areas. Red sores or blisters can be painful and itchy, and in certain cases, physicians may take samples of the bacteria from a sore’s liquid to identify effective antibiotics for the treatment of impetigo infection. Dermatologists may also insist on blood and urine laboratory testing, which allow physicians to prescribe effective antibiotic drugs, accelerate recovery process, and avoid serious complications. As evidence shows, adults are at higher risk of complications, which may result in sepsis, guttate psoriasis, pneumonia, cellulitis, osteomyelitis, arthritis, and other serious conditions. Acute poststreptococcal glomerulonephritis (APSGN) and acute rheumatic fever (ARF) are two serious complications of non bullous impetigo (impetigo contagiosa) that affect one to five percent of patients. In most cases, acute glomerulonephritis only worsens the condition and even leads to fatal consequences. According to the statistical data, “the short-term prognosis of APSGN in children is excellent; but in adults, and particularly in debilitated adults, the mortality rate can be as high as 30%, as a consequence of a cardiovascular complication” (Rodriguez-Iturbe & Haas, 2016).

Due to effective medical interventions and therapy, the signs of impetigo are successfully disappeared within two or three weeks without leaving any scarring. But often impetigo is “an under-recognized disease and in conjunction with scabies, comprises a major childhood dermatological condition with potential lifelong consequences if untreated” (Bowen et al., 2015). The aim of treatment is to relieve impetigo painful symptoms, reduce itchy symptoms, minimize discomfort, and provide good cosmetic effects. Thus, early interventions and treatment are crucially important as they help prevent the spread of bacteria within the infected person and to other people. The patients with diabetes or low immune system are at high risk of developing eczema (a chronic skin condition that leave scars), kidney diseases (infection may damage kidneys functioning), and cellulitis (life threatening symptom that affects tissues underlying a person’s skin and may easily spread to the bloodstream). Study after study shows that “without treatment of impetigo or secondarily infected dermatoses, serious and sometimes fatal complications can occur, including sepsis, invasive infection and post-streptococcal sequelae” (May et al., 2016).  In most cases, this bacterial skin infection is a minor problem, which just requires the prescription of antibiotic creams and ointments that may include mupirocin, fusidic acid, or retapamulin. If creams do not improve the condition, dermatologists may prescribe oral antibiotics to reduce severe infection and avoid spreading of the bacteria. Antibiotic tablets may include cephalosporins, dicloxacillin, erythromycin, amoxicillin, cloxacillin, or clindamycin. As evidence shows, after at least 48 hours of treatment with antibiotic pills the risk of contagion has drastically reduced.

Good hygiene is an essential step for preventing the risk of developing and spreading bacteria. Strict hygiene measures help prevent the spread of impetigo to other individuals and reduce bacteria spreading to other parts of the body. Isolation of personal items of the infected person is also important as impetigo may be easily transmitted through things of the infected patient, such as bed linen, clothing, towels, toys, and other toiletries. For the individuals with impetigo, it is crucially important to avoid contacts with newborn babies to reduce the risk of contagion. Topical disinfectants and exclusion measures are essential in avoiding the spread of dermal infection. Dermatologists state that it is crucially important to keep cuts, injuries, and scratches clean and covered with plaster to prevent the reoccurrence of impetigo infection. It is also important to wash hands regularly with antibacterial soap, take a regular shower, and change clothes frequently to reduce dermal bacterial colonization. As evidence shows, impetigo is a highly contagious condition, thus strict hygiene is the first step in preventing the development of infection and avoiding impetigo complications, which may result in cellulitis, guttate psoriasis, bacterial infection of the blood, scarlet fever, poststreptococcal glomerulonephritis, or bacteremia.      

References:

Bowen, AC., Mahe, A., Hay, R.J., Andrews, R.M., Steer, A.C., Tong, S.Y., &       Carapetis, J.R. (2015). The Global Epidemiology of Impetigo: A Systematic Review of the Population Prevalence of Impetigo and Pyoderma. PLoS ONE, 10(8), e0136789.

May, P., Bowen, A., Tong, S., Steer, A., Prince, S., Andrews, R., Currie, B., &    Carapetis, J. (2016). Protocol for the systematic review of the prevention,  treatment and public health management of impetigo, scabies and fungal skin infections in resource-limited settings. Systematic Reviews, 5(1): 162. 

Rodriguez-Iturbe, B., & Haas, M. (2016). Post-Streptococcal Glomerulonephritis. In: Ferretti JJ, Stevens DL, Fischetti VA, editors. Streptococcus pyogenes: Basic Biology to Clinical Manifestations [Internet]. Retrived from  https://www.ncbi.nlm.nih.gov/books/NBK333429/  

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[Accessed: April 1, 2020]

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