Streptococcal Skin Infections

Organism Streptococcus pyogenes, group A.

Clinical features Streptococcal infections of the skin can present as pyoderma, impetigo, erysipelas or scarlet fever. Pyoderma and impetigo are superficial skin infections with vesicles, pustules and crusts. Erysipelas is a red, tender, oedematous cellulitis of the infected part of the body, originating from the point of infection. Scarlet fever presents as a generalized rash that blanches on pressure with high fever, strawberry tongue and flushing of the cheeks. In some cases, there is an appreciable mortality or else it can result in otitis media, glomer-ulonephritis or acute rheumatic fever (ARF, Section 13.10). Although not a skin infection, streptococci can also cause puerperal fever due to post-delivery infection of the female genital tract.

Diagnosis Culture of the organism from the point of infection or pharynx on blood agar.

Transmission is mainly by the respiratory route or direct contact with the lesion or skin (in impetigo). Flies can transfer the organism and are a major means of infecting scratches and wounds in tropical countries. The organism can be carried in the nose, pharynx, anus and vagina or in chronic skin lesions, and is an important cause of hospital infections.

Incubation period 1-3 days.

Period of communicability 10-21 days or until a chronic infection has been treated.

Occurrence and distribution Worldwide, predominantly in children, but scarlet fever is more common in temperate regions. Infected skin lesions either due to streptococci or staphylococci are very common in tropical regions.

Control and prevention Treat all cases promptly and dress infected lesions in a sterile manner. Any person with an infected lesion should not be involved in operations or hospital duties until healed. Personal hygiene, especially the washing of hands after defecation, and the discouragement of nose-picking should be advocated. Use of proper latrines and the control of flies are long-term preventive measures.

Treatment Benzathine penicillin G intramuscular, or penicillin G or V orally.

Surveillance Scarlet fever and puerperal fever are notifiable diseases in some countries.

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