Streptokokkeninfektionen der Haut

Klinik 1, Allgemeine Kinderheilkunde und Jugendmedizin Zentrum für Kinderheilkunde und Jugendmedizin, Universitätsklinikum Freiburg; Klinik 1, Allgemeine Kinderheilkunde und Jugendmedizin Zentrum für Kinderheilkunde und Jugendmedizin, Universitätsklinikum Mathildenstraße 1 79106 Freiburg
Monatsschrift Kinderheilkunde (Impact Factor: 0.19). 01/2005; 153(4):322-329. DOI: 10.1007/s00112-005-1111-8

ABSTRACT Streptokokken der Gruppe A (Streptococcus pyogenes) sind gemeinsam mit Staphylococcus aureus die hufigsten Erreger bakterieller Hautinfektionen im Kindesalter. Die ber 80 M-Serotypen von S.pyogenes gehen mit verschiedenen streptokokkenassoziierten Krankheitsbildern einher. Klassische Hautmanifestation ist die sehr leicht bertragbare Impetigo contagiosa. Einzeleffloreszenz ist ein subkorneales Eiterblschen, das platzt, eintrocknet und sich mit einer honiggelben Borke bedeckt. Durch Verschmieren des Inhalts zerkratzter Pusteln entstehen weitere Effloreszenzen. Die kleinblasige Form ist eher durch Streptokokken, die groblasige eher durch Staphylokokken verursacht. Als Folgeerkrankung kann eine hmorrhagische Nephritis auftreten. Weichteilinfektionen mit Manifestationen an der Haut sind Erysipel und Phlegmone mit Erregerausbreitung in den oberflchlichen Lymphbahnen. Charakteristisch sind eine sich rasch zentrifugal ausbreitende Rtung und Schwellung. Der Rand des Erythems ist erhaben, unregelmig und scharf abgesetzt. Die Haut ist deutlich berwrmt. Die Phlegmone ist die schwere Verlaufsform des Erysipels. Sie kann in eine nekrotisierende Fasziitis bergehen. Klinisch kann das Bild vom streptococcal toxic-shock syndrome (STSS) begleitet sein. Bei der antibiotischen Behandlung ist Penizillin Mittel der Wahl. Beim STSS wird zustzlich mit Clindamycin und Immunglobulinen behandelt. Streptococcus pyogenes (a group A streptococcus) and Staphylococcus aureus are still the most common bacterial pathogens causing skin infections in childhood. There are more than 80 M-serotypes of S.pyogenes, which are linked with various streptococcus-associated clinical pictures. Impetigo is a highly contagious disease and is the classic dermatological manifestation of streprococcal infection. An isolated efflorescence is a subcorneal pustule, which bursts, dries out and becomes covered with a honey-coloured scab. Further efflorescences are caused when the content of pustles is spread by scratching. The form with small pustules is more often caused by streptococci and the form with large pustules, more frequently by staphylococci. Hemorrhagic nephritis can follow streptococcal impetigo. Soft tissue infections with dermatological manifestations are erysipelas and phlegmon with the pathogen spreading in the superficial lymph tracts. Characteristically, redness and swelling spread out rapidly from a central focus. The skin is decidedly overheated. Phlegmon is the severe form of erysipelas and can degenerate into necrotizing fasciitis; in clinical practice there can be a concomitant streptococcal toxic shock syndrome (STSS). For antibiotic treatment penicillin is the medication of choice. In the case of STSS clindamycin and immunoglobulins are also administered.

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