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Impetigo contagiosa

Zuletzt geändert von Thomas Brinkmeier am 2025/04/25 21:47

Impetigo contagiosa

Def: epidermale, nicht follikulär gebundene, hochkontagiöse Streptokokken und/oder Staphylokokkeninfektion

Pg: Eintrittspforte der Erreger sind kleinste Hautläsionen

Ink: 2-10 Tage

Vork: meist Kinder (ansteckend)

DD: - superinfizierte Herpes-Infektion

- superinfizierte Insektenstiche

- Tinea

Bsp: Trichophyton mentagrophytes var. granulosum

- Diphtherie

Lit:  

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Etlg: - kleinblasige Form

Err: meist beta-hämolysierende A-Streptokokken

- großblasige Form

Err: meist Staph. aureus

Hi:  

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KL: honiggelbe Krusten, die sich aus oberflächlichen Bläschen und Pusteln entwickeln

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Prog: narbenlose Abheilung (da oberflächliche Infektion) meist binnen 1-2 Wochen

Lok: Prädilektionsstellen: Kopf, Hals, Hände

Kopl: - eitrige Konjunktivitis

Th: z. B. Refobacin-Augensalbe

- Otitis media

- Glomerulonephritis

Bed: gefährlichste Komplikation

Di: Kontrolluntersuchungen: Urinstatus zu Beginn der Therapie und 6 Wochen danach

Lab: - Wundabstrich vom Blaseninhalt

- Antistreptolysin (ASL)-Titer: seltener erhöht

- Anti-Streptodornase-B-(ADB)-Titer: meist erhöht

- ggf. CRP erhöht und Leukozytose

Ind: insbesondere auch zur Differenzierung zwischen viraler/herpetischer und bakterieller Infektion

Erg: Eine CRP-Schwelle ≥ 2,05 mg/dl zeigte eine Diagnose einer bakteriellen Haut- und Weichteilinfektion mit einer Sensitivität von 80% und einer Spezifität von 83,8% an. Für Leukozyten ≥ 7,3 × 109/l hatte die Diagnose einer Haut- und Weichteilinfektion eine Sensitivität von 75% und eine Spezifität von 67,6%.

Lit: Acta Derm Venereol. 2019 Oct 18. http://doi.org/10.2340/00015555-3357

Lit:  

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Th: - lokale Antseptika und Antibiotika

Bsp: Octenidin, Polyvidon-Jod, Fusidinsäure, Mupirocin, 8-Chinolinol (ggf. als Vollbad), Methylrosaniliniumchlorid, Retapamulin

Altn: Natriumbituminosulfonat

- penicillinasefeste Penicilline

Appl: systemisch

Ind: makrolidresistenter Staph. aureus

Stoff: - Oxacillin

- Dicloxacillin

- Flucloxacillin

Altn: Cephalosporine der 1. Generation

Wirk: gegen Streptokokken und Staphylokokken

Bsp: Cephalexin

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