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Kinderdermatologie

Aktuelle Aspekte bakterieller Hautinfektionen im Kindesalter

Pediatric dermatology

New aspects of bacterial skin infections in children

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Zusammenfassung

In diesem Beitrag werden wichtige Aspekte von Hauterkrankungen im Kindesalter durch Staphylococcus aureus, β-hämolysierende Streptokokken der Gruppe A (Streptococcus pyogenes) und Borrelia burgdorferi dargestellt. Zur Diagnose der Lyme-Borreliose im Kindesalter sind v. a. die Früherkennung der sehr variablen Erscheinungsformen des Erythema migrans und die hämatogene Disseminierung mit multiplen Erythemata migrantia von großer Bedeutung. Eine rationale Therapie der Impetigo contagiosa muss Begleiterkrankungen des Kindes, die Art des Erregers sowie regionale Resistenzmuster berücksichtigen. Mit Retapamulin steht ein neues Antibiotikum zur topischen Therapie zur Verfügung. Die perianale streptogene Dermatitis sollte bei Genitoanalerkrankungen im Kindesalter in die Differenzialdiagnose einbezogen werden. Die Diagnose wird durch den Nachweis von β-hämolysierenden Streptokokken der Gruppe A gesichert, die Behandlung erfolgt mit Oralpenizillinen über mindestens 14 Tage.

Abstract

We review important aspects of bacterial skin diseases in children, most commonly caused by Staphylococcus aureus, group A β-hemolytic streptococci (Streptococcus pyogenes) and Borrelia burgdorferi. For early diagnosis of Lyme borreliosis in children it is important to be familiar with the variable clinical presentation of erythema migrans and early hematogenic dissemination with multiple erythemata migrantia. Treatment of impetigo in children requires consideration of concomitant diseases, the specific pathogen as well as local resistance patterns. Recently retapamulin has been released as a new antibiotic for topical use in impetigo contagiosa. Perianal streptococcal disease has been underdiagnosed and is an important differential diagnosis of perianal skin disease in children. Diagnosis is made by culturing group A β-hemolytic streptococci; a 2-week course of oral penicillin represents the treatment of choice.

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Literatur

  1. Abeck D, Mempel M, Seidl HP et al (2000) Impetigo contagiosa – Erregerspektrum und therapeutische Konsequenzen. Dtsch Med Wochenschr 125:1257–1259

    Article  PubMed  CAS  Google Scholar 

  2. Afset JE, Maeland JA (2003) Susceptibility of skin and soft-tissue isolates of staphylococcus aureus and streptococcus pyogenes to topical antibiotics: indications of clonal spread of fusidic acid-resistant staphylococcus aureus. Scand J Infect Dis 35:84–89

    Article  PubMed  Google Scholar 

  3. Amagai M, Mattsuyoshi N, Wang ZH et al (2000) Toxin in bullous impetigo and staphylococcal scalded-skin syndrome targets desmoglein 1. Nat Med 6:1275–1277

    Article  PubMed  CAS  Google Scholar 

  4. Arnez M, Pleterski-Rigler D, Luznik-Bufon T et al (2002) Solitary erythema migrans in children: comparison of treatment with azithromycin and phenoxymethylpenicillin. Wien Klin Wochenschr 114:498–504

    PubMed  CAS  Google Scholar 

  5. Atherton DJ (1994) Eczema in childhood. The facts. Oxford paperbacks, Oxford University Press

  6. Axelsson I (2004) Treatment of impetigo: save mupirocin. BMJ 329:979

    Article  PubMed  Google Scholar 

  7. Brettschneider S, Bruckbauer H, Klugbauer N, Hofmann H (1998) Diagnostic value of PCR for detection of Borrelia burgdorferi in skin biopsy and urine samples from patients with skin borreliosis. J Clin Microbiol 36:2658–2665

    PubMed  CAS  Google Scholar 

  8. Brzonova I, Wollenberg A, Prinz JC (2002) Acrodermatitis chronica atrophicans affecting all four limbs in an 11-year-old girl. Br J Dermatol 147:375–378

    Article  PubMed  CAS  Google Scholar 

  9. Christen HJ, Hanefeld F (1993) Lyme-Borreliose im Kindesalter. Monatsschr Kinderheilkd 141:513–526

    PubMed  CAS  Google Scholar 

  10. Cunningham MW (2000) Pathogenesis of group A streptococcal infections. Clin Microbiol Rev 13:470–511

    Article  PubMed  CAS  Google Scholar 

  11. Denton M, O’Connell B, Bernard P et al (2008) The EPISA study: antimicrobial susceptibility of staphylococcus aureus causing primary or secondary skin and soft tissue infections in the community in France, the UK and Ireland. J Antimicrob Chemother 61:586–588

    Article  PubMed  CAS  Google Scholar 

  12. Dressler F (1994) Lyme borreliosis in European children and adolescents. Clin Exp Rheumatol 12 (Suppl 10):S49–S54

    PubMed  Google Scholar 

  13. Groner A, Laing-Grayman D, Silverberg NB (2008) Outpatient pediatric community-acquired methicillin-resistant Staphylococcus aureus: a polymorphous clinical disease. Cutis 81:115–122

    PubMed  Google Scholar 

  14. Herbst RA, Hoch O, Kapp A, Weiss J (2000) Guttate psoriasis triggered by perianal streptococcal dermatitis in a four-year-old boy. J Am Acad Dermatol 42:885–887

    Article  PubMed  CAS  Google Scholar 

  15. Hofmann H (2005) Lyme-Borreliose. Kutane Manifestationen. Hautarzt 56:783–795

    Article  PubMed  CAS  Google Scholar 

  16. Honig PJ, Frieden IJ, Kim HJ, Yan AC (2003) Streptococcal intertrigo: an underrecognized condition in children. Pediatrics 112:1427–1429

    Article  PubMed  Google Scholar 

  17. Howden BP, Grayson ML (2006) Dumb and dumber – the potential waste of a useful antistaphylococcal agent: emerging fusidic acid resistance in staphylococcus aureus. Clin Infect Dis 42:394–400

    Article  PubMed  CAS  Google Scholar 

  18. Jappe U, Heuck D, Strommenger B et al (2008) Staphylococcus aureus in dermatology outpatients with special emphasis on community-associated methicillin-resistant strains. J Invest Dermatol 128:2655–2664

    Article  PubMed  CAS  Google Scholar 

  19. Jongen J, Eberstein A, Peleikis HG et al (2008) Perianal streptococcal dermatitis: an important differential diagnosis in pediatric patients. Dis Colon Rectum 51:584–587

    Article  PubMed  Google Scholar 

  20. Koning S, Mohammedamin RS, van der Wouden JC et al (2006) Impetigo: incidence and treatment in Dutch general practice in 1987 and 2001 – results from two national surveys. Br J Dermatol 154:239–243

    Article  PubMed  CAS  Google Scholar 

  21. Koning S, van der Wouden JC (2004) Treatment for impetigo. BMJ 329:695–696

    Article  PubMed  Google Scholar 

  22. Koning S, Suijlekom-Smit LW van, Nouwen JL et al (2002) Fusidic acid cream in the treatment of impetigo in general practice: double blind randomised placebo controlled trial. BMJ 324:203–206

    Article  PubMed  CAS  Google Scholar 

  23. Laurent F, Tristan A, Croze M et al (2009) Presence of the epidemic European fusidic acid-resistant impetigo clone (EEFIC) of Staphylococcus aureus in France. J Antimicrob Chemother 63:420–421 (author reply 421)

    Article  PubMed  CAS  Google Scholar 

  24. Mempel M, Kerzl R, Ring J (2008) Methicillin-resistenter Staphylococcus aureus (MRSA). Relevanz in der Dermatologie. Hautarzt 59:659–665 (quiz 666)

    Article  PubMed  CAS  Google Scholar 

  25. Oranje AP, Chosidow O, Sacchidanand S et al (2007) Topical retapamulin ointment, 1%, versus sodium fusidate ointment, 2%, for impetigo: a randomized, observer-blinded, noninferiority study. Dermatology 215:331–340

    Article  PubMed  CAS  Google Scholar 

  26. Peltomaa M, Saxen H, Pyykko I (1997) Pediatric facial paralysis – a spirochetal infection with good prognosis? Acta Otolaryngol Suppl 529:116–118

    Article  PubMed  CAS  Google Scholar 

  27. Prinz JC, Kutasi Z, Weisenseel P et al (2009) „Borrelia-associated early-onset morphea“: a particular type of scleroderma in childhood and adolescence with high titer antinuclear antibodies? Results of a cohort analysis and presentation of three cases. J Am Acad Dermatol 60:248–255

    Article  PubMed  Google Scholar 

  28. Rose CD, Fawcett PT, Eppes SC et al (1994) Pediatric Lyme arthritis: clinical spectrum and outcome. J Pediatr Orthop 14:238–241

    PubMed  CAS  Google Scholar 

  29. Salazar JC, Gerber MA, Goff CW (1993) Long-term outcome of Lyme disease in children given early treatment. J Pediatr 122:591–593

    Article  PubMed  CAS  Google Scholar 

  30. Shapiro ED, Seltzer EG (1997) Lyme disease in children. Semin Neurol 17:39–44

    Article  PubMed  CAS  Google Scholar 

  31. Szer IS, Taylor E, Steere AC (1991) The long-term course of Lyme arthritis in children. N Engl J Med 325:159–163

    Article  PubMed  CAS  Google Scholar 

  32. Upton A, Lang S, Heffernan H (2003) Mupirocin and Staphylococcus aureus: a recent paradigm of emerging antibiotic resistance. J Antimicrob Chemother 51:613–617

    Article  PubMed  CAS  Google Scholar 

  33. Wilske B (2000) Lyme Borreliose, MIQ 12, Qualitätsstandards in der mikrobiologisch-infektiologischen Diagnostik. Urban und Fischer, München

  34. Meury SN et al. (2008) Randomized, comparative trial of oral penicillin versus cefuroxime for perianal streptococcal dermatitis in children. J Pediatr 153: 799–801

    Article  PubMed  CAS  Google Scholar 

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  1. Klinik und Poliklinik für Dermatologie am Biederstein, TU München, Biedersteinerstraße 29, 80802, München, Deutschland

    H. Hofmann & C. Schnopp

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  1. H. Hofmann
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  2. C. Schnopp
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Correspondence to H. Hofmann.

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Hofmann, H., Schnopp, C. Kinderdermatologie. Hautarzt 60, 183–193 (2009). https://doi.org/10.1007/s00105-008-1659-z

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