Staphylococcus aureus ( Staphylococcus aureus ) is a spherical, immobile and aerobic (capable of existing in the air) bacteria, positively Gram-stained, which causes various diseases in children and less often in adults.
Its name “golden” Staphylococcus received from the golden glow, which publishes when sown on a nutrient medium. Translated from the Greek slaphyle – “bunch” and coccus – “spherical”, staphylococcus under a microscope resembles a bunch of grapes. Staphylococcus aureus is widespread in the environment, it can be sown from household items, from toys, from medical instruments, from breast milk and affected skin and mucous membranes of a sick and healthy person.
Normally, Staphylococcus aureus lives on the skin and mucous membranes of almost all people. But healthy people with good immunity do not suffer from staphylococcal infection, since normal microflora inhibits the growth of staphylococcus and does not show its pathogenic essence. But with the weakening of the body’s defenses, the microbe “raises its head” and causes various diseases, including infection of blood or sepsis.
High pathogenicity of Staphylococcus aureus is associated with three factors.
- First, the microorganism is highly resistant to antiseptics and environmental factors (can withstand boiling for 10 minutes, drying, freezing, ethyl alcohol, hydrogen peroxide, with the exception of “green water”).
- Secondly, Staphylococcus aureus produces penicillinase and lidazu enzymes , which makes it protected from almost all penicillin-type antibiotics and helps to melt the skin, including the sweat glands, and penetrate deep into the body.
- And thirdly, the microbe produces endotoxin, which leads to both food poisoning and the syndrome of general intoxication of the body, up to the development of toxic shock.
And, of course, it should be noted that immunity to Staphylococcus aureus is absent, and a person who has had a staphylococcal infection may become infected with it again.
Staphylococcus aureus is especially dangerous for infants in the hospital. It is in hospitals that the concentration of this microbe in the environment is high, to which the violation of the rules of asepsis and the sterilization of instruments and carriage of staphylococcus among honey gives considerable importance. staff.
There is no doubt that the cause of a staph infection is usually Staphylococcus aureus. Infection occurs with a decrease in immunity, which is facilitated by a number of factors:
- antibiotics and hormonal drugs;
- unhealthy diet;
- hypo – and avitaminosis;
- intestinal dysbiosis;
- non-compliance with personal hygiene;
- the immaturity of the child at birth;
- artificial feeding;
- late attachment to the chest.
There are generalized and local forms of staphylococcal infection.
Generalized forms include sepsis ( septicopyemia and septicocemia ).
Local forms include diseases of the skin, mucous membranes, internal organs, bones, joints, mammary glands and umbilical cord. Also, a separate column is to highlight food poisoning with Staphylococcus endotoxin.
In addition, a staph infection can be primary and secondary (in the presence of a primary focus). The course of acute, protracted and chronic forms, and the severity of staphylococcal infections mild, moderate and severe.
The symptoms of a staph infection depend on the location of the staphylococcus in the child’s body and on the degree of reduction of the body’s defenses. The main signs of staph infection are
- pronounced intoxication syndrome (lethargy, weakness, lack of appetite, nausea).
Microbial lesion of the umbilical wound, which is accompanied by swelling of the umbilical ring, purulent discharge from the wound. With the involvement of the umbilical vein, a compacted and thickened vein is palpable. There is also hyperemia, which extends upwards, towards the sternum.
- When pseudofurunculosis (damage to the sweat, but not the sebaceous glands) there are dense, red nodules in the skin folds (accumulation of sweat glands), which then suppurate.
- Vesiculopustosis characterized by the formation of bubbles with liquid contents, which spontaneously open and a crust forms in their place.
- Exfoliative dermatitis (Ritter’s disease), or “scalded skin syndrome” is characterized by the formation of large blisters that look like burns, then the skin is exfoliated and unprotected wounds are formed.
- Abscess – damage to the deep layers of the skin with visible redness and compaction. Formed cavity containing pus.
- Felon – the defeat of the extreme phalanx of the finger.
- Cellulum – in addition to the skin, the subcutaneous tissue is involved, which suppuate.
At damage of a mucous eye develops conjunctivitis (photophobia, tearing, eyelid edema, purulent discharge from the eyes).
Lesion of the airways
Rhinitis – redness of the mucous membrane with copious purulent discharge from the nose. With the penetration of infection below develops sore throat, characterized by sore throat, pharyngitis , tracheitis with a dry and painful cough.
Infection of the bronchi and lungs leads to bronchitis and pneumonia. As a rule, bronchitis and pneumonia occur combined with pharyngitis, rhinitis, tracheitis.
There is a significant increase in temperature (up to 39-40 ° C), dry cough, shortness of breath.
Possible development of stenosis of the respiratory tract.
Central nervous system damage
Penetration of Staphylococcus aureus into the brain leads to the development of meningitis and brain abscess. Diseases in children are difficult, with high fever and intoxication.
Characterized by “brain” vomiting, headaches, positive meningeal symptoms, episyndrome and skin rash. When spinal puncture fluid flows under pressure, has a greenish hue with an admixture of pus.
Damage to the urinary tract
Develop urethritis, cystitis, pyelonephritis. Typical symptoms: frequent and painful urination, pain in the lumbar region, high fever. In urine tests are determined protein, a large number leukocyte count , Staphylococcus aureus is inoculated.
Damage to the bones and joints
When infections of bones and joints develop arthritis and osteomyelitis .
Foodborne Disease Infection
It develops when eating contaminated or spoiled food and proceeds with symptoms of acute enterocolitis. Characterized by fever, nausea, vomiting up to 10 or more times a day, loose stools with a touch of green.
Infection of blood or sepsis, occurs when severe immunodeficiency. The course of the disease is severe, with a very high temperature, severe symptoms of intoxication, impaired consciousness (from agitation to lethargy).
With the development of toxic shock sharply decreases blood pressure, the patient loses consciousness and may fall into a coma.
Septicopyemia is the circulation of Staphylococcus aureus in the blood with the formation of purulent foci, both on the skin of the child and in the internal organs.
When septicemia is characterized by the development of infectious toxicosis. Septicemia may be complicated by the accession of pneumonia, the development of DIC syndrome And so on.
Differential diagnosis of staphylococcal infection should be carried out with streptococcal infection. In the diagnosis of diseases of staphylococcal etiology using the following serological methods, characterized by speed and high accuracy:
- Standard coagulase test in vitro, which lasts 4 hours, but with a negative result is extended for a day.
- Latex agglutination, which uses commercial sets of latex particles associated with antibodies to staphylococcus (A-protein, adhesion factor and a number of surface antigens), which makes it also useful for species and strain identification of the pathogen
- General blood and urine tests (leukocytosis, neutrophilia,increased ESR, and urine protein, leukocytes, staphylococcus).
- Sowing biological material on nutrient media.
Sowing on nutrient media is carried out in order to identify the causative agent of the disease and determine its sensitivity and resistance to antibiotics.
Sowing feces should be done no later than 3 hours after defecation, smears from the mucous membranes of the mouth and nasopharynx should be taken on an empty stomach, before brushing your teeth and before taking medicine.
Smear with staphylococcal conjunctivitis is taken from the lower eyelid with a sterile swab dipped in distilled water and before washing.
In skin diseases, smears are taken after pre-treating the skin around the wound with an antiseptic solution and removing the necrotic areas (crusts) from the wound.
- Vidal agglutination reaction
Allows you to determine the dynamics of the disease and the effectiveness of treatment. It is held 2 or more times with intervals of 7-10 days. The increase in antibody titer in the blood of more than 1: 100 indicates the progression of infection.
- Phagotyping of isolated staphylococci
Allows you to determine the sensitivity of the microbe to phage viruses for the appointment of appropriate treatment.
In milder forms of staphylococcal infection, antibiotics are not required.
In moderate and severe forms, semi-synthetic penicillins ( amoxiclav ) are prescribed , which are effective for the resistance of the microorganism to penicillins and cephalosporins ( kefzol , ceftriaxone ).
The duration of treatment depends on the severity of the disease and infection of the skin or internal organs (from 7 days to several months).
In case of purulent-inflammatory skin diseases (furunculosis, carbuncle, impetigo), local treatment is prescribed – mupirocin or pleuromutilin derivatives . In their absence, wounds can be treated with antiseptic solutions: brilliant green, hydrogen peroxide, potassium permanganate and antibacterial ointments (synthomycin , oleandomycin ointment, baktroban ).
With conjunctivitis The eyes are washed daily with a weak solution of potassium permanganate, and a 30% solution of albucide 4-5 times a day is instilled .
In case of purulent skin lesions ( abscesses, cellulitis), surgical opening of abscesses for the outflow of pus is performed.
In addition, the prescription of antistaphylococcal bacteriophage, antistaphylococcal plasma and immunoglobulin (in sepsis and severe disease) is shown.
When staphylococcal food toxicoinfection antibiotics are not prescribed, used antistaphylococcal toxoid. Gastric lavage and replenishment of the circulating blood volume with intravenous infusions of saline solutions (physical solution, glucose solution, rehydron and others) are carried out .
For the prevention of intestinal dysbiosis, the use of antifungal drugs ( Diflucan, Nystatin ) in parallel with antibiotics is recommended .
Immunocorrective therapy is prescribed simultaneously (vitamins of group B, C, levamisole, Taktivin and others).
The treatment of a staph infection in children is performed by a pediatric infectious diseases specialist.
Methods of treatment are selected depending on the damage of certain organs. The child is hospitalized in a separate ward-box, where the daily change of bed and underwear and the daily shower of the patient.
Staphylococcus aureus is especially dangerous for infants. Possible complications:
- infectious toxic shock;
The prognosis depends on the severity of the disease and the effectiveness of treatment.
With light lesions of the skin and mucous membranes, the prognosis is favorable. Massive infection with Staphylococcus aureus, especially with the development of sepsis in 50% is fatal.