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Causes

Impetigo is caused by bacteria, specifically two types of bacteria as


staphylococcus aureus and staphylococcus pyogenes.

There are two ways an initial infection can occur:

• primary impetigo - is when the bacteria invades the skin through a cut,
insect bite, or other injury, and
• secondary impetigo - is where the bacteria invades the skin because the
skin barrier has been disrupted by another skin infection, such as scabies
or eczema.

Once a person has become infected it is very easy for them to spread the
infection to other people through close physical contact or through sharing towels
or flannels.

Impetigo does not cause any symptoms until four to ten days after the initial
exposure to the bacteria, so it is easy for people to spread the condition as they
do not realise they are infected.

It is thought that the condition is more common in children because their immune
system has not yet fully developed

Clinical manifestations/Signs and Symptoms

Impetigo contagiosa

Bullous impetigo

Ecthyma
The following are signs and symptoms of impetigo:

• Red sores that quickly rupture, ooze for a few days and then form a
yellowish-brown crust
• Itching
• Painless, fluid-filled blisters
• In the more serious form, painful fluid- or pus-filled sores that turn into deep
ulcers

Types of impetigo

• Impetigo contagiosa. The most common form of impetigo is impetigo


contagiosa, which usually starts as a red sore on your child's face, most often
around the nose and mouth. The sore ruptures quickly, oozing either fluid or pus
that forms a honey-colored crust. Eventually the crust disappears, leaving a red
mark that heals without scarring. The sores may be itchy, but they aren't painful.

Your child isn't likely to have a fever with this type of impetigo but may have
swollen lymph nodes in the affected area. And because it's highly contagious, just
touching or scratching the sores can spread the infection to other parts of the
body.

• Bullous impetigo. This type primarily affects infants and children younger
than 2 years. It causes painless, fluid-filled blisters — usually on the trunk, arms
and legs. The skin around the blister is usually red and itchy but not sore. The
blisters, which break and scab over with a yellow-colored crust, may be large or
small, and may last longer than sores from other types of impetigo. which causes
large, painless, fluid-filled blisters
• Ecthyma. This more serious form of impetigo penetrates deeper into the
skin's second layer (dermis). Signs and symptoms include painful fluid- or pus-
filled sores that turn into deep ulcers, usually on the legs and feet. The sores
break open and scab over with a hard, thick, gray-yellow crust. Scars can remain
after the sores heal. Ecthyma can also cause swollen lymph glands in the affected
area.

• non-bullous impetigo - which causes sores that quickly rupture leaving a


yellow-brown crust.

Complications

Complications of impetigo are rare but they can occasionally be serious. So you
should stay alert for any changes or worsening in symptoms and report them to
your GP.
Cellulitis

Cellulitis occurs when the infection spreads to a deeper layer of skin. Cellulitis
can cause symptoms of red inflamed skin, fever and pain. The condition can be
treated with antibiotics, and paracetamol can be used to relieve symptoms of
pain.

Guttate psoriasis

Guttate psoriasis is a non-infectious skin condition that can develop in children


and teenagers after a bacterial infection. It is normally more common after a
throat infection, but some cases have been linked to impetigo. It causes small
(less than 1 cm/one third of an inch) droplet-shaped sores on the chest, arms,
legs and scalp.

Creams can be used to help control the symptoms of guttate psoriasis.

Scarlet fever

Scarlet fever is a rare bacterial infection that causes a fine pink rash across the
body. Associated symptoms of infection such as nausea, pain, and vomiting are
common. The condition is usually treated using antibiotics.

Scarlet fever is not normally serious, but it is contagious, so it is important to


isolate an infected child and avoid close physical contact. You should keep your
child away from school and other people until they have had at least five days
treatment with antibiotics.

Septicaemia

Septicaemia is a bacterial infection of the blood. It can cause symptoms of fever,


rapid breathing and vomiting. Also the person may feel confused, faint and dizzy.
Septicaemia is potentially life-threatening and requires immediate admission to
hospital for treatment with antibiotics.
Post-streptococcal glomerulonephritis

Post-streptococcal glomerulonephritis is a very rare complication of impetigo. It is


an infection of small blood vessels in the kidneys.

Symptoms of the condition include a change in the colour of urine to a reddish-


brown, or cola, colour. Post-streptococcal glomerulonephritis also causes a rise
in blood pressure.

Post-streptococcal glomerulonephritis can be fatal in adults, but deaths in


children are very rare. In fact, less than 1% of children who develop post-
streptococcal glomerulonephritis die as a result of the condition.

People with post-streptococcal glomerulonephritis will normally require hospital

Nursing Diagnosis

*Impaired skin integrity related to invasion of skin sutures by pathogenic


organisms

*Acute pain related to infection and itching

Nursing Interventions

As impetigo is very contagious it is important to take hygiene precautions to stop


the bacteria spreading and prevent other people catching it. The advice below
should help prevent the spread of infection.

• Keep children off nursery, playgroup or school until the spots have
stopped blistering or crusting, or until 48 hours after starting treatment.
• Don’t share flannels, sheets or towels with infected people, and wash
them at a high temperature after use.
• Wash the sores with soap and water and cover them loosely with a gauze
bandage or clothing.
• Do not touch the sores.
• Wash hands frequently.
• Avoid contact with newborn babies until the risk of contagion has passed
(which is when any rash has crusted over or at least 48 hours of treatment
with antibiotics).

To prevent the impetigo returning, keep cuts and scratches clean and ensure that
any condition causing broken skin, such as eczema, is treated promptly.

Pathophysiology
Impetigo is an infection caused most commonly by coagulase-positive Staphylococcus
aureus, and less often by group A beta-hemolytic streptococci (GABHS). The organisms
are thought to enter through damaged skin and are transmitted through direct contact.
After infection, new lesions may be seen on the patient with no apparent break in the
skin. Frequently, however, upon close examination, these lesions will demonstrate some
underlying physical damage.

Nonbullous (crusted) impetigo resulting from a chigger bite


infected by group A beta-hemolytic streptococci. Courtesy of
Professor David Taplin, Department of Dermatology and
Cutaneous Surgery, University of Miami School of Medicine,
Miami, Fla.

Besides skin trauma, common predisposing factors include warm and humid temperature
and atopic disease.

The presentation of impetigo may take on more than one form. Some authors suggest that
differences are due to the staphylococcal strain involved and the relative activity of the
exotoxin.
In bullous impetigo, the separation of the epidermis is at the subgranular layer and due to
an exotoxin (exfoliatoxins A-D) produced by staphylococci, which is the pathologic
organism present in cases of bullous impetigo. The target molecule is desmoglien 1.

In impetigo, isolation of methicillin-resistant S aureus can be very high.

On histologic examination, the lesions in all presentations reveal a subcorneal


neutrophilic infiltrate. Granular layer separation is noted in the bullous disease.

Nursing D