Natural history of impetigo

Dajani, Adnan S.; Ferrieri, Patricia; Wannamaker, Lewis W.

doi:10.1172/jci107109

Cited by 75 publications

(5 citation statements)

References 23 publications

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“…As healing begins, the scab shrinks, tethering surrounding skin to heal the eroded base, often without scarring . Without treatment, resolution can take 30 days, and infection of all other household members may occur within 21 days (Box 2).…”

Section: Definitionsmentioning

confidence: 99%

Skin infections in Australian Aboriginal children: a narrative review

Davidson

Knight

Bowen

2019

Medical Journal of Australia

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Summary Impetigo, scabies, cellulitis and abscesses are common in Australian Aboriginal children. These conditions adversely affect wellbeing and are associated with serious long term sequelae, including invasive infection and post‐infectious complications, such as acute post‐streptococcal glomerulonephritis and acute rheumatic fever, which occurs at the highest documented rates in the world in remote Aboriginal communities. Observational research in remote communities in northern Australia has demonstrated a high concurrent burden of scabies and impetigo and their post‐infectious complications. Few data are available for other Australian states, especially for urban Aboriginal children; however, nationwide hospital data indicate that the disparity between Aboriginal and non‐Aboriginal children in skin infection prevalence also exists in urban settings. The Australian National Healthy Skin Guideline summarises evidence‐based treatment of impetigo, scabies and fungal infections in high burden settings such as remote Aboriginal communities. It recommends systemic antibiotics for children with impetigo, and either topical permethrin or oral ivermectin (second line) for the individual and their contacts as equally efficacious treatments for scabies. β‐Lactams are the treatment of choice and trimethoprim–sulfamethoxazole and clindamycin are effective alternatives for treatment of paediatric cellulitis. Abscesses require incision and drainage and a 5‐day course of trimethoprim–sulfamethoxazole or clindamycin. Addressing normalisation of skin infections and the social determinants of skin health are key challenges for the clinician. Research is underway on community‐wide skin health programs and the role for mass drug administration which will guide future management of these common, treatable diseases.

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Section: Definitionsmentioning

confidence: 99%

Skin infections in Australian Aboriginal children: a narrative review

Davidson

Knight

Bowen

2019

Medical Journal of Australia

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“…The natural history of skin sores is that an uncomplicated impetigo heals spontaneously within two weeks [ 15 , 16 ]. Detailed studies of the natural history of impetigo primarily caused by S. pyogenes found that the mean time to spontaneous healing was 12.6 days, with a range of 6–31 days [ 17 ]. These data and assumptions may not be generalisable to impetigo in non-endemic settings where Staphylococcus aureus is the primary pathogen.…”

Section: Methodsmentioning

confidence: 99%

Scabies and risk of skin sores in remote Australian Aboriginal communities: A self-controlled case series study

et al. 2018

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BackgroundSkin sores caused by Group A streptococcus (GAS) infection are a major public health problem in remote Aboriginal communities. Skin sores are often associated with scabies, which is evident in scabies intervention programs where a significant reduction of skin sores is seen after focusing solely on scabies control. Our study quantifies the strength of association between skin sores and scabies among Aboriginal children from the East Arnhem region in the Northern Territory.Methods and resultsPre-existing datasets from three published studies, which were conducted as part of the East Arnhem Healthy Skin Project (EAHSP), were analysed. Aboriginal children were followed from birth up to 4.5 years of age. Self-controlled case series design was used to determine the risks, within individuals, of developing skin sores when infected with scabies versus when there was no scabies infection. Participants were 11.9 times more likely to develop skin sores when infected with scabies compared with times when no scabies infection was evident (Incidence Rate Ratio (IRR) 11.9; 95% CI 10.3–13.7; p<0.001), and this was similar across the five Aboriginal communities. Children had lower risk of developing skin sores at age ≤1 year compared to at age >1 year (IRR 0.8; 95% CI 0.7–0.9).ConclusionThe association between scabies and skin sores is highly significant and indicates a causal relationship. The public health importance of scabies in northern Australia is underappreciated and a concerted approach is required to recognise and eliminate scabies as an important precursor of skin sores.

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“…itching and is a key risk factor in the development of GAS impetigo in many tropical communities (10)(11)(12). Also, it is not uncommon for Staphylococcus aureus to be a copathogen along with GAS in impetiginous skin lesions (13,14). At least some strains of GAS that cause impetigo can subsequently spread from skin lesions to colonize the URT, peaking at 2 to 3 weeks post-skin infection (7,8) (Fig.…”

Section: Ecology: Host Tissues and Diseasesmentioning

confidence: 99%

Molecular Epidemiology, Ecology, and Evolution of Group A Streptococci

2018

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The clinico-epidemiological features of diseases caused by group A streptococci (GAS) is presented through the lens of the ecology, population genetics, and evolution of the organism. The serological targets of three typing schemes (M, T, SOF) are themselves GAS cell surface proteins that have a myriad of virulence functions and a diverse array of structural forms. Horizontal gene transfer expands the GAS antigenic cell surface repertoire by generating numerous combinations of M, T, and SOF antigens. However, horizontal gene transfer of the serotype determinant genes is not unconstrained, and therein lies a genetic organization that may signify adaptations to a narrow ecological niche, such as the primary tissue reservoirs of the human host. Adaptations may be further shaped by selection pressures such as herd immunity. Understanding the molecular evolution of GAS on multiple levels-short, intermediate, and long term-sheds insight on mechanisms of host-pathogen interactions, the emergence and spread of new clones, rational vaccine design, and public health interventions.

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Natural history of impetigo

Cited by 75 publications

References 23 publications

Skin infections in Australian Aboriginal children: a narrative review

Skin infections in Australian Aboriginal children: a narrative review

Scabies and risk of skin sores in remote Australian Aboriginal communities: A self-controlled case series study

Molecular Epidemiology, Ecology, and Evolution of Group A Streptococci

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