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CONDITION/DISORDER SYNONYMS

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  • Superficial pyoderma

  • Streptococcal impetigo

  • Impetigo contagiosa

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ICD-9-CM CODE

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  • 041.01 Streptococcus infection in conditions classified elsewhere and of unspecified site, Streptococcus, group A

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ICD-10-CM CODE

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  • B95.0 Streptococcus, group A, as the cause of diseases classified elsewhere

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PREFERRED PRACTICE PATTERN1

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  • 7B: Impaired Integumentary Integrity Secondary to Superficial Skin Involvement

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PATIENT PRESENTATION

A 62-year-old male presents with swelling, pain, and discoloration of the right foot. His wife reports that he stepped on a sharp object on the floor 3 days ago. He now has fever, diarrhea, and is showing some confusion. The patient has no complaints of pain. He has a history of type II diabetes. Because of the possible associated and unidentifiable fever and confusion the patient was referred to a walk in medical clinic.

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KEY FEATURES

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Description
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  • Streptococcus pyogenes (group A Streptococcus) is responsible for infections in the skin

  • Group A infections

    • Cellulitis and erysipelas

    • Impetigo

    • Scarlet fever

    • Severe strep infections

  • Highly infectious skin rash, spreads rapidly

  • It occurs most often in tropical climates or during the summer months in nontropical climates

  • With this infection, the patient is usually afebrile and has no pain

  • Lesions are most often on the face and extremities and may become a mild but chronic illness if untreated

  • Most common in children, particularly those in unhealthy living conditions

  • In adults, it may follow other skin disorders or a recent upper respiratory infection, such as a cold or other virus

  • Preceding a streptococcal respiratory infection

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Essentials of Diagnosis
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  • Diagnosis is usually made by considering medical history and signs and symptoms, including the distinctive sores.

  • A culture may be used to confirm the diagnosis or to rule out another cause.

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General Considerations
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  • Highly contagious and can be spread through close contact or sharing items.

  • Scratching can spread the sores to other parts of the body.

  • It can be difficult to distinguish clinically between skin infection caused by streptococci and other bacteria such as Staphylococcus

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FIGURE 57-1

Structure of the skin. (From Chandrasoma P, Taylor CR. Concise Pathology. 3rd ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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Demographics
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  • Highest prevalence in children 2 to 5 years of age

  • Can be seen in adults, but is more prevalent in children

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CLINICAL FINDINGS

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SIGNS AND SYMPTOMS

  • Impetigo

  • Erysipelas

  • Rash

  • Blisters filled with pus

  • Fever

  • Malaise

  • Vomiting: Childhood type

  • Itching blister

  • Erythematous denuded areas

  • Honey-colored crusts

  • Localized area of redness

  • Purulent vesicles covered with a thick, confluent, honey-colored fluid

  • Swollen lymph nodes near the infection

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