Causes and pathogenesis of streptoderma

Streptoderma is a disease that almost every one of us has encountered, although not everyone suspected it. The causes and pathogenesis of streptoderma are in many respects similar to the etiology and mechanism of development of other infectious diseases, but still has its own characteristics. A high prevalence of infection can not but alarm. [1], [2]Belonging to the category of skin diseases, this pathology has a large variety of its manifestations and is far from being harmless, most often affecting children and people with weak immunity.

Is it an infection?

How many of us, having discovered a wound in the nose or  irritation in the corners of the lips, popularly called “zadyoy”, suspect an infectious disease? Actually, these may be manifestations of streptoderma - a disease caused by coccal microflora, which includes streptococcus,  pneumococcal staphylococcus, and some other representatives of the bacterial microflora that lives next to us. At the same time, contact with bacteria can be so close and long that one wonders how this person remains healthy for so long.,

Considering the causes and pathogenesis of streptoderma, we are confronted with the fact that although the coccal microflora has a rather large variety, this pathology, like any other infectious disease, has its characteristic pathogens. It is believed that the symptoms of streptoderma occur under the influence of streptococci, affecting mainly the skin, with which the name of the disease.

Streptococci are globular bacteria with a history of more than one millennium. Like other microscopic organisms, they existed even before the appearance of plants, animals, and humans. It is not surprising that for a long time of its development, bacteria have learned to adapt well to various environmental conditions and maintain their appearance, even in the conditions of active struggle with them by people.

Streptococci are considered the "indigenous" inhabitants of our skin and mucous membranes, that is, they coexist with us for the time being without reminding about themselves. For this reason, they are referred to as conditionally pathogenic microflora, whose representatives provoke diseases only under certain conditions, namely, when the body’s defenses are weakened, which allows microbes to actively develop and penetrate into the deeper layers of the skin and mucous membranes.

It should be understood that streptococci is a generic name for various types and strains of bacteria that are similar in structure. However, their action may vary significantly. Some types of streptococci do not carry danger, coexisting peacefully with a person throughout his life. Others may even be helpful in maintaining the body’s normal microflora. But there are those with which most of the infectious diseases (and not only skin) are associated.

These hidden parasites include beta-hemolytic streptococcus group A (Streptococcus pyogenes), which is capable of destroying red blood cells (erythrocytes) and belongs to pyogenic bacteria, along with Staphylococcus aureus. It is pyogenic streptococcus that is considered the main causative agent of streptoderma and other infectious pathologies characterized by a rather severe course (tonsillitis, scarlet fever, endocarditis, glomerulonephritis, etc.).

But what is the peculiarity of this parasite, and how does it affect the tissues of the body, causing their destruction? Studying the pathogenesis of streptoderma and other diseases that Streptococcus pyogenes becomes the culprit, scientists found that beta-hemolytic streptococcus is a bacterium that, during its existence, releases several poisons and toxins that are dangerous to the human body. These include the specific poison streptolysin capable of destroying red blood cell cells, as well as a special enzyme leukocidin, which destroys the cells of the immune system.[3]

In addition, Streptococcus pyogenes synthesizes enzymes streptokinase, hyaluronidase, amylase, proteinase, which help maintain the activity of the microorganism and help destroy healthy tissues along the way of infection. [4]

The fight against such an infringer of health is conducted only with the help of antimicrobial preparations (antiseptics and antibiotics). But resistant to radioactive radiation, Streptococcus group A is also gradually learning to resist antimicrobial drugs. The benefit of strains of pyogenic streptococcus with antibiotic resistance is much less than those among staphylococci and pneumococci.

Risk factors for streptoderma

Skin infections are one of the most numerous groups of skin pathologies. This is due to the large number of their pathogens (bacteria, viruses, fungi, protozoa) that penetrate the upper layers of the skin from the outside or live on the surface of the skin, gaining pathogenic effect only with active reproduction, which is characteristic of coccal microflora.

Usually, human immunity inhibits the active reproduction of cocci, and some low-active individuals do not pose a particular danger. But there is a certain part of microorganisms that can weaken the body's defenses. This is also characteristic of hemolytic streptococcus, which is considered to be the culprit of streptoderma and other infectious pathologies. It turns out that even a good immunity does not always help to avoid the development of the disease, although it significantly reduces its likelihood.

Consideration of the causes and pathogenesis of streptoderma allows us to determine the risk factors that make some people more susceptible to the effects of the infection, while others do not experience problems from the neighborhood with microbes:

• One of the main and most common causes of streptoderma is the presence on the skin surface of small or large lesions that violate the natural protective barrier and allow microbes to penetrate into the body.
• The second reason is insufficient hygiene of the skin and mucous membranes, because the violation of the integrity of the skin is not yet a guarantor of wound infection. But on the other hand, excessive hygiene hygiene can play a cruel joke, disrupting the pH of the skin and thereby reducing its protection against microorganisms.
• Although streptococci have learned to reduce local immunity somewhat, they still have fewer chances of unhindered reproduction when coordinated work of the immune system, while weak general immunity is unlikely to restrain this process.
• Inadequate work of the immune system causes a person to develop allergies. If the latter has the appearance of (rash and itching on the skin), there is a risk of scratching the tissue in violation of the integrity of the skin. But microscopic organisms are able to penetrate even into the smallest wounds, invisible to the naked eye.[5]

But let us dwell on the immune system, since it is the main defender from all sorts of infections, and consider what factors may make its work insufficient to perform the main function:

• As you know, the biggest blow to the immune system is caused by chronic diseases, regularly weakening our body. That is why people with long-term diseases have a higher risk of developing infectious diseases, including streptoderma. The most vulnerable to infection are those who have skin diseases that occur in a chronic form, or internal pathologies in which wounds form on the skin (for example, diabetes mellitus). At the same time, streptoderma, occurring against the background of such diseases, will also be chronic.
• A complete balanced diet, optimally distributed in time, so that the body regularly receives the necessary nutrients it needs to support the work of all systems, including the immune system, reduces the risk of infectious diseases. If the food is irregular, depleted in vitamins and microelements, there is no need to rely on a strong immunity, which means that the risk of infections increases.
• Various kinds of intoxication weaken not only the nervous system, but also other systems of the body, which it controls. It is not surprising that after the poisoning the immunity is noticeably weakened and the person can easily pick up the infection.
• Special attention should be paid to our mental health. The fact that stress factors adversely affect the functioning of the immune system is known to many. But not everyone knows that frequent nervous overstrain can also cause external reactions, so-called autoimmune skin diseases (for example, psoriasis or eczema) in which the barrier function of the skin is disturbed, which gives the infection a wide scope for development.
• Immunity may be reduced during the period of respiratory infectious diseases. Particularly dangerous in this regard are considered viral infections, greatly weakening the immune system. If during and after the illness you do not take measures to restore it after contact with a patient with streptoderma, you can see the skin manifestations of the disease after a few days.

Moreover, streptoderma can be quietly earned during illness. For example, streptoderma after chickenpox  , an acute viral disease with multiple rashes throughout the body, which most people are sick in early childhood, is considered commonplace.

Sores and sores formed on the site of papules and vesicles are an easy way to penetrate the infection, and since they appear in large numbers, it does not cost the indigenous people of the skin and mucous membranes to penetrate them deep into the body in several places, thereby manifesting the development of a severe form of the disease. At the same time, chickenpox can already go down (eruptions appear within 2-9 days), while the first symptoms of streptoderma unexpectedly appear.

Vitamin deficiency (avitaminosis), helminth infection, exposure to negative environmental factors (radiation, chemical and thermal damage, drying effect on the skin of the wind) along with the above factors affect the protective properties of our body and can be considered as risk factors for streptoderma. Thus, you can save yourself from the disease only if both basic conditions are met simultaneously:

• prevention of acute and chronic diseases,
• strengthening immunity, which contributes to good nutrition and an active lifestyle without bad habits,
• skin hygiene.

True, such preventive measures are more relevant for adults and adolescents than for toddlers whose immune system is still in the formative stage, therefore, it cannot cope with the infection on its own.

Who is most often sick?

The causes and pathogenesis of streptoderma help to understand who among the people is at risk. Despite the fact that the statistics claims the presence of streptococci on the skin and mucous membranes of almost 100% of the population of our planet, the disease does not develop at all.

Most often, streptoderma is diagnosed in preschool children due to inadequate immunity and skin features of the child. Children's skin is delicate and thin, so all kinds of microdamages are very easily formed on it. And if we consider that the barrier function of the skin of a child is still weak, the risk of streptoderma, as one of the infections, will be especially high.

In addition, small children do not always carefully observe the hygiene of the hands and face, not to mention other areas of the skin. Those who are not yet able to take care of themselves depend on their parents, and moms and dads often seek to harm their children, who have disrupted the pH of the skin and do not form a strong immune system, in pursuit of excessive cleanliness and sterility.

Women are also at risk, because their skin is also more tender than that of men. This causes frequent damage to the skin, and streptococcus does not cost anything to enter the body through wounds. The risk of infection in adult women and girls increases during pregnancy, when hormonal changes occur in the body of the expectant mother, and the body's defense weakens.

Do not relax and men whose professional activities or hobbies are associated with a greater risk of skin injury, especially hands, where there is always enough bacteria.

Animal and insect bites, scratching, prickly heat and diaper rash, wounds, scratches and burns, cracks formed on excessively dry skin, contribute to the penetration of the infection into the body and increase the risk of streptoderma regardless of gender and age.

It is clear that there is a high risk of infection in people with immunodeficiency, chronic beriberi, chronic diseases, skin diseases of any nature, especially during the period of exacerbation and the appearance of external symptoms.

Is streptoderma contagious or not?

Infectious diseases today there are a great many, and most of them are considered dangerous to others. Not surprisingly, having heard of such an infection as streptoderma, we will have a natural question about whether the disease is transmitted from person to person and what are the ways of infection?

Speaking about the pathogenesis and causes of streptoderma, we mentioned that streptococcus is a bacterium that lives on the surface of the skin and mucous membranes of a person, which means that it does not cost her to change the owner by moving to the body of another person. In a patient, the bacteria on the skin are no longer in a single amount, therefore, upon contact with another person or object, they can remain on the skin and surfaces in large groups, ready for action in appropriate conditions.

Considering the microscopic size of the parasites, we cannot see this, but it is only necessary to touch this cluster of damaged skin, as bacteria seize the opportunity to parasitize the conditions of the human body suitable for their life and reproduction.

Speaking about the ways of infection of Streptococcus pyogenes, it should be noted that in most cases we are talking about the contact route of transmission, which means that not only the skin of the patient, but also bedding, toys, clothes, ie any items of use with which the patient was in contact. This explains the high prevalence of infection in children's groups (kindergartens, nurseries).

The airborne route, in which infection may settle on the mucous membranes of the nose and mouth (especially in the corners of the lips), is also not excluded, but such cases are more rare.

Who is a danger to others? First, patients directly streptoderma, because their skin is a breeding ground for infection, especially in the area of local lesions. Secondly, patients with respiratory infections, for example, sore throat, often caused by Streptococcus pyogenes, can be considered as a source of streptococcal infection. An identical situation is observed with scarlet fever, which is also a serious contagious disease.[6]

The source of infection can be considered not only those people who have skin manifestations of streptoderma, as well as those who got infected, but do not yet know about their illness. A person can be considered contagious from the moment of infection, and the first symptoms can appear only after 7-10 days. At the same time, people who have once had a streptococcal infection may develop immunity to it, and if they become infected again, they will be asymptomatic carriers of the infection.[7], [8]

The same applies to people with strong immunity and lack of damage to the skin. When they come into contact with a sick person, they can become carriers of the infection and be dangerous to others, whose immunity is not so strong, for example, people at risk.

Any dermatologist will say that streptoderma, although it is caused by opportunistic microflora, is a highly contagious disease. And given that strong immunity for many is more a dream than a reality, there remains a great risk of infection if the patient is not isolated. And here the problems begin, because from the beginning of the infection until the first signs of the disease usually take about a week, it means that during this period the carrier could infect other people who also will not have symptoms within 7-9 days.

For this reason, in large children's groups, when a case of streptoderma is detected, quarantine is prescribed, which lasts about 10 days. During this period, all infected people already have symptoms of the disease, and children do not attend educational institutions and the pool until they are completely cured. It is desirable to limit the stay of the patient, as well as those who care for him, in any public places, so as not to contribute to the spread of infection.

How many streptoderma are contagious? Based on the fact that the infection has external manifestations, having the possibility of transmission by contact and household contact, doctors believe that a person remains infectious from the moment of infection until the disappearance of the characteristic signs of the disease (during treatment, the symptoms go away in 3-14 days). The disappearance of external symptoms speaks of stopping the infection, i.e. A marked decrease in its activity and the death of most microbial particles. Inactive surviving individuals remain relatively safe inhabitants of the skin and mucous membranes and do not bear danger to others.

But we have already noted that in people with weak immunity and chronic diseases, streptoderma can take a long time with periods of remission and exacerbation of the disease. During the latent course, such patients are considered non-infectious, but when acute symptoms appear, they again become dangerous to others. Such a person becomes a permanent source of infection for loved ones.

Having studied the pathogenesis and causes of streptoderma, it can be concluded that even conventional opportunistic microorganisms that are familiar to us, our close and seemingly quite safe "neighbors" under certain conditions can be the worst enemies that can cause more or less serious violations of human health. Mankind does not yet know the ways of peaceful coexistence with bacteria, except for maintaining strong immunity, which does not allow germs to multiply on the surface and inside the body. So, it is not yet time to relax and stop monitoring your health.