Antimicrobial resistance in staphylococci from canine pyoderma: a prospective study of first-time and recurrent cases in Sweden

In a prospective study involving eight veterinary clinics during 1995 and 1996, samples from first-time and recurrent cases of canine pyoderma were collected by a needle technique. Three hundred and ninety-four staphylococci were isolated and their susceptibility to various antimicrobial drugs was assessed by a microdilution technique. Resistance to macrolides, lincosamides, fusidic add, tetracycline and streptomycin was significantly more common in isolates from the recurrent cases than from the first-time cases; 20 per cent of the isolates from the first-time cases were resistant to three or more of the antimicrobials tested, compared with 45 per cent of those from the recurrent cases. Coresistance between macrolide-lincosamides, tetracyclines and streptomycin was common. No resistance to penicillinase-stable beta-lactams was observed. A comparison with earlier studies indicated that there had been a marked increase in resistance during the previous five years.

Pyoderma among Hajj Pilgrims in Makkah

OBJECTIVE

Bacterial skin infections have been considered as a possible health problem of the Hajj pilgrims. Significant increase in the rate of resistance to commonly used antibiotics against gram positive organisms has been observed. The present study was planned to obtain the microbiological profile of bacterial skin infections and their susceptibility to antimicrobials.

METHODS

Pyodermas were investigated clinically and bacteriologically by a prospective study conducted on patients attending the dermatology clinic at the King Faisal Hospital, Makkah, Kingdom of Saudi Arabia during 2 Hajj periods (2000 - 2001).

RESULTS

Of a total of 80 pyoderma patients, 52.5% were primary and 47.5% secondary. The leading cause of primary pyoderma was found to be impetigo in 28.8% cases, and of secondary pyoderma was infected eczema in 18.8% cases. Positive cultures were found in 87.5% cases. The organisms responsible for primary pyoderma were: Staphylococcus aureus (65.6%), Streptococcus pyogenes (28.1%) or both (6.4%) while in secondary pydermas were: Staphylococcus aureus (44.7%), Streptococcus pyogenes (15.8%), or both (18.4%), and gram negative bacilli (21.1%). The resistant pattern of antimicrobials against Staphylococcus aureus was as follows: penicillin 80.85%, tetracycline 10.6%, gentamicin 6.4%, erythromycin 4.3% and cotrimoxazole [corrected] 4.3%. Oxacillin and cephalothin were found least resistant (2.1%).

CONCLUSION

Pyoderma appeared as one of the common health hazard of our Hajj pilgrims. Penicillin and tetracycline are found ineffective in treating skin infections caused by Staphylococcus aureus while oxacillin is recommended as first line of treatment.

A nursery outbreak of Staphylococcus aureus pyoderma originating from a nurse with paronychia

An outbreak of methicillin-susceptible Staphylococcus aureus pyoderma occurred in the nursery of a tertiary-care referral center. All strains retrieved from the outbreak, including one from a nurse's infected finger, were typed by arbitrarily primed polymerase chain reaction and automated ribotyping. The results indicated that the spread of the outbreak was probably facilitated by contamination of the nurse with paronychia.

Bacterial skin infections in a tropical environment

The subject of bacterial skin infection in the tropics has shown some significant advances in the past few years, although it is still relatively understudied. Of special interest is the emerging concern about the public health aspects of pyoderma, either primary or secondary to scabies, in developing countries. In addition, certain more unusual agents, such as Bacillus anthracis and Corynebacterium diphtheriae, continue to cause significant problems in some areas, while incidence of other tropical diseases, such as endemic treponematoses, has largely dropped.

Contrasting molecular epidemiology of group A streptococci causing tropical and nontropical infections of the skin and throat

Disease caused by group A streptococci (GAS) in tropical regions often takes the form of impetigo, whereas pharyngitis tends to predominate in temperate zones. GAS derived from asymptomatic throat infections and pyoderma lesions of rural Aboriginal Australians were evaluated for phylogenetic distant emm genes, which represent ecological markers for tissue site preference. On the basis of the percentage of total isolates from a given tissue, emm pattern A-C organisms exhibited a stronger predilection for the throat, whereas pattern D organisms preferred the skin. Only 16% of isolates collected by active surveillance displayed pattern A-C, which reflects the low incidence of oropharyngeal infection. Importantly, most (70%) pattern A-C organisms were isolated from skin sores, despite their innate tendency to infect the throat. Combined with findings from nontropical populations, analysis of the data supports the hypothesis that GAS tissue preferences are genetically predetermined and that host risk factors for infection strongly influence the differential reproduction of individual clones.

Skin infections and infestations in Aboriginal communities in northern Australia

The most important skin infections in Aboriginal communities in central and northern Australia are scabies and streptococcal pyoderma. Scabies is endemic in many remote Aboriginal communities, with prevalences in children up to 50%. The cycles of scabies transmission underlie much of the pyoderma. Up to 70% of children have skin sores, with group A streptococcus (GAS) the major pathogen. Group A streptococcus is responsible for the continuing outbreaks of post-streptococcal glomerulonephritis and acute rheumatic fever (ARF). The cycles of scabies transmission in dogs and humans do not appear to significantly overlap. Guidelines have been developed for community control of scabies and skin sores and successful community initiated coordinated programmes have occurred. The anthropophilic dermatophyte Trichophyton rubrum is ubiquitous in many communities, again reflecting living conditions. Other skin infections related to the tropical environment include melioidosis, nocardiosis, Chromobacterium violaceum and chromoblastomycosis. Sustainable and long-term improvements in scabies, skin sores and GAS-related disease and tinea require fundamental changes that address social and economic inequities and, in particular, living conditions and overcrowding.

Bacterial skin infections at a tertiary dermatological centre

BACKGROUND

Bacterial skin infections are common clinical problems encountered in most fields of clinical medicine. Staphylococcus aureus and group A streptococci are common invaders of eczematous, traumatised or immunocompromised skin. Advances in pharmacology have introduced a wide array of new antibiotics into the physician's armamentarium, but the rising incidence of bacterial resistance continues to be a problem. A retrospective study was carried out on 331 patients at the National Skin Centre, Singapore, to establish the causes of common primary and secondary pyodermas, as well as to determine the antibiotic sensitivities of the microorganisms responsible.

METHODS

A retrospective study of the medical records of 331 patients seen at the Centre for skin infections between October 1995 and May 1996 was done. Skin cultures and antibiotic sensitivity testing was carried out and the data analysed. Both primary pyodermas (impetigo, folliculitis, furuncles/carbuncles and cellulitis) and secondary pyodermas (infected ulcers and infected eczemas) were included. The results of bacterial isolation cultures and sensitivity of the organisms isolated to the commonly used antibiotics such as cloxacillin, penicillin, erythromycin and the tetracyclines were analysed.

RESULTS

Staphylococcus aureus was the commonest organism isolated from both primary and secondary pyodermas, accounting for 67% and 46.7% of the organisms isolated, respectively. There was no significant difference in the racial representation in each of the various skin infections, but there was a significantly greater female representation in the infected ulcers. The secondary pyodermas had a significantly higher incidence of gram negative organisms causing infections, as well as culture results showing multiple bacterial pathogens. The methicillin resistant strains of S. aureus were commoner in the secondary pyodermas, and accounted for 4.2% of the total organisms isolated and 7% of the total strains of S. aureus. The S. aureus had a high rate of resistance (89.5%) to penicillin and ampicillin, but was very sensitive (93%) to cloxacillin, cephalexin and cotrimoxazole. The incidence of erythromycin resistance was 18.7%.

CONCLUSIONS

In patients with primary pyodermas, cloxacillin should be the first line antibiotic used, with erythromycin as a useful but less preferred alternative. The favoured combination of ampicillin and cloxacillin has little place in routine treatment of skin infections, except for cellulitis and infected eczemas. A cephalosporin can also be used in these conditions if single drug therapy is desired. The secondarily infected ulcers are difficult to treat and would probably require the use of combination therapy in view of frequent mixed infections.

Phylogenetic analyses of Staphylococcus based on the 16S rDNA sequence and assignment of clinical isolates from animals

The nucleotide sequences of the 16S rDNA in 17 strains of 16 taxa of the genus Staphylococcus were determined. The sequences were compared phylogenetically together with the gene sequences of 10 (including 7 other species) Staphylococcus species retrieved from the DNA Data Bank of Japan. Although the primary and secondary structures of most of Staphylococcus species were very similar (homology values 96.4% or more) except for S. caseolyticus MAFF 911387T (homology values 95.4% or less), the 23 staphylococcal species were divided into 10 groups based on similarity, evolutionary distance and phylogenetic tree analysis. Nucleotide stretches in several variable domains in the 16S rDNA sequences appeared to be specific for the bacterial groups or the species. By comparing such characteristics in the sequence and phylogenies of 5 staphylococcal clinical isolates from bovine mastitis, canine and feline pyoderma, and feline urogenital syndrome with the information obtained in this study, the species level of each organism was identified.

Skin diseases of children in Mali: a public health problem

In order to estimate the importance as a public health problem of skin diseases, we investigated the prevalence and severity of skin diseases in a representative sample of children in Mali. 1817 children were randomly selected in 30 clusters by probability-proportional-to-size sampling in Koulikoro region. The mean prevalence (+/- 2 SD) of skin diseases was 34 +/- 4%. The most frequent dermatoses were pyoderma (12.3 +/- 1.6%), tinea capitis (9.5 +/- 2.5%), pediculosis capitis (4.7 +/- 1.4%), scabies (4.3 +/- 1.5%), and molluscum contagiosum (3.6 +/- 1%). The most troublesome dermatoses were scabies and severe pyoderma. Pyoderma was the only dermatosis associated with poor individual or household hygiene. Public health services were little used by the population for skin diseases, probably because of the lack of an adequate response by the services and the high cost of treatment. The high prevalence and the severity of many of the lesions, and the discomfort caused, make pyoderma and scabies a significant public health problem in Mali.

Multiple strains of Streptococcus pyogenes in skin sores of aboriginal Australians

A molecular technique (random amplification of polymorphic DNA) was used to characterize group A streptococcal (GAS) strains among 194 isolates from 55 swabs from 12 Australian Aboriginal children and adults with multiple pyoderma lesions. Ninety-three percent of the lesions contained only one strain of GAS, but 8 of 12 individuals were infected with more than one strain. We conclude that accurate epidemiologic surveys require that more than one swab specimen be obtained from each person, whereas typing of more than one colony per swab is less informative. Characterization of GAS strains by random amplification of polymorphic DNA analysis should help to provide important insights into the epidemiology of GAS, particularly in tropical populations where many isolates are M nontypeable, and into the mechanisms of genetic variation of GAS in such populations.

Group A streptococcal infection in an aboriginal community

OBJECTIVE

To determine whether group A streptococcal infection and poststreptococcal sequelae are still a significant health issue for Aboriginal communities.

DESIGN

A cross-sectional survey of streptococcal carriage, infection and antibody levels.

SETTING

A north Queensland Aboriginal community.

PARTICIPANTS

One hundred and twenty preschool and school-aged children (2 to 12 years of age) living in the Lockhart River Community on Cape York Peninsula.

RESULTS

Pyoderma was present in 43% of the children and in 76% of these culture of skin lesions grew group A streptococci. Group A streptococci also grew from 13% of throat swabs, making a total of 36% of children culture positive. Anti-streptolysin O and anti-DNAase B levels were remarkably high and increased with age.

CONCLUSIONS

The evidence presented confirms a high level of group A streptococcal carriage and infection in children of the Lockhart River Community. Further investigation of this problem is warranted in other Aboriginal communities with a view to instituting appropriate control programs.

Scabies and Pyoderma in Lilongwe, Malawi. Prevalence and seasonal fluctuation

From January 1988 to June 1989, data were collected daily on the patients who were seen at the Dermatology Clinic attached to the Kamuzu Central Hospital, Lilongwe, Malawi. Cases were diagnosed and patients were treated under the supervision of a dermatologist. A total of 34,002 patients were seen during the study period. Of these patients, 15,526 (45.7%) were children and 18,476 (54.3%) were adults. The prevalence of scabies was 40.4% in children and 31.6% in adults, whereas the prevalence of impetigo/bacterial skin infections was 26% in children and 10.4% in adults. Based on data accumulated for periods of 1 month, the incidence rate of scabies was highest during the cold, dry season (May-November) and the incidence rate of skin infection was highest during the hot, rainy season (December-April). Since the patients who were studied lived predominantly in rural settings, an explanation for the higher incidence rate of scabies during the cold season could be close body contact resulting from the overcrowding within the houses. The reason for the increase in the incidence rate of pyoderma during the rainy season might be linked to deficiencies in hygienic precautions. A community-based intervention strategy with children as its target population is proposed to combat these diseases.

The epidemiology of pyoderma in Jamaican children

Preschool and school-aged children from a small area of rural Jamaica were examined in an attempt to assess the epidemiologic factors predisposing certain persons to pyoderma. Twenty-three children were included in the affected group; their disease consisted of secondarily infected insect bites or infestations as well as primary pyoderma. The control group was composed of twenty-three children who had no evidence of infected skin disease. Comparison of the two groups revealed a significant difference in the socioeconomic status of the control and study groups. There was no statistically significant difference in nutritional status, size of family, bathing frequency, or water supply.

Scrum kidney: epidemic pyoderma caused by a nephritogenic Streptococcus pyogenes in a rugby team

In December, 1984, an outbreak of pyoderma affected five scrum players in the St Thomas' Hospital rugby team. The causative organism, Streptococcus pyogenes, was acquired during a match against a team experiencing an outbreak of impetigo, and was transmitted to two front row players of another team a week later, and to two girlfriends of affected St Thomas' players a month later. The strain was M-type 49, tetracycline-resistant, and virulent. It caused salpingitis in a girlfriend and acute glomerulonephritis in one rugby player. No case of subclinical glomerulonephritis was detected in eight patients with pyoderma. Screening of the St Thomas' Hospital team revealed four further cases of non-streptococcal skin infection, with evidence for contemporaneous spread of Staphylococcus aureus. Teams should not field players with sepsis, and it may be advisable to apply a skin antiseptic to traumatised skin after the match.

Resurgent yaws and other skin diseases in the Western Province of the Solomon Islands

A clinical study of the extent and nature of skin disease was undertaken among 10,224 Melanesians in the Western Province of the Solomon Islands. It was performed concurrently with a survey and selective mass treatment campaign for yaws which has reappeared in the area for the first time in 20 years. For children under 15 years old, prevalence rates for pyoderma and infectious yaws were 52% and 8.5%, respectively. Tinea versicolor was the commonest superficial dermatomycosis affecting nearly half of all adults seen. Glabrous skin (16% of all cases) and nails (25% of all cases) were the principle sites infected by the dermatophytes. Tinea imbricata, whilst uncommon, was restricted to small endemic foci. Pediculosis capitis was universal but scabies was present in only 4% of young children. Unfavourable environmental conditions and misconceptions about personal hygiene are important aetiological determinants. Education and motivation at a village level will be the mainstay of future control with specific therapy generally reserved for treponematoses, extensive dermatophytoses and scabies.

Epidemiologic approach to community dermatology

A survey on communicable dermatoses in economically weak villages in India showed wide variations in prevalence rates in similar ecologic setup. A skin diseases, on-spot-treatment, 1-day-camp was organized to treat 1787 subjects in five villages. Two applications of 1% lindane 1 week apart was the only treatment used without attending to hygiene for scabies and pediculosis. Application of 1% gentian violet with four daily doses of sulfamethoxy-pysidazine was administered for pyoderma. The cure rate for scabies and pediculosis was 86%. Epidemiologic determinants of communicable dermatoses are the most important factors in the practice of community dermatology.

Pediatric skin disease in Pakistan. A study of three Punjab villages

The population of children younger than 5 years old in three widely distributed villages in Punjab, Pakistan, was examined for skin disease in November 1980. Approximately 29% of the children had infectious skin disease, with pyoderma the predominant diagnostic category. There were significant differences in pyoderma prevalence rates between villages, with the suppressive effect of malathion spraying for malaria control on the insect population representing the most likely explanation for the observed differences. These data again emphasize the amount of skin disease, particularly in children, in rural areas of the lesser developed countries, and the desirability of focusing attention on the dermatologic needs of this vast sector of the world's population.

Epidemiology and control of staphylococcal pyoderma among newborn infants: evaluation of a method for routine cord care with 4 per cent chlorhexidine-detergent solution

The incidence and types of staphylococcal purulent lesions were prospectively studied among 3602 newborn infants. During an epidemic of post-discharge pyoderma, 87 per cent of all Staphylococcus aureus isolates from lesions could be traced to the nursery. The risk of post-discharge disease was related to the degree of staphylococcal skin colonization in the nursery. A method for routine cord care in the nursery with 4 per cent chlorhexidine-detergent solution was evaluated and proved to be effective in reducing staphylococcal colonization in the nursery as well as purulent skin disease at home. The clinical effectiveness of the regimen was followed up for 19 months and a persistent low infection rate was obtained among infants in the post-discharge period.

A three-year streptococcal survey among Singapore school children: Part II. Streptococcal infections

The cumulative streptococcal pyoderma and pharyngitis rates of 491 children followed over a period of three years were 19.8 and 15.7% respectively. Streptococcal infections occurred more commonly in Malays, in children from families with monthly household incomes of less than $500/- and in those living in attap/zinc-roofed houses. During the three years, streptococcal pyoderma and pharyngitis rates varied from 1.6-5.3 and 0.4-4.3% respectively. Skin sores occurred most frequently on lower limbs. About one in six acquisitions of streptococci in throats was accompanied by clinical manifestations of respiratory infections. 90.9% of pyoderma cases responded to penicillin therapy. Penicillin was effective in eradicating group A streptococci from the throats of 84.6% of 136 children with previous positive cultures. The treatment schedule implemented for School C did not seem to reduce the streptococcal infection and carrier rates in that school to a great extent.