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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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Key Features

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Description

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

  • Highly infectious skin rash, spreads rapidly

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

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  • 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

  • Lesions most often on face, lips, arms, and legs

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Functional Implications

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  • Very contagious, limiting contact and social status

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Possible Contributing Causes

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  • Skin lesions

  • Circulation impairment

  • Pain

  • Edema

  • Contact with someone with the skin infection

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Differential Diagnosis

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  • Tinea

  • Herpetic impetigo

  • Pemphigus vulgaris

  • Pemphigus foliaceus

  • Folliculitis

  • Pseudomonas folliculitis

  • Follicular mucinosis

  • Erysipelas

  • Lymphadenitis

  • Lymphadenopathy

  • S. aureus infection

  • Insect bites

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Means of Confirmation or Diagnosis

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Laboratory Tests

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  • Culture of the skin or lesion

  • Blood cultures: leukocytosis tests

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Treatment

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Medication

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  • Parental antibiotics

    • Penicillin

    • Cefazolin

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Referrals/Admittance

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