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Live Blog: Common Pediatric Bacterial/Fungal Infections – Faculty: Fred Ghali, MD

In this live blog from the Annual Summer SDPA Conference in Las Vegas, Fred Ghali, MD, presented a lecture on “Common Pediatric Fungal and Bacteria Infections.” Here are some of the highlights.

Dr. Ghali lectured about a range of fungus conditions including impetigo, folliculitis, boils, and Staphylococcal Scalded Skin Syndrome.

Impetigo bullous is a flaccid, thin-walled blister. These blisters will often spread in areas of the body that rub together often, such as the under arm and the side of the chest. The majority of these blisters are caused by staph infection and 70% of cases are the non-bullous type. Impetigo is best treated with oral antibiotics and topical mupirocin (which is also good for recurrent cases).

MSSA and MRSA are common causes of folliculitis. Staph infections thrive in warm and moist areas so it is commonly found on the bottom of the diaper-wearing child. One notorious trigger is the “pull-up” potty training diaper because pull-ups are not designed to be as absorbent as regular diapers.

Pseudomonal Folliculitis
This condition is likely caused by a poorly chlorinated pool or hot tub and often appears on the trunk, buttock, and legs. It will appear within a few days of exposure and, in most cases, will typically self-resolve after 5-10 days.

The majority of boils are MRSA. When you see a boil it’s important to first rule out inflamed molluscum. If it’s not molluscum it should be drained. Dr. Ghali notes: “You’re going to feel like the bad cop when you drain these boils, but it is very important to get all the puss out.” Oral antibiotics covering MRSA are clindamycin, TMP-Sulfa, and doxycycline for patients older than 9 years old. Try bleach baths of topical sodium hypochlorite products as preventive strategies. “Create a chlorinated pool in your home.”

Staphylococcal Scalded Skin Syndrome
This condition usually presents first with the nose, mouth or eyes, with radial fissures around the mouth. These patients will come in looking like and feeling like they have sunburn. They’ll also present with some fevers, irritability, and lethargy. Some health care workers may unknowingly act as carriers of the epidemic strain of S. aureus, sometimes resulting in SSSS infections in NICUs with neonates. Outpatient treatment is done for mild and older patients, while neonates, infants, and severe, widespread infections will require hospitalization.

Tinea Incognito
Inflammatory tinea can infect the small, fine hairs on the face. It’s often caused by previous treatment with topical steroid that has created an endothric infection. You need to treat these with oral antifungal agents.

“Id” Reactions
There is often an absence of fungus in the area of the id reaction, with demonstrable focus of pathogenic fungus at other location. Presentation consists of small, flesh colored papules on extensor arms, face, and trunk. Id reaction can happen with the primary rash as a nickel allergy, or inflamed molluscum. Id is always secondary to a primary reaction. Dr. Ghali stressed that while it may look like scabies, it is not scabies.

Image: Lynette

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