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STUDIES
Year : 1992  |  Volume : 58  |  Issue : 3  |  Page : 183-187

A Clinico-bacteriological study of primary pyodermas of children in Pondicherry




Correspondence Address:
S Mariette Mathew


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  Abstract 

One hundred and twenty children selected at random and diagnosed as having Primary Pyoderma lesions were studied for clinical patterns and bacteriological profile. Sixty percent of the cases were girls. The commonest clinical type was impetigo contagiosa (45%) followed by folliculities of the scalp (44.2%). Staphylococcus aureus was the etiological agent in 47.5% while 26.7% of the cases were due to mixed infection along with Streptococcus pyogenes. Almost all strains were sensitive to Erythromycin and Gentamycin. The highest resistance was to Penicillin (79.3%) followed by Ampicillin (73.9%) and Tetracycline (42.3%).


Keywords: Primary Pyoderma, Children, Antibiotic Sensitivity


How to cite this article:
Mathew S M, Garg B R, Kanungo R. A Clinico-bacteriological study of primary pyodermas of children in Pondicherry. Indian J Dermatol Venereol Leprol 1992;58:183-7

How to cite this URL:
Mathew S M, Garg B R, Kanungo R. A Clinico-bacteriological study of primary pyodermas of children in Pondicherry. Indian J Dermatol Venereol Leprol [serial online] 1992 [cited 2020 Jul 2];58:183-7. Available from: http://www.ijdvl.com/text.asp?1992/58/3/183/3790



  Introduction Top


Pyodermas are one of the commonest clinical conditions encountered in dermatological practices [1] especially in the paediatric age group. Various factors like poverty, malnutrition, overcrowding and poor hygiene have been stated to be responsible for its higher incidence in the lower socio-economic strata. [2] Climatic conditions also play a role with the hot and rainy seasons being the period of maximum occurrence.

Changing trends are being noted in the etiological aspect of Primary Pyodermas [3] and the problem of emergence of drug resistant strains is an ever increasing one. It would be ideal to do culture and sensitivity tests before prescribing antibiotics, but as this is not always feasible, studies should be conducted to determine the changing trends in etiological agents and antibiotic resistance. Keeping this in mind the present study was carried out.


  Materials and Methods Top


One hundred and twenty children below twelve years of age, with typical primary pyoderma lesions, were randomly selected from the Dermatology Out-Patient Department at the JIPMER Hospital, Pondicherry. Relevant details regarding the duration, progress of lesions, past and family history was elicited. A complete dermatological examination to type the lesions was done, as also a general examination. Swabs were taken from the purulent lesions and a smear was made, stained with Gram's stain and examined for identification of the organisms. Pus from the lesions was cultured. They were innoculated on blood agar aerobically at 37°C. Twenty-four hours later the organisms were identified by standard morphological and biochemical techniques. The tube coagulase test was done to identify Staphylococcus aureus. Antibiotic sensitivity testing was done by the disc diffusion method of Bauer er al [4] and the resistance patterns determined. Streptococcal strains sensitive to bacitracin were labelled as Streptococcus pyogenes.


  Results Top


Of the 120 children, 48 (40%) were boys and 72 (60%) were girls, The maximum number of cases came during the summer season and almost all the children were from the lower socio­economic strata, 50.6% being from urban areas. Twenty-seven percent of the cases gave a family history of concomitant pyoderma infection in a sibling and 54 children had a past history of recurring pyoderma more in the summer,

The maximum incidence was in the 1­4 year age group (54.2%), followed by the 5-8 years age group (24.2%). The youngest case was a baby 22 days old. The commonest clinical types were Impetigo contagiosa (46%) which occoured mostly on the face and neck, followed by Folliculitis (44.2%) which was predominantly seen on the scalp, The details of the age and clinical type distribution is seen in [Table - 1].

In the bacteriological analysis, 47.5% of the isolates grew Staphylococcus aureus Scientific Name Search  alone, 26.7% grew Staphylococcus aureus and Streptococcus pyogenes, whereas only 13.3% of the isolates grew  Streptococcus pyogenes Scientific Name Search  Other organisms cultured were coagulase negative staphyloccocci. The complete clinico-bacteriological analysis Is given in [Table 2]. The antibiotic resistance patterns as seen in [Table - 3] showed that resistance to penicillin (79.3%), ampicillin (79.3%) and tetracycline (42.4%) by Staphylococcus aureus was significant, whereas Streptococcus Pyogenes isolates were resistant to streptomycin (14.8%) and tetracycline (14.8%). Almost no resistance to gentamycin and erythromycin was noted.

Of the 58 cases of Impetigo contagiosa, 40 (70%) were caused by Staphylococcus aureus alone, or as a mixed infection. Of these isolates 32 (80%) showed resistance to penicillin, tetracycline and ampicillin.

Only 4 of 24 isolates of Streptococci causing impetigo showed resistance to penicillin and ampicillin.

Of the 86 cases of Folliculitis, Staphylococcus aureus was isolated from 84 cases and 74 (88%) were resistant to penicillin and 80 (90%) to ampicillin. There was a mixed sensitivity pattern to chloromycetin, tetracycline and streptomycin.

Thirteen of the 22 isolates from Furunculosis cases were Staphylococcus aureus and 17 (77%) were resistant to penicillin and ampicillin.

Of the 30 pyoderma cases with more than one clinical type in the same person, half were mixed bacteriological infections and the rest were due to Staphylococcus aureus alone, which showed complete resistance to pencillin, streptomycin and ampicillin.


  Comments Top


Most of the pyoderma cases came during the hot and rainy seasons as conditions during this period including microtrauma caused by biting insects predispose the susceptible children to these infections [5]. The preponderance in the, preschool age group could be due to the fact that these children are exposed to unhygienic conditions when left under improper supervision by parents who are working during the day as labourers. In some previous studies the extremities were the predominant sites of involvement [6]. However, this study as in others [5] showed a preponderance of lesions on the face, neck and scalp. The proximity to the common carrier sities like nares and throat may be responsible for the increased incidence at these sites [7].

Dillon et a1 [7] in their studies of pyodermas in children found streptococci to be the major cause of impetigo. However, later studies [8],[9] as well as this study indicate that Staphylococcus aureus is the predominant causative organism in most types of pyodermas. This points to a changing trend in the etiological pattern of pyodermas.

The drug sensitivity patterns in this study showed a high resistance of Staphylococcus aureus to penicillin. This probably is due to the emergence of penicillinase producing strains and their increased transmission between infected children due to overcrowding and poor hygiene. Previous studies have reported a range of resistance from 50 to 98 percent. Streptococcus pyogenes however showed a 98 per cent sensitivity to penicillin confirming its continued effectivity in streptococcal pyodermas. The high sensitivity to erythromycin and garamycin could be due to their discriminate use because of the high cost and non-availability on an out-patient basis in a general hospital.

As such most of the pyoderma lesions were due to mixed bacterial infection with Staphylococcus aureus and Streptococcus pyogenes with the former showing a high resistance to penicillin, ampicillin and tetracycline.

In conclusion, this study gives an indication of the present state of pyodermas in children in Pondicherry. With a knowledge of the likely causative organisms and their resistance patterns, (since these investigations may not be possible on a routine basis), proper antibiotic therapy can be given avoiding unnecessary medication with drugs known to be resistant.

 
  References Top

1.Mehta T K. Pattern of skin diseases in India. Ind J Dermatol Venerol, 1962; 28: 134-139.  Back to cited text no. 1    
2.Roberts S O B Highet A S: Bacterial Infections. In : Textbook of Dermatology, (Rook A, Wilkinson D S, Ebling F J G, eds), 4th edn. Bombay. Oxford University Press, 1987; 725-790.  Back to cited text no. 2    
3.Coskey R J, CoskeT L A Diagnosis and treatment of Impetigo. J Am Acad Dermatol, 1987; 17: 62-63.  Back to cited text no. 3    
4.Bauer A W, Kirby W M M, Sherris J C et al. Antibiotic succeptibility testing by a standardised single disc method. Am J Clin Patthol, 1966; 45 : 493-96.  Back to cited text no. 4    
5.Dajani AS, Ferrieri P, Wannamaker L W. Natural history of Impetigo - Etiological agents and bacterial interactions. J Clin Invest, 1972; 51: 2863-71.  Back to cited text no. 5    
6.MehtaG, Prakash K, SharmaK B. Streptococcal pyoderma and acute glomerulonephritis in children. Ind J Med Res, 1980; 71 : 692-700.  Back to cited text no. 6    
7.Dillon H C. Topical and systemic therapy for pyodermas. Int J Dermatol, 1980; 19 : 443-51.  Back to cited text no. 7    
8.Schachner L, Taplin D, Scott G B et al. A therapeutic update of superficial skin infection. Paediatr Clin North Am, 1983; 30 : 397-403.  Back to cited text no. 8    
9.Kar P K, Sharma N P, Shah B H. Bacteriological study of pyoderma in children. Ind J Dermatol Venereol Leprol, 1985; 5 : 325-7.  Back to cited text no. 9    


    Tables

[Table - 1], [Table - 2], [Table - 3]

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