Infantigo/ Impetigo

What is Infantigo?

It is a highly contagious bacterial infection, seen usually in children of age 2 years to 5 years. It may affect elder children and adults too. It is a very common skin infection among children. ^[2]

Is it Infantigo or Impetigo?

Infantigo is same as Impetigo. It is pronounced as ‘im-pet-eye-go’^[3]
For reimbursement purposes Impetigo is coded under ICD-10-CM Diagnosis Code- L01.00 ^[1]

Is Infantigo contagious?

Yes, Impetigo can easily spread from one person to another very easily by direct contact, sharing toys, towels or clothing. High risk group includes people living in poverty or crowded areas and those with underlying scabies ^[2].

How does Impetigo occur?

Primary impetigo may occur when there is a direct bacterial infection of previously normal skin ^[2]. Most common causative agent for Impetigo is Streptococcus pyogenes (Group A beta haemolytic streptococcus) or Staphylococcus aureus ^[4].

In cases of minor skin injuries such as abrasion or insect bites, the same organisms may invade the site and cause a secondary impetigo ^[2].

Types (Pictures) of Impetigo/ Infantigo

Non-bullous Impetigo

This is also called as Impetigo contagiosa. It is the most commonly seen type among the three. Reddish papules on face, neck and extremities which may develop into vesicles and burst. Once burst, the pus inside them ooze out and form crusts which are honey yellow or golden yellow in colour within a period of around 1 week.

These sores are characterized by itchiness and heal themselves usually without leaving any scar. To heal completely, it may take around 2 weeks. Regional lymphadenopathy (enlargement of the lymph nodes) may occur.^{[2, 5]}

What does non-bullous infantigo look like ?

Image 1 :Non-bullous impetigo showing characteristic golden yellow crust formation in adults

 

Image 2: Non-bullous impetigo in both infants

Photo Ref: impetigo-treatment.learnandenjoy.com

 

Bullous Impetigo

It can affect trunk, face, axillae and extremities. The lesions are bullae with clear or yellowish fluid inside. This fluid may become turbid or purulent. When the bullae rupture, it leaves behind an erythematous area surrounded by a thin rim of brown crusts. But there is no golden yellow crust formation.

Regional lymphadenopathy is not common with this type of impetigo. However, symptoms of systemic involvement such as fever, malaise and generalised weakness may be observed. Staphylococcus aureus releases a particular exotoxin called as ‘Epidermolytic toxin’, which is responsible for bullae formation ^{[2, 4, 5]}.

Ecthyma

It is the least common form of impetigo, but the most severe form. It extends into the deep tissues ^[6]. There is pustule formation which ruptures and forms an ulcer that extends well into the dermis. A thick grey- yellow crust covers the ulcer. Regional lymphadenopathy is usually present. The ulcer heals with scar formation ^[7].

Diagnosis

Usually a lab test is not required for Impetigo diagnosis. A detailed history with proper examination can give way to diagnosis ^[4]. For culture of the organism or drug sensitivity tests, sample from the lesion can be collected and sent to the laboratory.

Home remedies for infantigo

Unproven claims of olive & coconut oil had been raised as a beneficial treatment for impetigo ^[5].

Treatment for Infantigo

Normally impetigo does not require a treatment. However, a treatment with the following helps in early recovery and return to school ^[5]. The child can return to school within 1-2 days of starting of antibiotic therapy as the chance of being infectious would have reduced by the antibiotic usage.

• Topical antibiotic ointment
• Oral antibiotic treatment

Complications

Under normal scenario, complications are rare in case of impetigo. Nevertheless, they are not impossible. The following complications are seen occasionally ^[5].

• Cellulitis – When the bacterial infection remains uncontrolled and spread through the deeper layers of skin to the surrounding tissues, it leads to a painful condition, cellulitis.
• Scarlet fever – It is caused by Streptococcus pyogenes.
• Septicemia – Uncontrolled spread of the bacteria through blood.
• Post-streptococcal glomerulonephritis – It is a Type 3 hypersensitivity reaction that occurs following a streptococcal infection such as impetigo. It affects the small blood vessels in kidneys.

Prevention

Prevention is only possible to an extent.

• Avoid contact with infected children.
• Avoid using the same utensils, clothes or toys.
• Frequent washing of hands with soap.
• Avoid touching the lesions.
• Usage of gloves to apply antibiotic to the lesions^{[5, 8]}.

Reference:

1. http://www.icd10data.com/ICD10CM/Codes/L00-L99/L00-L08/L01-/L01.00
2. https://www.uptodate.com/contents/impetigo#subscribeMessage
3. https://dictionary.cambridge.org/pronunciation/english/impetigo
4. https://emedicine.medscape.com/article/965254-overview
5. https://www.medicalnewstoday.com/articles/162945.php
6. https://en.wikipedia.org/wiki/Ecthyma
7. https://emedicine.medscape.com/article/1052279-clinical#b4
8. https://www.webmd.com/skin-problems-and-treatments/tc/impetigo-overview#1