impetigo
Introduction
Introduction to impetigo Impetigo is a highly contagious, bacterial skin infection that occurs in younger children, especially babies. The disease mainly affects the child's mouth and nose skin and the baby's diaper area, and sometimes it can appear in other parts of the body. Bacteria can enter the body through wounds, insect bites or certain skin diseases such as atopic eczema and hemorrhoids, causing impetigo. basic knowledge Sickness ratio: 0.0001%-0.0005% Susceptible people: Occurs in younger children, especially babies. Mode of infection: contact with infection. Complications: acute lymphangitis acute lymphadenitis glomerulonephritis
Cause
Cause of impetigo
Pathogen infection (65%):
The main pathogens are coagulase-positive staphylococcus type 71 and its group II, but also can be type 80/81 and class A-type hemolytic streptococcus, mostly 3/13, 12, 8, 49 and 57, some of which are Nephritis, such as type 49 and M2; can also be a mixed infection of the two, group II 71 Staphylococcus can produce a kind of epidermal release toxin, so that the epidermal granule layer is loosened, resulting in bullae and disease, also There are people infected with streptococci or white staphylococcus.
Low immunity (5%):
Children with impaired immune function, delicate skin, poor disease resistance, scratching, trauma, poor skin hygiene, pruritic skin diseases, etc., the temperature is high, when the humidity is high, bacteria can easily invade, which can promote the disease.
Other incentives (30%):
The body's weak or suffering from pruritic skin diseases, such as local skin resistance, or personal stimulation due to occupational relationships, trauma, etc., are the cause of this disease.
Prevention
Impetigo prevention
1. Popularize health education, especially for nurseries, kindergarten nurses, and regularly carry out publicity and education on the prevention and treatment of this disease.
2, pay attention to cleanliness, often trim nails, remove dirt, wash hands frequently, bathe frequently, change clothes frequently, damage to small skin, should be protected and treated in time to prevent infection, and actively treat primary pruritic skin disease.
3, exercise, reasonable nutrition, improve the body's resistance, delivery room, baby room, nursery school or kindergarten should be timely isolation treatment, clothing, bedding, towels, utensils, toys, dressing utensils and dressings should be promptly disinfected, the above If the staff of the institution suffers from this disease, they should leave the work temporarily. Patients with pyoderma should not enter the public bath and swimming pool.
Complication
Impetigo complications Complications acute lymphangitis acute lymphadenitis glomerulonephritis
Severe cases may be associated with lymphangitis, lymphadenitis, caused by streptococcus can cause glomerulonephritis.
Symptom
Impetigo symptoms Common symptoms Spotted rash yellow greasy pustules Skin oil too much inner thigh erythema rosy itching scalp sagging spleen deficiency nervous
Bullous impetigo (bullous impetigo): The initial damage is from rice to soybean big blisters. The content is yellow and clear at first, and then becomes cloudy gradually, and increases like broad beans or larger, thin wall, and blistering is lighter. After a few days, the blister wall is loosened by tension. Due to the positional relationship, the blister fluid deposits on the bottom of the blister, which is a semilunar-like fallic pustule, which is consciously itching. After the blister breaks, it forms a bright red smashed surface, and the blister fluid gradually dryes and pale yellow. The skin, after the peeling off, leaves brown spots and leaves no scars.
Impetigo vulgaris: The initial lesion is red rash, which rapidly develops into blisters or pustules. The blister wall is thick, the blister fluid is turbid, the surrounding redness is significant, and the blister is sallowed or yellowish. .
Bullous impetigo, pustular vulgaris is common in exposed areas such as face and limbs. It is easy to be infected and has its own vaccination. It can often be popular in rural and child care units. After a short period of time, it can also be caused by Exposure to infection, self-inoculation, scratching or friction and other factors cause skin lesions to spread, mainly in children, more common in 2 to 7 years old, adults can also be infected, often in summer and autumn, generally no systemic symptoms, large spread area There may be fever and increased total white blood cells, severe cases may be associated with lymphangitis, lymphadenitis, caused by streptococcus can cause glomerulonephritis.
Examine
Examination of impetigo
The total number of white blood cells, neutrophils can be increased, the skin lesions are edema, the mucin can be increased, and return to normal after recovery. The anti-O" caused by streptococcus is generally increased, and the pus culture is mostly Staphylococcus aureus. About 90%, the plasma coagulation test is mostly positive, the phage typing is the most in group II 71, up to 57%, and the drug sensitivity test is mostly resistant to penicillin.
The pustule is located under the horn layer and contains most neutrophils, fibrin and cocci. There are a few spinous processes in the bottom of the bullae, sponge formation and neutrophil infiltration in the spine, and obvious vasodilation in the upper part of the dermis. Edema and neutrophil and lymphocyte infiltration.
Diagnosis
Diagnosis of pustulosis
diagnosis
Bullous impetigo is characterized by superficial thin-walled bullae, which forms a bright red smashed surface after breakage, forms a thin sputum after drying, and remains brown pigmentation after sputum removal. The lesion of pemphigus vulgaris is characterized by blister The wall is thicker, the edge has a significant redness, and after drying, it forms a thick yellow sputum. Combined with the medical history, the diagnosis is not difficult.
TCM pathogenesis and syndrome differentiation: This disease is caused by the evil of dampness and heat, invading the lungs, stagnation on the skin, heat in the lungs, spleen and stomach are wet, and the two qi and qi are mixed, and the inside and outside are fighting, and the disease is poisonous.
Dialectical classification:
1. Shushi heat accumulates pustules dense, yellowish and surrounded by red, smashed red, itchy, near lymph nodes, body heat, dry mouth, do not drink, urine yellow, dry stool, red tongue, yellow coating Greasy, slippery or slippery.
2. Spleen deficiency and wetness test pustule sparse, gray or yellowish, smashed face reddish, consciously itching, eating less, staying sallow, pale complexion, loose stools, pale tongue, white or greasy fur, fine pulse.
Differential diagnosis
Should pay attention to the identification of the following diseases:
1. Chickenpox has fever and other systemic symptoms. The rash is distributed to the heart. It can affect the mucous membrane. The main damage is the blister of mung bean to soy bean size. The surrounding is surrounded by a large blush, generally no pustules and purulent sputum. Winter and spring.
2. The epidemic eczema lesions are diffuse flushing, the boundary is unclear, the rash is pleomorphic, and there is no certain predilection. The incidence has nothing to do with age and season.
