[Skin and soft tissue infections in children: consensus on diagnosis and treatment]. / Infecciones de piel y partes blandas en pediatría: consenso sobre diagnóstico y tratamiento.

Skin and soft tissue infections are a common reason for consultation in primary health care centers. Data from the local epidemiology of these infections are rare, but Staphylococcus aureus and Streptococcus pyogenes are known to be the major etiologic agents. The appearance in recent years of community-originated strains of methicillin-resistant S. aureus and erythromycin-resistant pyogenes raises controversy in the choice of initial empirical treatment. This national consensus is for pediatricians, dermatologists, infectiologists and other health professionals. It is about clinical management, especially the diagnosis and treatment of community-originated skin and soft tissue infections in immunocompetent patients under the age of 19.

Infecciones de piel y partes blandas en pediatría: consenso sobre diagnóstico y tratamiento: Parte 1 / Skin and soft tissue infections in children: consensus on diagnosis and treatment

Las infecciones de piel y partes blandas son una causa frecuente de consulta en los centros de atención primaria de la salud. Los datos de la epidemiología local de estas infecciones son escasos; el Staphylococcus aureus y el Streptococcus pyogenes son los principales agentes etiológicos. La emergencia, en los últimos años, de cepas de S. aureus meticilino resistentes provenientes de la comunidad y S. pyogenes resistentes a eritromicina plantea controversias en la elección del tratamiento empírico inicial. Este consenso nacional está dirigido a médicos pediatras, de familia, dermatólogos, infectólogos y otros profesionales de la salud. Trata el manejo clínico, especialmente el diagnóstico y tratamiento, de las infecciones de piel y partes blandas de origen bacteriano provenientes de la comunidad en pacientes inmunocompetentes menores de 19 años de edad.

Skin and soft tissue infections are a common reason for consultation in primary health care centers. Data from the local epidemiology of these infections are rare, but Staphylococcus aureus and Streptococcus pyogenes are known to be the major etiologic agents. The appearance in recent years of community-originated strains of methicillin-resistant S. aureus and erythromycin-resistant pyogenes raises controversy in the choice of initial empirical treatment. This national consensus is for pediatricians, dermatologists, infectologists and other health professionals. It is about clinical management, especially the diagnosis and treatment of commu-nity-originated skin and soft tissue infections in immunocompetent patients under the age of 19.

Blistering eruption in a Latino migrant farmworker.

Skin rashes are among the most common problems seen by those providing health care to agricultural workers. We present a case report of a migrant farmworker patient with a painful, blistering eruption of the axilla and adjacent skin developing after an insect bite. The possibility of infection was not initially considered, and teledermatology was helpful in making the diagnosis of bullous impetigo. This was important because initial culture confirmation was not obtained and antibiotic treatment had not been initiated. After the consultation, the impetigo was treated by empiric antibiotic coverage. The environmental conditions of migrant farmworkers raise special issues for infectious skin diseases like bullous impetigo. Crowded living conditions, lack of proper sanitary facilities, and poor accessibility to health care increase the risk of occurrence and spread of this disease. With the recent emergence of multi-drug-resistant organisms such as methicillin-resistant Staphylococcus aureus in community settings, this case report should serve to reinforce the need to recognize the possibility of infection and to obtain culture specimens at the initial visit to better treat and control this infectious skin condition.

Tinea faciei in an infant caused by Microsporum gypseum simulating a dry impetigo.

We report a 14-month-old White boy who was referred to our dermatology unit for evaluation of a skin eruption on his nose. The initial examination led us to the clinical diagnosis of impetigo. The mycologic studies found an uncommon dermatophyte agent, Microsporum gypseum. The main differential diagnosis of tinea faciei is discussed.

[Impetigo in French Guyana. A clinical, bacteriological, toxicological and sensitivity to antibiotics study]. / L'impétigo en Guyane Française. Etudes clinique, bactériologique, toxinologique et de sensibilité aux antibiotiques.

OBJECTIVE: We evaluated pertinent features of impetigo in French Guyana due to the increasing number of therapeutic failures with macrolides and fusidic acid. PATIENTS AND METHODS: A prospective study study was conducted over a 14-month period in the dermatology unit of the Cayenne hospital. Two groups of patients were identified: group 1 included patients with impetigo and group 2 patients with infected skin reactions. Epidemiological, bacteriological, toxinological (exofoliatines, leukocidine) and antibiotic data were recorded. RESULTS: Forty-one patients with impetigo and 31 patients with infected skin reactions were included. Staphylococcus infection alone was identified in most patients (68 p. 100) in the impetigo group. Exfoliatine-producing strains were strongly associated with Staphylococcus-induced bullous and non-bullous impetigo (93 p. 100) compared with other origins (impetigo with streptococcal infection or infected skin reactions). Resistance to macrolides was high (erythromycin 41 p. 100, fusidic acid 42 p. 100) for all isolated strains of Staphylococcus aureus. CONCLUSION: A sub-group of patients with impetigo was identified. These patients had pure staphylococcal infections characterized by strong association with exfoliatine production. The rate of resistance to macrolides was particularly high in this sub-group. Resistance to fusidic acid was high for all Staphylococcus strains isolated.

Impétigo a propósito de un caso / Impétigo with regard to a case

Analiza que el Impétigo es una afección cutánea, producida por estafilococos o estreptococoss, sólos, o asociados entre si. Para diagnosticarlo debe tomarse en cuenta factores epidemiológicos como el hábitat del agente causal, infecciones cutáneas o faringeas previas, grupos de riesgo, hábitat del huésped, clima, factores socio-económicos, etc, además de manifestaciones clínicas d ecada variedad de impétigo, entre ellas, características de la costra entre otras. Es necesario el reconocimiento oportuno de la enfermedad para poder extender un tratamiento adecuado como es la antibióticoterapia y de esta manera evitar complicaciones que pueden afectar el estilo de vida del paciente. En la presente descripción se describe un caso, en el cual el diagnóstico, y su manejo y resulatados muy didáctico...

Recent advances in pediatric infectious disease and their impact on dermatology

The past five years have seen numerous advances in the field of pediatric infectious diseases, and many of these have a substantial impact on the practice of dermatology. We review some of these advances and discuss their implications on etiology, diagnosis, therapy and complications of some relatively common conditions. The etiologic agent of exanthum subitum (roseola infantum) has been clearly implicated as a herpesvirus-6. Although in the classically described situation high fever in a young child is followed by defervescence and rash, two new scenarios have been described associated with this virus. The first is fever without rash and the second is rash without fever. The etiologic agent of erythema infectiosum ("slapped cheek") has been shown to be a human parvovirus B19. The virus has also been associated with aplastic crises (in hemoglobinopathies), hydrops fetalis, and a syndrome of subacute arthralgias in women. The etiologic agent in cat-scratch disease has recently been shown to be a small pleomorphic bacillus that also can produce pyogenic granuloma-like lesions in patients with acquired immunodeficiency syndrome. The number of cases of congenital syphilis, particularly in large cities, is increasing tremendously. Many of these infants have received no prenatal care because of drug abuse problems in their parents. Finally, we describe the changing etiology of impetigo that is predominantly associated with Staphylococcus aureus. We further describe the growing resistance to erythromycin and several new erythromycin drug-drug interactions.