Streptoderma in children: causes and symptoms

Streptoderma is one of the types of skin pyoderma (diseases caused by bacterial infection). Streptoderma in children  is caused by a specific type of microorganism - bacteria of the Streptococcus genus. These are gram-negative cocci-shaped sticks (round shape), combined in clusters. Most often develop on the background of reduced immunity, impaired microflora, and manifest various skin rashes, inflammation, irritation. It can be both local manifestations at the level of the skin, and systemic manifestations at the level of the whole organism with the formation of new foci of the infectious process, inflammatory and necrotic areas, infiltrates.

Epidemiology

The number of cases of streptococcal pyoderma as of 2005 in children under 15 years of age is estimated at 111 million. [1]According to statistics, in about 45% of cases of rapid development of streptoderma, with a short incubation period, occurs against a background of reduced immunity, increased pain in a child, and general weakness of the body.

The appearance of streptoderma in these children is accompanied by diseases such as caries, pulpitis, pharyngitis, tonsillitis, bronchitis. Many children (up to 20%) have chronic foci of infection in the throat and mouth. [2]These can be chronic dental diseases (12%), gums (10%), adenoids (2-3%), inflamed tonsils (5-6%), fistulae and follicles (up to 7%), clogged maxillary sinuses (up to 5% ). In other cases, it is a variety of acute and chronic diseases of the upper and lower respiratory tract.

In 65.5% of cases of streptoderma, the accompanying factors were hormonal imbalance, immune imbalance, increased reactivity, and body sensitization. In about 35% of cases, streptoderma develops after a child’s stay in inpatient hospital care (hospital infection). In about 5-10% of cases, the disease develops against the background of general intoxication of the body, in 70% of cases - against the background of a violation of the microflora of the skin, mucous membranes, and oral cavity. Approximately 15-20% of cases are due to hormonal and immune changes. In 25% of cases, the development of the disease is associated with underweight, vitamin deficiency, minerals, and individual nutrients. In 30% of cases, the development of the disease is associated with overweight and increased body mass index.

The peak incidence of streptoderma occurs in children aged 2 to 5 years, but can also be observed among older children and adults, whose occupation may lead to cuts or abrasions on the skin (Adams, 2002; Fehrs, et al., 1987; Wasserzug, et al., 2009). There are no differences in susceptibility between girls and boys.[3]

Causes of the streptoderma in a child

The reason for the development of streptoderma (main) - one. This is a bacterial infection, but rather a microorganism belonging to the genus Streptococcus. Its intensive reproduction on the background of reduced immunity and impaired body resistance, causes an intense spread of the inflammatory and infectious process, its progression. Other causes may indirectly influence - it is certainly low immunity, disruption of normal metabolic processes in the body, lack of vitamin, trace elements, mineral components. Contact with an infectious patient can also cause streptoderma. This may also include a child getting into the center of infection (for example, into an epidemic zone, or a nosocomial infection prosperity zone), failure to comply with sanitary and hygienic norms and requirements, poor housing conditions that contribute to the spread of infection.[4]

Risk factors

At risk are children with reduced immunity, unvaccinated children, or children vaccinated without complying with the rules of vaccination, who have had vaccine complications, often ill children, children with long-term recurrent, recurrent diseases, chronic infection, and allergic reactions. However, it is worth noting that the lack of vaccination also adversely affects the state of health, and can cause the development of both serious infectious diseases and streptoderma.

These include children with various foci of infection, with chronic infectious and somatic diseases, including dental and dermatological profile. Children with avitaminosis are at risk, especially if the body is deficient in vitamins C and D. As shown in a number of studies and clinical cases, vitamin D deficiency is often associated in children with the development of infectious diseases of varying severity and localization. It is also worth noting that with a deficiency of this vitamin, the diseases are much more difficult and entail numerous complications.[5], [6], [7]

In addition, risk factors include antibiotic therapy, the use of certain drugs with severe toxic effects on the body (antiparasitic, antifungal therapy, chemotherapy, tuberculosis treatment). Strong painkillers, anesthesia, anesthesia, and even local anesthesia act in a similar way. Prolonged stay of the child in the hospital due to various diseases can also cause the development of streptoderma, since in almost all hospitals there is a hospital infection. [8]People at risk are after radiation therapy, chemotherapy, after long hospitalization, surgery, transplantation and blood transfusion.

Also at risk include children born with various types of intrauterine infection, birth injuries, weakened children, children with low body mass, underdevelopment or functional immaturity of the body, children born prematurely, or in connection with the operation of cesarean section.

Pathogenesis

The basis of pathogenesis is the development of a bacterial infection on the skin. The main causative agent of streptoderma in a child is streptococcal infection. It develops, as a rule, against a background of reduced immunity, a general decrease in body resistance and endurance, with a lack of vitamin or minerals. As a rule, in the early stages of low-grade bacterial invasion, affects only the superficial layers of the skin. However, gradually the infection affects the deeper layers of the skin, respectively, it becomes more difficult to cure. It is worth noting that either the surface layers (epidermis) or the deep layers (the dermis itself) are most often affected. In rare cases, the subcutaneous fat is involved in the inflammatory-infectious process.

The surface structures of streptococci, including the M protein family, the hyaluronic capsule, and fibronectin-binding proteins, allow bacteria to adhere, colonize, and penetrate human skin and mucous membranes [9], [10]under various environmental conditions.[11]

Is streptoderma contagious in children?

Often you hear the question, is streptoderma contagious in children? Let's understand this question. Streptoderma is caused by a bacterial infection, and more specifically, by bacteria of the genus Streptococcus. Any bacterial infection a priori means a certain level of infectiousness, since it has the properties to spread and be transmitted from one person to another, regardless of whether it is sick in an open form, or hidden, or is simply a bacteriocarrier.[12]

But the fact is that in one child who was in contact with an infectious patient, the disease can manifest itself, whereas in the other it will not manifest. It all depends on the state of immunity, as well as on the susceptibility of the body to infectious diseases. Each person has their own level of susceptibility. Therefore, in any case, it is necessary to proceed from the fact that the disease is contagious. With the development of the acute form of the disease, it is better to refrain from contact with other children, to withstand quarantine. This will help not only not to infect other children, but will also facilitate the easier and faster course of the disease, without any complications, since there will be no extraneous microflora, which only aggravates the situation.

How is streptoderma transmitted in children?

Streptoderma is transmitted in the same way as a number of other diseases of bacterial origin through direct contact with an infectious patient. The disease can be transmitted by contact, handshake, when using the same linen, dishes, hygiene items. In some cases, with a particularly severe form of the disease, it can be transmitted by airborne droplets.[13]

If your child is sick, you definitely need to know how streptoderma is transmitted in children to avoid infecting other children. Make sure your child is not in direct contact with other children. Teach him the basic rules of hygiene: before walking and after it, wash hands thoroughly with soap, treat the skin with alcohol, alcohol-containing tinctures or lotions, or other antiseptics. This will reduce skin contamination by pathogenic microflora.

You also need to understand that some time after the child has had a disease, he still remains a carrier of bacteria, and the likelihood of infecting a healthy child is still there. Therefore, doctors recommend to maintain a 2-week quarantine, and to prevent the child with streptoderma from contacting other children. Quarantine should be kept even after recovery, because the bacteria are still stored in the body, and can be a danger to other children.

Although not all doctors share this view. Some doctors are convinced that a child with streptoderma can safely communicate with other children. And he does not pose any danger to them. This is due to the fact that a disease can develop only in a child who has preconditions for this, and predisposition, for example, low immunity, or impaired natural microflora with reduced colonization resistance. Otherwise, the body itself will resist infection and will not allow the development of the disease.

Symptoms of the streptoderma in a child

The incubation period of streptoderma in children is determined by many factors. On average, it is from 1 to 10 days. So, if the immune system and the natural resistance of the body are normal, or at a high level, the disease can develop after 7-10 days, and even more after contact with a person with streptoderma.

Often there are cases when the immune system suppresses the infection, and does not allow it to develop. In such cases, the disease does not develop at all. With a weak immunity, high susceptibility, the disease can develop much faster. There are cases in which the incubation period of streptoderma in frequently ill children was 1-2 days (the disease developed rapidly, almost instantly after contact with the infection).

The main symptom is the development of a purulent inflammatory process on the skin surface. This may first be a slight redness, irritation, which gradually develops into a weeping, red (inflamed) area. It is impossible to touch this area due to increased pain. Often the process is accompanied by an increase in body temperature, the development of a local reaction in the form of itching, redness, formation of an abscess or compaction. Separate blisters can form that are filled with purulent contents (bacteria, dead skin cells, leukocytes and lymphocytes, other blood cells that have migrated to the inflammatory focus are included).

In a more advanced form (chronic) develop in the form of moist, non-healing ulcers, which are characterized by increased pain. Tendency to bleeding, long-term non-healing, progressive growth. In the foci of inflammation may be involved more and new skin. Often, ulcers merge with each other. At the bottom of the ulcer can be observed purulent and necrotic areas filled with purulent masses. On the sides of the formed areas of granulation. As a rule, such ulcers rise above the surface of healthy skin, there are signs of infiltration.

The first signs of how streptoderma begins in children

If the child has been in contact with an infectious patient, he may develop streptoderma during the incubation period. Therefore, be sure to ask how begins streptoderma in children. The first signs need to be monitored closely, because it is on how early they are detected that the success of further treatment of the disease depends. It is no secret that the success of any treatment depends on timely treatment started.

If the child was in contact with the patient, you need to treat him much more closely. It is necessary to examine the body daily for the appearance of the first signs of skin damage with a bacterial infection. So, streptococcus, as a rule, mainly affects the surface layers, so the first reactions will touch the surface layers. First, there is redness, which may itch very much, or it may not. But later it develops into a small boil, or sore.[14]

Pus develops, serous exudative reaction increases. The area around the affected area becomes compacted, inflamed and painful. Often develops severe swelling. A flabby bubble (conflict) may form on the surface. The rupture of this bubble, as a rule, entails the formation of new foci of the inflammatory process.

Temperature at streptoderma in children

In children with streptoderma, the temperature may rise, since streptoderma is an infectious disease caused by bacterial microflora. Temperatures up to 37.2 (subfebrile temperature) usually indicate the presence of an infection in the body, and also that the body has activated all the resources to fight the infection. This indicates that the immune system, the system of nonspecific resistance, is in an active state and provides reliable protection against the progression of infection. In some cases, low-grade fever can be a sign of regenerative processes in the body. As a rule, it is not necessary to take any action at this temperature, but you need to carefully monitor the child and monitor the temperature graph - measure the temperature at least 2 times a day, at the same time, and record the indicators in a special temperature sheet. This can be very informative and useful for the attending physician, will allow to track the status of the child in dynamics. But this does not exclude the need for consultation with a doctor.[15]

If the temperature rises above 37.2 (febrile temperature) - this is usually a cause for concern. This means that the body is in a tense state, and it lacks the resources to fight infection. In this case, it is necessary to give the child an antipyretic as a symptomatic therapy. It is better to give simple tools that are active ingredients - analgin, aspirin, paracetamol. Infant formulas, suspensions, and other antipyretic drugs for children are best excluded, since they can cause additional undesirable reactions, getting into a tense organism, and this, in turn, can aggravate the condition, causing the progression and spread of streptoderma.

If the temperature in a child rises above 38 degrees, urgent measures should be taken to reduce the temperature. Any febrifuge will do. They can also be combined with classic anti-inflammatory drugs. It is not recommended to allow the child to increase the temperature above 38 degrees, because, above this temperature, the child, unlike an adult, already begins to denature blood proteins. It is also worth noting that at temperatures above 38 degrees, burdened by a bacterial infection, emergency medical care may be required. If the child’s condition worsens, it is impossible to delay the emergency call. If the temperature does not decrease within 3 days, hospitalization may be required. The cases of any, even a slight increase in temperature in children on the background of streptoderma, should be immediately reported to your doctor.

Streptoderma in an infant

The appearance of streptoderma signs in an infant is quite dangerous, since streptoderma is a bacterial disease. In the infant, the natural microbiocenosis is not yet formed. In infants, colonization resistance of the mucous membranes and skin is completely absent, and immunity is also not formed. Up to three years the microflora and immunity of the child are identical to the immunity and microflora of the mother. Own microflora is not yet, it is at the stage of formation, so the body is most vulnerable and susceptible to any type of infection, including streptococcal.[16]

A characteristic feature of streptoderma in an infant is that it proceeds hard, often accompanied by fever, and progresses rapidly, covering more and more new skin areas. In some cases, streptococcal infection can also affect the mucous membranes. Quite often, a fungal infection joins, which aggravates the situation and aggravates the child’s condition. Streptoderma in a child can cause intestinal dysbacteriosis as a complication, which leads to serious digestive disorders, stool. The disease is characterized by a tendency to chronization and recurrent course.

When the first signs of the disease appear, it is necessary to consult a doctor as soon as possible and conduct appropriate treatment from the first days. If complications or progression of the disease appear, hospitalization may be required. Self-medication can not be engaged, all appointments should be done only by a doctor.