User:Wxia1/Streptococcal intertrigo

Streptococcal intertrigo is a skin condition seen in infants and young children, often characterized by a fiery-red color of the skin, foul odor with an absence of satellite lesions, and skin softening (due to moisture) in the neck, armpits or folds of the groin. Newborn children and infants commonly develop intertrigo because of physical features such as deep skin folds, short neck, and flexed posture.

Signs and Symptoms

The most common symptom associated with streptococcal associated intertrigo are erysipelas, commonly known as an infection of the upper or superficial layers of the skin. Mostly associated with beta hemolytic group A streptococcal bacteria as this is associated with the normal skin flora. This group of microorganisms typically invade and affect the lymphatic vessels, often reducing to a localized inflammation. This is often recognized by tongue-like or irregular extensions of the rash, accompanied by systemic effects such as; fever, chills, or malaise.

Cause

Intertrigo is a skin condition often associated with rashes in deep skin folds with increased friction and moisture exposure. There are various causes that can lead to intertrigo including fungal and viral, although the agent would depend on the nature of the infection whether it be candidal or bacterial. In the case of bacterial infections, the main etiological agents are either group A beta hemolytic streptococci or Staphylococcus aureus. Group A streptococci (GAS) are ubiquitous microorganisms found in the surrounding environment and in the normal skin microbiota. Although there are different severities of infections GAS can affect individuals, with broken skin and wounds this allows easier access for colonization of the bacteria. The streptococci family has its own factors that aid in its promotion of infection and virulence. GAS have surface molecules of lipoteichoic acid and protein F which aid in the adhesion to host cells, and once adhered, releases streptolysin and hyaluronidase to further degrade host tissues enabling a deeper colonization. In addition to the attachment and dissemination factors, GAS are also encapsulated, and have other varying protein factors that defend it from host immunity.

Etiology

The main causes of intertrigo are mechanical factors, such as heat and maceration of the skin, and secondary infections, which mostly happens due to moister building up in the skin folds and makes those areas the most ideal feeding places for these secondary bacterial and fungal infections. A lot of cases of this disease are seen in patients with diabetes mellitus since because of their condition, they have higher pH levels in their skin folds. Because of these reasons mentioned, we see higher cases of intertrigo in patients who are obese, have diabetes mellitus, immunodeficiency virus infection, bedridden, large skin folds, or were diaper that traps moisture, like babies or older adults.

Prevention

In order to prevent future infections of this kind it's best to keep the affected area and other skin folds dry of moisture. It is also helpful to expose these areas to air and limit skin on skin friction as much as possible.

Treatment

The most common treatment options of intertrigo complicated with secondary bacterial infection such as group A beta-hemolytic streptococcus are topical mupirocin, erythromycin, low potency steroids, and oral antibiotics (such as oral penicillin, cephalexin, ceftriaxon, cefazolin, and clindamycin).