Page 1 - 60 surgical-infection&infestations15-19_opt

CHAPTER 15

Common Bacterial Infections

in Children

Iftikhar Ahmad Jan
Kokila Lakhoo

Introduction help in early healing of the lesions. Most impetigos heal without any
Bacterial infections are the cause of significant mortality and morbid- sequel, but such complications as toxic shock syndrome may be seen in
ity in children. Infections of surgical importance may affect virtually immune-compromised cases. Poststreptococcal glomerulonephritis and
any organ or tissue in the body. These may be community or hospital rheumatic fever are threats that warrant early and adequate treatment of
acquired. The major groups of community-acquired infections are skin skin lesions in children.
and soft tissue infections, bone infections, and infections of specific Folliculitis
organs. Hospital-acquired infections may further be classified as infec- Folliculitis is an infection of the hair follicle. It usually presents as
tions of surgical wounds, infections in wards, and infections in immu- a small tender nodule of the hair follicle. It is commonly caused by
nocompromised and critically ill patients. Bacterial infections are more Staphylococcus aureus. Two types of lesions are seen. In superficial fol-
common at extreme ages, and thus babies less than 2 months of age are liculitis, multiple hair follicles are involved and cause small pustules at
highly susceptible to bacterial infection. Other conditions such as malnu- the opening of the adjacent hair follicles. The deeper form of folliculitis
trition, immune-deficiency states, and prolonged illnesses, make children affects a single hair follicle and causes local swelling and tenderness.
more susceptible to acquire infections. These are usually seen on the scalp in children. There is local tender-
Skin and Soft Tissue Infections ness but no fever or other constitutional symptoms. It is usually caused
by local trauma, sweating, friction, and local lesions such as eczema.
Skin and soft tissue infections are better described according to the depth
Hot tub folliculitis is caused by Pseudomonas aeruginosa and occurs in
of tissue involved. Common bacterial infections in children are impetigo,
hot tubs and pools with improper cleaning and disinfection. Folliculitis
scalded skin syndrome, follicultis, furuncle or boil, carbuncle, erysipelas,
is a self-limiting condition in most cases but may progress to form
necrotising fasciitis, clostridial myonecrosis (gas gangrene), nonclostrid-
furuncle, which is a severe infection of the hair follicle and append-
ial myonecrosis, synergistic gangrenes, lymphadenitis, and abscesses. In
ages. The treatment of folliculitis is by cleaning and topical antibiotics.
addition, ear and throat infections and infections of specific systems (e.g.,
In immunocompromised patients and diabetics, systemic antibiotics
urinary tract infections, respiratory tract infections) may be important in
should be started to avoid any complications.
the management of paediatric surgical patients.
Impetigo Furuncle or Boil
Impetigo is an infection of the superficial layers of the skin. It is caused by a Furuncles are severe infections of the hair follicles, sweat glands, and sur-
minor breach in skin continuity and is common in babies with poor hygiene, rounding tissues. They may occur anywhere in the hair-bearing areas of
in crowded living conditions, and living in warm and humid areas. Impetigo body, but they are most common on the face, neck, armpits, buttocks, and
is a disease of babies and children, and may constitute 4–6% of all bacte- thighs. Staphylococcus aureus is the causative organism in most cases, but
rial infections in the paediatric population. Underlying conditions, such as other organisms may be involved. Furuncles usually start as painful nod-
eczema, insect bites, small cuts, or abrasions, may initiate the process. ules and develop into large inflamed and tender areas with constitutional
Impetigo may be described as bullous and nonbullous, according symptoms of fever, malaise, and anorexia. They are uncommon lesions
to the presentation. Nonbullous impetigo constitutes more than 70% of in the paediatric population, but may be seen in patients with immune
impetigo infections. It presents as a thick, honey-colored crust on the face deficiency and diabetes mellitus. Multiple lesions may occur, especially
or limbs. It may be mildly painful, but other constitutional symptoms are after inadequate treatment. If untreated, the lesion may lead to spreading
not present. Healing is spontaneous and usually does not lead to scarring, cellulitis and can be dangerous in areas such as the nose and face, where it
it is mostly caused by Staphylococcus aureus or Streptococcus pyogenes. may lead to thrombosis of the cavernous sinus with serious consequences.
Bullous impetigo is less common and is often seen in babies and young Diagnosis is obvious by the classic appearance of the lesion, which
children due to their soft skin. It is mostly caused by Staphylococcus initially presents as a tender lesion with a wide red indurated area and an
aureus and presents as blister-like lesions filled with fluid pus. Both obvious central punctum. Pus expressed through the head of the lesion
varieties of impetigo are diagnosed by the classic appearance, and gives relief of symptoms. Furuncles are especially dangerous in immune-
investigations are not necessary. A swab from the lesion may cause compromised patents. Multiple crops of the lesions may occur and
growth of the causative organism. Nasal swabs from patients and combine to form a carbuncle. Furuncles need treatment by oral antibiotics,
mothers may help, however, in identifying the source in patients with cloxacillin, amoxicillin clavulanate, macrolides, or cephalosporins.
repeated appearances of new lesions. Once the abscess has drained, the patient improves rapidly; however,
Topical antibiotics, such as fuscidic acid, mupirocin, or polymyxin-B, antibiotics treatment should be continued until complete healing of the
may help in early healing of the lesions and also make the lesions soft and lesion to prevent new lesions.
less irritating. Cases resistant to fuscidic acid due to the widespread topical Carbuncle
usage of fuscidic acid have now been reported, however. Some patients A carbuncle is a spreading infection in the subcutaneous tissue planes
with multiple lesions and those not responding to topical antibiotics may caused by multiple infected hair follicles. Carbuncles are rare in chil-
need systemic antibiotics and cephalosporins. Amoxil-clavunate will dren but may be seen in hairy and immunocompromised patients; these