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 microorganisms - bacteria of the genus Streptococcus. These are gram-negative coccoid (round) rods, combined into clusters. Most often they develop against the background of reduced immunity, disturbed microflora, and are manifested by various skin rashes, inflammation, irritation. These can be both local manifestations at the skin level, and systemic manifestations at the level of the whole body with the formation of new foci of the infectious process, inflammatory and necrotic areas, infiltrates.

Epidemiology

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

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

In 65.5% of cases of streptoderma development, the accompanying factors were hormonal imbalance, immune imbalance, increased reactivity, and sensitization of the body. In about 35% of cases, streptoderma develops after the child has been hospitalized (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 impaired microflora of the skin, mucous membranes, and oral cavity. Approximately 15-20% of cases are caused by hormonal and immune changes. In 25% of cases, the development of the disease is associated with insufficient weight, deficiency of vitamins, minerals, and individual nutrients. In 30% of cases, the development of the disease is associated with excess body weight and an increased body mass index.

The peak incidence of streptococcal impetigo occurs in children aged 2 to 5 years, but may also occur in older children and adults whose occupations may result in cuts or abrasions of the skin (Adams, 2002; Fehrs, et al., 1987; Wasserzug, et al., 2009). There is no difference in susceptibility between girls and boys. [ 3 ]

Causes streptoderma in a child

There is one main reason for the development of streptoderma. It is a bacterial infection, or more precisely, a microorganism belonging to the genus streptococcus. Its intensive reproduction against the background of reduced immunity and impaired resistance of the body causes an intensive spread of the inflammatory and infectious process, its progression. Other reasons can also indirectly influence - this is certainly low immunity, disruption of normal metabolic processes in the body, lack of vitamins, microelements, mineral components. Contact with an infectious patient can also cause the development of streptoderma. This can also include the child's entry into a source of infection (for example, into an epidemic zone, or a zone of prosperity of a hospital infection), failure to comply with sanitary and hygienic norms and requirements, poor housing conditions that contribute to the spread of infection. [ 4 ]

Risk factors

The risk group includes children with reduced immunity, unvaccinated children, or children vaccinated without observing vaccination rules, who had complications from vaccinations, frequently ill children, children with long-term, recurring diseases, chronic infections, allergic reactions. However, it is worth noting that the lack of vaccination also has a negative impact on health, and can cause the development of both severe infectious diseases and streptoderma.

This includes children with various foci of infection, with chronic infectious and somatic diseases, including dental and dermatological profile. The risk group includes children with vitamin deficiency, especially if the body has a deficiency of vitamins C and D. As a number of studies and clinical cases show, 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, diseases are much more severe and entail numerous complications. [ 5 ], [ 6 ], [ 7 ]

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

Also at risk are children born with various types of intrauterine infection, with birth injuries, weakened children, children with low body weight, underdevelopment or functional immaturity of the body, children born prematurely or as a result of a cesarean section.

Pathogenesis

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

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

Is streptoderma contagious in children?

One often hears the question, is streptoderma contagious in children? Let's look into this issue. Streptoderma is caused by a bacterial infection, or more precisely, by bacteria of the genus streptococcus. Any bacterial infection a priori means a certain level of contagiousness, since it has the ability to spread and be transmitted from one person to another, regardless of whether the person is ill in an open or latent form, or is simply a carrier of the bacteria. [ 12 ]

But the fact is that one child who has been in contact with an infectious patient may develop the disease, while another will not. Everything depends on the state of the immune system, as well as the body's susceptibility to infectious diseases. Each person has their own level of susceptibility. Therefore, in any case, you need to proceed from the fact that this disease is contagious. When an acute form of the disease develops, it is better to refrain from contact with other children and remain in quarantine. This will not only help avoid infecting other children, but will also contribute to an easier and faster course of the disease, without any complications, since there will be no foreign microflora that 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 through contact, shaking hands, using the same underwear, dishes, and 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 that your child is not in direct contact with other children. Teach him basic hygiene rules: before and after a walk, wash your hands thoroughly with soap, treat the skin with alcohol, alcohol-containing tinctures or lotions, or other antiseptics. This will reduce skin contamination with pathogenic microflora.

It is also important to understand that some time after the child has recovered, he or she still remains a carrier of the bacteria, and the probability of infecting a healthy child still remains. Therefore, doctors recommend maintaining a 2-week quarantine and not allowing a child with streptoderma to come into contact with other children. Quarantine should be maintained even after recovery, since the bacteria still remain in the body and can pose a danger to other children.

Although not all doctors share this point of 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 the disease can only develop in a child who has the prerequisites and predisposition for this, for example, low immunity, or impaired natural microflora with reduced colonization resistance. Otherwise, the body itself will resist the infection and will not allow the disease to develop.

Symptoms 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. Thus, if the immunity and natural resistance of the body are normal or at a high level, the disease can develop after 7-10 days, or even more after contact with a person sick with streptoderma.

There are often 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 weak immunity, high susceptibility, the disease can develop much faster. There are known cases in which the incubation period of streptoderma in children who are often ill 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 initially be a slight redness, irritation, which gradually develops into a wet, red (inflamed) area. This area cannot be touched 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, the formation of an abscess or compaction. Separate blisters filled with purulent contents may form (the composition includes bacteria, dead skin cells, leukocytes and lymphocytes, other blood cells that have migrated to the site of inflammation).

In a more advanced form (chronic), they develop as weeping, non-healing ulcers that are characterized by increased pain. Tendency to bleeding, prolonged non-healing, progressive growth. More and more new areas of skin may be involved in the foci of inflammation. Often, ulcers merge with each other. At the bottom of the ulcer, purulent and necrotic areas filled with purulent masses may be observed. Granulation areas form on the sides. As a rule, such ulcers rise above the surface of healthy skin, signs of infiltration appear.

The first signs of how streptoderma begins in children

If a child has been in contact with an infectious patient, he or she may develop streptoderma during the incubation period. Therefore, it is imperative to inquire about how streptoderma begins in children. The first signs should be monitored carefully, since the success of further treatment of the disease depends on how early they are detected. It is no secret that the success of any treatment depends on timely treatment.

If the child has been in contact with a sick person, you need to treat him much more carefully. It is necessary to examine the body daily for the first signs of skin damage by a bacterial infection. Thus, streptococcus, as a rule, affects mainly the superficial layers, so the first reactions will concern the superficial layers. At first, redness appears, which may itch a lot, or may not itch. But later it develops into a small abscess, or ulcer. [ 14 ]

Pus develops, and the serous-exudative reaction increases. The area around the affected area becomes compacted, inflamed, and painful. Often, severe edema develops. A flaccid blister (phlyctena) may form on the surface. Rupture of this blister, as a rule, entails the formation of new foci of the inflammatory process.

Temperature in children with streptoderma

In children with streptoderma, the temperature may rise, since streptoderma is an infectious disease caused by bacterial microflora. A temperature of up to 37.2 (subfebrile temperature) usually indicates the presence of an infection in the body, as well as the fact that the body has activated all resources to fight the infection. This indicates that the immune system, the non-specific resistance system, is active and provides reliable protection against the progression of the infection. In some cases, subfebrile temperature may be a sign of regenerative (restorative) processes in the body. As a rule, at such a temperature, no action is needed, but you need to carefully monitor the child and track the temperature chart - measure the temperature at least 2 times a day, at the same time, and record the indicators on a special temperature sheet. This can be very informative and useful for the attending physician, it will allow you to track the child's condition 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 does not have enough resources to fight the infection. In this case, you need to give the child an antipyretic as symptomatic therapy. It is better to give simple drugs that act as active ingredients - analgin, aspirin, paracetamol. It is better to exclude baby formulas, suspensions, and other antipyretic drugs for children, since they can cause additional adverse reactions when they enter a tense body, and this, in turn, can aggravate the condition, causing the progression and spread of streptoderma.

If the child's temperature rises above 38 degrees, it is necessary to take urgent measures to reduce the temperature. Any antipyretic drugs will do. They can also be combined with classic anti-inflammatory drugs. It is not recommended to allow the child's temperature to rise above 38 degrees, since above this temperature, in a child, unlike an adult, denaturation of blood proteins already begins. It is also worth noting that at a temperature above 38 degrees, aggravated by a bacterial infection, emergency medical care may be required. If the child's condition worsens, you cannot delay calling an ambulance. If the temperature does not decrease within 3 days, hospitalization may be required. Any cases of even a slight increase in temperature in children against the background of streptoderma must be immediately reported to the attending physician.

Streptoderma in an infant

The appearance of signs of streptoderma in an infant is quite dangerous, since streptoderma is a bacterial disease. In an infant, the natural microbiocenosis has not yet been formed. In an infant, colonization resistance of the mucous membranes and skin is completely absent, and immunity is also not formed. Up to three years, the child's microflora and immunity are identical to the mother's immunity and microflora. There is no microflora of its own yet, it is at the stage of formation, so the body is maximally vulnerable and susceptible to any type of infection, including streptococcal. [ 16 ]

A characteristic feature of streptoderma in infants is that it is severe, often accompanied by fever, progresses rapidly, affecting more and more areas of the skin. In some cases, streptococcal infection can also affect the mucous membranes. Fungal infection often joins in, which worsens the situation and aggravates the child's condition. Streptoderma in children can cause intestinal dysbacteriosis as a complication, which entails serious digestive and stool disorders. The disease is characterized by a tendency to become chronic and recurrent.

When the first signs of the disease appear, you need to see a doctor as soon as possible, and carry out appropriate treatment from the first days. If complications arise or the disease progresses, hospitalization may be required. Self-medication is prohibited, all appointments should be made exclusively by a doctor.