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.

Don’t expect too much from this and we’ll all be happy.

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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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If you have any questions or comments please let me know. If I’ve said anything incorrect I welcome correction. I’ll catch you next week for episode 85. Something beginning with the letter J. Send me suggestions.
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MFF0073: PANDAS

There’s a basic principle for sore throats. The vast majority are caused by pathogenic viruses for which there are no effective and cheap drugs. The one bacteria we all worry about is Streptococcus pyogenes or the Group A streptococci (GAS for short). There is no way by just looking into someone’s mouth to tell if the cause of the sore throat is Streptococcus pyogenes. The presence or absence of pus is generally meaningless. The only reliable method is to refer the patient for a diagnostic test. This can be culture or any of the newer reliable methods.


It’s Monday 03 July 2017.

Tonight’s show is inspired by a friend’s status update on Facebook. My friend is holidaying on a resort in a country which doesn’t regulate drugs in the same way as we do in Australia, the United States, Canada and the UK, you know the like-minded nations.

My friend mentioned she had a sore throat and could buy antibiotics over the counter without a prescription.

I asked what she bought and she replied amoxicillin (Amoxil™).

This raised a few concerns

Most pharyngitis or sore throat is caused by a viral infection. It’s often associated with those viruses that cause head colds. Amoxil is not going to kill viruses. Secondary bacterial infections of the pharynx rarely occur so that’s not a good reason to take Amoxil either.

The Amoxil will be swallowed, absorbed and distributed through the body. Any resident bacteria, especially bowel bacteria will be exposed and through natural selection, susceptible good bacteria will be killed and resistant bacteria will remain. This could potentially, create an imbalance that if other factors are present could lead to colonisation with drug-resistant bacteria. Should the person suffer an injury, say a burn or a significant soft tissue injury of a lower limb, the drug-resistant bacteria may colonise and then infect the wound. This is not a good outcome.

PANDAS

The other problem with Amoxil is that if the sore throat was part of an infectious mononucleosis and the cause is the Epstein-Barr virus, Amoxil commonly results in a rash which sometimes can be quite severe. While this reaction may be allergic-like, it does not result in true allergy. So the problem we face is that a patient may suffer a rash and sometimes that rash can be quite severe. The patient may also come away with the mistaken belief that he or she is allergic to Amoxil and every time he or she needs an antibiotic, he or she may state this with such confidence, that a simple infection that could be treated with Amoxil may be treated with something more potent and more expensive. In some situations, doctors will assume the patient is allergic to all beta-lactam drugs making a whole class of valuable medication unavailable on a misunderstanding.

There’s a basic principle for sore throats. The vast majority are caused by pathogenic viruses for which there are no effective and cheap drugs. The one bacteria we all worry about is Streptococcus pyogenes or the Group A streptococci (GAS for short). There is no way by just looking into someone’s mouth to tell if the cause of the sore throat is Streptococcus pyogenes. The presence or absence of pus is generally meaningless. The only reliable method is to refer the patient for a diagnostic test. This can be culture or any of the newer reliable methods.

The classical treatment in patients who are not allergic to penicillin is penicillin for 10 days. In fact, if we know the cause is definitely group A streptococci, then Amoxil is fine too. The duration is important because the aim is to reduce the opportunity for post-infectious immunological sequelæ like glomerulonephritis and rheumatic fever.

However, it’s not known if antimicrobial therapy will change the incidence of PANDAS or Pædiatric autoimmune neuropsychiatric disorder associated with group A streptococci. PANDAS is an observation that in children with group A streptococcal infection, they may be prone to obsessive-compulsive disorders and tics. That is, T I C S which are spasmodic muscle contractions and not T I C K S the eight-legged blood eating arachnids.

If you disagree with anything in these podcasts or if you would like to voice a different view, please feel free to write a comment. If I have said something incorrect I welcome correction. Please also feel free to share your comments on social media.

You can find me on Twitter and Facebook. Please follow me on Twitter and like my Facebook page.

MFF0032: Quinsy

Q is for Quinsy and no I’m not talking about Quincy MD, the forensic pathologist played by the late and great Jack Klugman many moons ago.


Medical Fun Facts logo from Gary Lum

Q is for Quinsy and no I’m not talking about Quincy MD, the forensic pathologist played by the late and great Jack Klugman many moons ago.

Given episode 31 was dedicated to pus, this episode in some ways carries on from that.

Quinsy refers to an abscess around the tonsils. Quinsy is fairly uncommon these days, but it is a serious condition.

The abscess usually forms between one of the tonsils and the wall of the pharynx.

It is regarded as a medical emergency because of the serious complications and consequences associated with a growing mass in the throat.

Quinsy can occur in children and adults. Symptoms begin to appear a few days to a week before the abscess forms. The first symptom is often pain when swallowing which is then followed by persistent pain on the side of the abscess along with fever, malaise, headache and hot potato vowels (imagine you have a mouth full of hot potato and you’re trying to count 1 to 10 out loud).

Swollen lymph nodes accumulating cellular immune cells lead to neck pain and swelling with referred ear pain and halitosis. If it’s difficult for the patient to open their mouth, this is a significant sign of an abscess.

A variety of bacteria can cause a quinsy including streptococci, staphylococci, hæmophili, and oral anaerobes.

Quinsy often requires surgical incision and drainage along with antimicrobial therapy.

Complications of quinsy include retropharyngeal abscess, an extension of the abscess into the loose connective tissue spaces of the neck which can lead to a very substantial collection of pus, bacteræmia and septicæmia, and immunological lesions like acute glomerulonephritis and rheumatic fever (when caused by Group A streptococci aka Streptococcus pyogenes).

If you disagree with anything in these podcasts or if you would like to voice a different view, please feel free to write a comment. If I have said something incorrect I welcome correction. Please also feel free to share your comments on social media.

You can find me on Twitter and Facebook. Please follow me on Twitter and like my Facebook page.