Diagnosis of streptoderma in a child

In order to diagnose streptoderma in children, it is necessary to consult a doctor. This may be a local pediatrician, a dermatologist, an infectious diseases specialist, and a bacteriologist. To begin with, it is recommended to contact your local pediatrician, who will prescribe the necessary examination, and, if necessary, refer you to other specialists. Diagnostics should be comprehensive - this is both laboratory methods and instrumental diagnostics. Differential diagnosis is used, in particular, in most cases it becomes necessary to differentiate streptoderma from other diseases of bacterial or fungal origin, as well as from various pyodermas, eczema, from herpes.

The diagnosis is based on laboratory diagnosis, which consists in accurately identifying the qualitative and quantitative characteristics of the bacteria detected (bacteriological examination). The diagnosis of streptoderma is confirmed if streptococcus is secreted as a pathogen. As an additional method of research, it is recommended to conduct an analysis of antibiotic sensitivity. [1]It allows you to choose the most effective antibacterial drug and its optimal dosage. Usually carried out in conjunction with bacteriological seeding.

Analyzes

Bacteriological seeding is considered as the main method of laboratory diagnosis of streptoderma, both in children and adults. The principle of the method is that samples of skin scraping, or swabs from the surface of the affected area, are seeded on nutrient media, incubated, and then a pure culture is isolated with its subsequent identification. During the study, it is important to determine the exact species and genus of the microorganism, its quantity. [2]Together with bacteriological seeding, it is advisable to carry out an analysis of antibiotic sensitivity (the selected microorganism is selected for the preparation that will be most effective, and its optimal dosage is calculated). Based on this, prescribe further treatment. This approach is considered the most rational, because it allows you to make the treatment as effective as possible.[3], [4]

Apply and other research methods. The gold standard for laboratory diagnosis is a clinical, or complete blood count,, biochemical blood test. Often, these analyzes are used at the stage of early diagnosis, allow to twist the overall picture of the pathology, the focus of the main pathological processes in the body. This analysis allows you to effectively and accurately assign additional methods of research.

Sometimes they perform a blood test or a smear from the affected area for sterility. [5], [6]The presence of bacteria is indicated by conventional signs:

• + means a small amount of bacteria
• ++ means a moderate number of bacteria
• +++ means high levels of bacteria
• ++++ is a sign of bacteremia and sepsis.

The presence of any of these signs requires an extended diagnosis, and is the basis for the purpose of bacteriological examination.

An important diagnostic value may be microscopy of a smear from the affected area. This analysis allows the structure of the pathology. With this analysis, not only bacteria are detected, but also cellular structures. It is also possible to identify hemolysis zones, indicating the defeat of the blood vessels. It is possible to timely identify the decay products of individual tissues, to identify necrosis zones in a timely manner Other methods are also used, but they are used mainly in conditions of dermatovenerologic dispensaries, or other specialized departments and hospitals.

Analyzes of antibodies to streptolysin O (ASO) are not important in the diagnosis and treatment of streptoderma in a child, because the ASO reaction is weak in patients with streptococcal impetigo (Kaplan, Anthony, Chapman, Ayoub & Wannamaker, 1970; Bisno, Nelson), Waytz, & Brunt, 1973) [7], presumably because the activity of streptolysin O is inhibited by skin lipids (Kaplan & Wannamaker, 1976) [8]. In contrast, anti-DNase B levels are elevated and, thus, can be evidence of a recent streptococcal infection in patients suspected of having post-streptococcal glomerulonephritis.

Instrumental diagnostics

Instrumental diagnostics is an important additional method of research, without which it is impossible to make an accurate diagnosis. Instrumental diagnostic methods are used depending on the situation, if you suspect any concomitant pathology. From instrumental methods, ultrasound of the kidneys, bladder, stomach, intestines, heart, rheography, electrocardiogram, Doppler, X-rays can be used. Computed or magnetic resonance imaging, gastroscopy, colonoscopy, irrigoscopy, gastroduodenoscopy, endoscopy, and other methods may be required, especially if you suspect concomitant gastrointestinal diseases.

With the help of these methods, they track changes in dynamics, obtain data on the structure and functional features of the studied organs. This makes it possible to judge the effectiveness of therapy, prescribe a particular treatment, make a decision about the appropriateness of additional procedures, treatment of comorbidities.

Differential diagnostics

With the help of differential diagnosis methods, it is possible to differentiate signs from one disease from signs of another disease. Streptoderma must be differentiated, first of all, from the herpes of  [9], atopic dermatitis [10]and from other types of bacterial diseases, from pyoderma of various origin, from fungal and protozoal infections.[11], [12]

The main method of differential diagnosis is bacteriological culture, during which the microorganism that became the causative agent is isolated and identified. When a fungal infection secretes a fungus, which is characterized by continuous growth, white bloom. Protozoal, parasitic infection is quite easily detected by conventional microscopy.

Streptococcal infection is more severe, prone to relapse. In most cases, streptoderma, unlike conventional pyoderma, occurs chronically, with periodic exacerbations. Bubbles form with turbid, green contents. Numerous erosions are formed, ulcers that heal and form crusts. Often, the infection affects the mucous membranes: lips, corners of the mouth. Painful cracks and conflicts may appear.[13]

How to distinguish herpes from streptoderma in a child?

Many parents wonder how to distinguish herpes from streptoderma in a child? Not surprisingly, at first glance, the manifestations of these diseases are very similar. But it turns out that there are a number of differences in the clinical picture of pathology.[14]

Herpes begins with severe itching, showing, often accompanied by severe pain. Then a red spot appears, like swelling. It appears a large number of bubbles, the size of a pin head. The bubbles are filled with clear serous contents. After 3-4 days the bubbles dry up, form wet erosion. Also, the disease is often accompanied by inflammation of the regional lymph nodes, fever, chills, headache, malaise, muscle and joint pain (typical signs of a viral infection). The temperature can rise to 38-39 degrees. After 2-3 days the crusts disappear, epithelization occurs. The duration of the disease is usually 1-2 weeks. When streptoderma temperature rises rarely, often the child feels relatively well, malaise and weakness is not observed.

Herpes is most often located around the natural openings - the nose, lips, ears, eyes, often affects the mucous membranes. Bacterial infection, in particular, streptoderma in children is usually localized throughout the body.