2. Learning tasks
At the end of this session, students are expected to
be able to:
• Define the term Impetigo
• Describe the epidemiology and risk factors/
causes
• Describe the pathophysiology
• Describe the clinical features and complications
• Identify differential diagnosis
• Manage and prevent Impetigo
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4. Definition of Impetigo
• Is a highly contagious superficial skin
infection characterized by skin lesions
containing pus and predominantly caused by
staphylococcus (MoHCDGEC, 2019).
• Also known as Impetigo contangiosum
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5. Epidemiology
• The estimate of global population of children
suffering from impetigo is 162 million,
predominantly in tropical, resource-poor
countries.
• Impetigo is an under-recognized disease and in
conjunction with scabies, comprises a major
childhood dermatological condition with
lifelong consequences if not treated.
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6. Risk factors
• Malnutrition
• Tonsillitis
• Sores in the nose
• Age (common at the age of 2-5 years)
• Crowded area such as schools and care settings
• Warm, humid weather: Common in summer
• Broken skin such as, a cut or a scrape.
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7. Causes
• Common micro-organisms:
o Staphylococcus aureus: Commonest
o Streptococcus pyogenes (group A beta haemolytic): Alone
or combination with Staphylococcus.
• Route of transmission:
o Direct contact with the sores of infected person:
o Animal or insect bite: leading to secondary bacterial
infection
o Indirectly through contact with clothing of infected patient,
such as: Bed sheets, bed covers, towels, clothing, door
knobs and furniture.
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8. The pathophysiology
• Impetigo is an acute, highly contagious gram
positive bacterial infection of the superficial
layers of the epidermis.
• The disease occur primarily when there is a direct
bacterial invasion of normal skin that has minor
breaks.
Or
• The infection is secondary to an underlying skin
infections such as chicken pox.
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9. The clinical features
• Purulent or blister.
• The lesion are prevalently on head, back of hands,
around neck, in axillae, around umbilicus and
groin.
• In neonates the lesions occur day 1 of life or later.
• Lesions are solitary at first, then spreading to
other parts.
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12. Management
• Admit the child.
• Wear clean examination gloves then:
o Wash the affected area using antiseptic solution
and clean gauze.
o Swab the pustules with 0.5% gentian violet
solution.
o Repeat four times daily until the pustules are gone.
Have the mother do this whenever possible.
o Remove crust.
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13. Management cont…
• Observe for signs of sepsis (poor feeding,
vomiting, breathing difficulties, fever).
• Antibiotic treatment:
o IV Ampicillin, Cloxacillin and Gentamycin
according to baby’s age and weight for 7 days.
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14. Preventive measures
• Proper hygiene using IPC guideline: eg,
washing with soap and water
• Parent education on:
o Disease itself.
o Separate towel and bath facilities.
o Isolation of infected child.
• Early diagnosis and proper treatment of
infected children.
• Disinfection of household, work place, school.
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15. Key points
• Is a highly contagious superficial skin infection
characterized by skin lesions containing pus and
predominantly caused by staphylococcus
• The infection can be transmitted through direct
contact or indirectly through contact with clothes.
• Patient should treated by IV combination of
antibiotics (Ampicillin, Cloxacillin and
Gentamycin for 7 days).
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16. Review questions
• What is impetigo?
• What are the clinical features of impetigo?
• How will you manage a 14-day-old baby
weighing 2.5 Kg who diagnosed to have
impetigo?
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17. Reference
• WHO (2013). Hospital Care for Children: Guideline for the
Management of Common Childhood Illnesses, 2nd Edition.
• Stanfield, P. et al, (2005), Child Health: A manual for Medical and
Health Workers in Health Centres and Rural Hospitals, 3rd ed,
AMREF, Nairobi. Kenya.
• MoHCDGEC (2017). Standard Treatment Guidelines and National
Essential Medicines List: Tanzania Mainland (4th Ed).
• MoHCDGEC, (2019). National Guideline for Neonatal Care and
Establishment of Neonatal Care Unit, RCH Section, Dodoma
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18. Reference cont…
• WHO (2003). Managing Newborn Problems:
A guide for doctors, nurses, and midwives.
Department of Reproduction Health and
Research, World Health Organization, Geneva.
• MoHCDGEC (2018). Standard Treatment
Guidelines and National Essential Medicines
List: For Children and Adolescents (1st Ed).
Dodoma.
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