MFF0084: Impetigo

I didn’t realise until recently that the term ‘school sore’ isn’t universally understood. In Australia, especially when I was a boy growing up in Brisbane, school sores were common and parents were asked to get their children to see their family GP whenever school sores erupted.


Hello, and welcome to Medical Fun Facts.

It’s Monday 18 September 2017

Thanks for listening and thanks for watching Medical Fun Facts, a short sharp show with a few facts and hopefully one or two funny lines.

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Last week I spoke about hæmaturia or blood in urine.

This week I want to speak about Impetigo or school sores.

I didn’t realise until recently that the term ‘school sore’ isn’t universally understood. In Australia, especially when I was a boy growing up in Brisbane, school sores were common and parents were asked to get their children to see their family GP whenever school sores erupted.

The most common way school sores present is when you see a crusty yellow rash on a child’s face, arms or legs. The most common cause of impetigo is Streptococcus pyogenes whereas in the less common form, that is, bullous impetigo, the cause is usually Staphylococcus aureus. This crude classification with causation is not hard and fast, but it pretty well follows that if you see large blisters with fluid in them the bacterium most likely to be isolated is Staphylococcus aureus or golden staph. Please note that when we use the term golden staph it does not automatically mean it is a multi-drug resistant bacterium.

For more information on golden staph you can go back all the way to episode 2 and check the notes. I’ve put the link to episode 2 in the show notes. Risk factors for school sores include crowding, day care, poor nutrition, diabetes mellitus and contact sports whether they be organised or just playing footy during the lunch break at school. When I was at primary school, I recall Mum warning me that if I see a kid with school sores not to touch or tackle them because I could get the infection too. As far as I know I never had impetigo as a kid.

The best prevention measures include hand washing, avoiding contact with people who have impetigo and cleaning wounds and injuries.

The infection can be treated with simple antibiotics. Although, without treatment, most impetigo resolves within about three weeks.

The problem with not treating this infection though is that the infection can spread and develop into cellulitis and then immunological complications like glomerulonephritis. Impetigo and similar skin infections are common in tropical and subequatorial areas like the Top End of Australia. Unfortunately, Indigenous Australian children living in these tropical and subequatorial zones are prone to impetigo and we see significant problems with acute glomerulonephritis and subsequent renal or kidney disease in these Australians. Along with diabetes mellitus, impetigo is a significant cause of the high rates of renal failure in Indigenous Australians. Such Australians are then prone to other more serious infections and sequelæ. A lot of efforts have gone into preventing skin disease in Indigenous Australian children.

Questions for listeners

So, I have some questions for listeners.

  • Have you ever had school sores?
  • Did you have them more than once?
  • If you have kids what do you tell them about school sores?

Please leave your answers in the comments section of the show notes or on the Facebook page or on YouTube.

That’s episode 84 in the can.

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MFF0002: Golden staph

If you read a newspaper or listen to the news on the radio or watch the news on TV you’d think golden staph was a so-called superbug.


Staph and Gary Lum
My favourite golden staph

If you read a newspaper or listen to the news on the radio or watch the news on TV you’d think golden staph was a so-called superbug.

I hate calling bacteria bugs. Bugs have legs. Bugs are eucaryotic creatures. Bacteria are bacteria, some of them can be super virulent but that does not make them super resistant to treatment.

There’s a view amongst journalists without medical training that any bacterium which is resistant to multiple antibiotics is super. I disagree. In my mind, something super would have special powers in terms of virulence. A super bacterium wouldn’t only be resistant to common antimicrobial agents it would have a super penetrative capability, it would have super persistence, it would be resistant to the body’s cellular and humoral immune system.

Put simply golden staph is any run of the mill Staphylococcus aureus. It’s called staph because microscopically the cocci are arranged in grape-like clusters. It’s called golden because on horse or sheep blood agar, colonies of Staphylococcus aureus have a golden or yellow colouration.

The fact is these days most strains we see in the clinical laboratory are not golden but tend to be white. Which is a bit confusing because in the old days we’d call staphylococci that formed white colonies ‘Staph. albus’.

Golden staph prefers temperatures of about 30 °C and that’s why you’ll find it in your nostrils, armpits and groins. Because of the coagulase enzyme, it is good at forming abscesses which can range from a zit or a pimple to a large loculated carbuncle. I really like carbuncles, they are so cool to look at and even better to incise and drain. Mmm… pus!

As far as antimicrobial resistant golden staph is concerned the best-known group is MRSA or methicillin-resistant Staphylococcus aureus. MRSA can be broken down into multi or nonmulti resistant. Then there is vancomycin-resistant Staphylococcus aureus, VRSA is a particularly nasty bugger.

For the majority of mild superficial skin infections caused by golden staph, you do not need antimicrobials. Scrub the wound, keep it clean and dress it properly.

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