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链球菌皮肤感染

作者:艾米博士Stanway MB慢性乙肝,注册,Department of Dermatology, Waikato Hospital, Hamilton, New Zealand.


链球菌皮肤感染 - 代码和概念
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Introduction

链球菌(复数链球菌)是bacteria通常发现无害地生活在人类呼吸,肠道和genitourinary系统。几种物种能够引起人类的疾病,包括皮肤病。

What skin disease is due to streptococcal skininfection

Skin diseases due to direct infection with streptococcus include:

链球菌疾病

此外,链球菌能够通过直接感染皮肤的方式引起皮肤病;例如:

  • 猩红feveris a reaction to a circulatingtoxinthat is produced by some strains of streptococcus
  • Streptococcaltoxic震惊syndrome(STSS)
  • 过敏hypersensitivity对链球菌细菌可能导致红斑Nodosum.or血管炎
  • 银屑病, 尤其胫骨可以通过链球菌感染激发或加重形式
  • PustulosisAcuta Generalisata:疏散无菌pustules在有链球菌上呼吸道感染后的手,脚和其他地方;可能与痛苦的关节有关。

链球菌的细菌学

链球菌基于它们的外观归类为革兰氏阳性COCC1microscope。它们是球形或卵形的形状,并且倾向于形成彼此的链。

导致人类疾病的链球菌通常是兼容性的anaerobes.; that is, they prefer lower levels of oxygen in their environment. Streptococci are further classified into subtypes based on sugar chains expressed on their outer shell (Lancefield group) and their behaviour when grown in the laboratory (alpha- or beta-溶解)。大多数链球菌在皮肤中重要感染属于Lancefield组A,C和G,并且是beta-摇溶解。链球菌肺炎(肺炎球菌)是肺炎和肺炎重要的细菌脑膜炎但很少引起皮肤病。肺炎球菌是α-血液溶解的,不属于兰田群组。

兰西菲尔德集团A.

该组由一种称为型链球菌组成的Streptococcus pyogenes。Up to one-fifth of the healthy population can carryS. pyogenes在喉咙里。S. pyogenes产生许多人toxinsand这有助于它建立感染。这是一个重要原因咽炎,Impetigo,蜂窝织炎和坏死性筋膜炎。它能够诱导猩红热,感染后肾小球肾炎(肾脏疾病)和风湿fever(心脏病)。

这些产品中的一些产生了一个抗体response in the patient's blood that aids in detection of recent streptococcal infection (eg, anti-DNAase, anti-streptolysin). These can help in the diagnosis of rheumatic fever, post-streptococcal glomerulonephritis and erythema nodosum.

  • 血清感染后三到六周的影像达到最大值,并开始落在六到八周后,返回基线6-12个月后。
  • 这血清anti-DNase Btitre最多可以花六到八周到最大达到最大值,并在感染后三个月开始跌至秋季,慢慢恢复基线。

快速结果咽喉拭子也可用但不是绝对可靠,并且应该在临床背景下解释(记住这一点无症状carriage of streptococci in the throat is common).

兰西菲尔德集团C和G

这些细菌偶尔会导致类似于Lancefield组A的感染,并且通常会影响老年人或慢性病的患者。

Pneumococci

S肺炎细菌可能住在健康人的喉咙和鼻子里。它们在其外壳上产生粘性物质,使它们能够连接到鼻子或喉咙的衬里并侵入,导致一些患者感染。大多数感染涉及呼吸道或脑膜,但肺炎球菌偶尔会导致蜂窝织炎。由于肺炎球菌的蜂窝织炎通常会影响患者connective tissue疾病或疾病HIV感染。

治疗链球菌皮肤感染

It can be difficult to distinguish clinically between skin infection caused by streptococci and other bacteria such asStaphylococcus aureus。因此,应选择抗生素来涵盖最有可能的organisms。Flucloxacillin is more appropriate than simplepenicillinas it treats bothStaphylococcusstaph)和strep。

If the laboratory has confirmed streptococcal infection, then the most appropriate antibiotic is usually penicillin. All streptococci in the Lancefield group are very sensitive to penicillin. Those patients with penicillin过敏may be given红霉素或者是对大多数链球菌有效的头孢孢菌素(例如,头孢曲松),尽管一些红霉素抗性正在出现。非常严重S. pyogenes感染,如坏死性筋膜炎,clindamycinmay be added to penicillin as very large numbers of bacteria may overwhelm penicillin's mechanism of action.

肺炎球菌皮肤感染通常用青霉素治疗,但最近据报道了低水平的抗性。在更严重的感染中,头孢曲松或万古霉素可能更合适。

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