IMPETIGO

acute, highly contagious gram +

2 form:
Impetigo bullous
- affect intact sin, cause! by "# $ureus
- to%in-me!iate! erythro!erma large
area of sin loss&
- 'omplications ecthyma( !eeper
ulcerate! infection, )+lympha!enitis*
- "# $ureus pro!uce to%in yang
menyebaban subcoorneal epi!ermal
clea+age#
- 2,- M."$
- target cell: !esmoglein I yg
maintain cell a!hesion, punya
superantigen yg ati+asi T
lymphocyte# Punya coagulase yg biin
racun remain !i loal upper epi!ermis
- /ena e neonatal seringnya#
- 'iri2: thin-roofe!, flacci!, an!
transparent bullae 01cm, !an bullae
sgt fragile
- 2ullae clear, yello3 flui! later turns
clou!y an! !ar yello3, saat rupture
ninggalin scale aroun! erythematous
moist base# $fter !esiccation leasion
has a bro3n-lac4uere! or scal!e! sin
appearance
- 'entral healing: circinate lesion
- Ter5a!i !i intact sin atau area2
tertentu aya leher, a%illary an!
crural fol!s, !iaper area
- 2isa ena buccal mucous membranes
- 6ess contagios !rp! nonbullous
Impetigo non-bullous7contagious
- lebih sering( 8,- asus impetigo
- enain e ulit mua atau e%tremities
yang pernah ena
gigitan7tusuan7abrasi7trauma7beas
penyait( +aricella
- paling sering !i ana2
- lebih contagious !rp! bullous
- arena "taphylococcus $ureus, group
$ beta hemolytic )G$29"7 "#
Pyogenes* atau ombinasi e!uanya
- a3alnya: tiny +esicle terus rupture !i
replace! honey-colore! crusting
)02cm*# Ele+ation crust moist
erythematous base# "aat sembuh
heal 37o scarring
- lesion bisa 5! multiple !an enlarge
arena infesi nyebar periferal
- loasi: face )mouth:nose* : e%pose!
parts of the bo!y )arms legs*
- ; erythema, ; e!ema
- .egional lympha!enopathy, ; sore
throat
Pathophysiology
- 9anya bisa menyerang ulit yang
pernah lua( ulit utuh ga aan
enapa2#
- <ntu nempel G$29" !an " $ureus
butuh epithelial cell receptor
component !an fibronectin ut
coloni=ation# >ibronectin receptor cmn
a!a !i ulit lua
G$29" coloni=ation:
- bisa ena e normal sin( teroloni
!ulu# Tapi saat ulit sehat ini a!a
se!iit lesi, langsung 5a!i impetigo ?-2
minggu
- G$29" bisa !i!itect !i nose an! throat
2-1 minggu setelah lesi tumbuh
"# $ureus coloni=ation
- bateri biasanya terolonisasi !i
hi!ung, by org yg recurrent epis!oes
!i hi!ung !an mulut# 2isa nyebar !r
hi!ung e ulit !alam 3t 8-?@ hari,
muncul lesion 8-?@ hari emu!ian
- " aureus ?,- terolonisasi !i
perinum, a%illa, pharyn%, han!s# Ai
orang sehat tapi 5a!i normal flora#
- biasanya ena e pasien yg ena
atropic !ermatitis&
'omplications:
Pe!al e!ema, hypertentionnonbullous
tan!a2 renal !ysfunction arena
poststreptococcal
glomerulonephritismuncul ?, hari stelah
?st lesion impetigo muncul biasanya
biasanya ena !i ana2 2-@ tahun
9istologic fin!ings:
2ullous
fe3 or no inflammatory cells present !i
bulla#
polymorphous infiltrate !i upper !erms
acantholysis !i granular layer
Bonbullous
serum crust !i abo+e epi!ermis
neutrofil !i crust
a!a gram + cocci
Treatment:
- gentle cleansing, remo+al honey crust
pae antibacterial soap + 3ashcloath
- initial empiric choice beta lactam&
Obat:
Topical antibiotic treatment
Mupirocin
ut lesion !an clear chronic nasal carrier
bagus ut single lesion nonbullous
impetigo or small areas of in+ol+ement, 2-
1% sehari, selama ? minggu
.etapamulin
ut impetigo " pyogenes !an M."$ bayi
!iatas C bulan, 2 ali sehari selama D hari
fusi!ic aci!!i eropa !oing
"ystemic antibiotic )ut 3i!esprea! or
complicate!*
amo%icillin !an cla+ulanate
- campur broa! spectrum + beta lactamase
inhibitor
- amo%icillin inhibit bacterial 3all synthesis,
cla+ulanat ihibit beta lacamase pro!ucing
bacteria
!iclo%aclin mirip amo%icillin, ut terapi
staphylococcal
erythromycicnbloc t.B$ !r !ibosom
ut staphy+strepto infection
obat ca!angan alo yg lain ga a!a
clyn!amicinut stphy, bisa ut
aerobic+anaerobic streptococci
clo%acillin
sulfametho%a=ole-trimethoprim ut
M."$, tp ga bisa ut " pyogenes
6e+oflo%acnut M."$
ciproflo%acin ut M"$
$ntihistamine supporti+e ut urangin
gatel
!eslorata!ine
cetiri=ine
lorata!ine
semua inhibit histamine 9? receptor