A frequent medical complaint during the August holidays is impetigo. Impetigo is an acute superficial infection of the skin caused by bacteria. It’s commonly called “sores” or “septic spots” in T&T.
It is also wrongly called eczema. Eczema is a skin allergy usually to milk, egg white, chocolate, corn curls, artificial juices or other junk foods. There is a relationship between eczema and impetigo.
Impetigo is more common in children with eczema. Eczema itches, and children scratch, often with dirty fingernails.
The germ that causes impetigo lives in dirt and is often found under fingernails.
When the child scratches, the skin is broken and the bacteria inserts itself into the skin and cause typical sores. So you have eczema that has become infected, and which has a big name, impetiginous eczema. Impetigo sores are also very itchy. When you scratch them, bacteria can become trapped under your fingernails. Scratching or even touching other parts of your body or other people can easily spread the infection.
In the tropics, impetigo is almost always an outdoor disease. Fingernails play a major role in the infection as both a carrier for the bacteria and a primary tool for self-inoculation. Children usually get impetigo from playing with other children who have impetigo. It is very contagious, and contact with drainage from the skin lesions usually means contamination. It is most common in children aged two to five but can occur at any age. It is more common during holidays.
Little boys love to play in mud. Sliding and slipping across a muddy field, they nick their ankles and calves, scratch the lesions with dirty, infected fingernails, do not bathe for hours and within a few days develop sores on their legs, and this is impetigo. The same thing happens to college football players during the football season.
In another scenario, a child might get bitten on an arm by one of our very successful, Ministry-of-Health-resistant mosquitoes, scratch at the bite with dirty fingernails and within two or three days develop a sore. These sores are full of bacteria, which stick on to fingers and nails and get transferred from one site to another.
Since children dig their noses a lot, any bacteria on their fingers automatically get transferred to their noses. Noses and the upper lip are therefore common sites for sores to appear.
The arms and buttocks are also frequently involved for obvious reasons: bites, cuts and itching.
The infection appears as tiny, isolated skin blisters which soon break down to become superficial sores covered with golden-yellow or honey-coloured crusts. These sores are highly contagious, and the germ can be transmitted from one child to another through direct contact, as occurs when they return to the classroom.
Impetigo is easy to prevent if you can get to the child before the bacteria establish a permanent residence in the skin. That means soap and water. Ordinary soap kills off the bacteria before it penetrates the skin. But you have to bathe the child within a couple of hours, and that is difficult to do with active, happy-go-lucky children, even if you are a traditional mother who works at home.
The germ that causes impetigo is called Streptococcus. It is the same organism that is responsible for “strep throat” in temperate countries, and up north or in the deep south, transmission is mostly by direct person-to-person spread through respiratory droplets.
For unknown reasons, it prefers to attack skin in tropical areas. Might have something to do with our outdoor style of living.
Since it is a bacterium, it is destroyed by antibiotics. Although one or two infected spots can be treated by an anti-infective soap or antibiotic creams, once there are two or more parts of the body affected, you need to give a ten-day course of antibiotics.
Within 48 hours of starting treatment, the child is no longer infective and can return to camp or school.
This is usually the end of the problem. Sometimes, however, the disease returns again and yet again. This may mean that there is somewhere in the home a nest of bacteria that is not apparent. Pets are usually blamed, but there is no evidence that pets can transmit the bacteria to humans.
Humans are the primary reservoir for the bacteria, usually found in someone’s nostrils or throat. Once you have exhausted the soap-and-water and antibiotic regimen, the entire family may need to be tested for the presence of the bacteria and treated for infection.
In the good old days, the ones that old folk say were so good, having forgotten the diseases that then abounded, the skin infection would occasionally cause a kidney or heart problem. But that story is for another day.
