Liszajec zakaźny nie mógł zostać pominięty w naszych “wysypkowych” rozważaniach, ponieważ jako najczęstsza bakteryjna choroba skóry u dzieci może sporo “namieszać” w funkcjonowaniu żłobkowo – przedszkolno – szkolnym. Średni wiek dziecka w momencie choroby to 2-5 lat i niestety nie uzyskujemy odporności po przechorowaniu, nawroty są możliwe, szczególnie w okresie letnim. Nie chcę tak typowo schematycznie tego przedstawiać. Skupię się na najistotniejszych dla praktyki cechach szczególnych
żródło: www.enzyklopaedie-dermatologie.de
6 miesięczne niemowlę, widzimy głównie “zdrapane” miejsca i przyschnięte miodowe strupki, które powstały w efekcie pęknięcia krost wypełnionych treścią surowiczo-ropną.
Gronkowiec ( S.aureus) lub Paciorkowiec ( S. pyogenes) to dwa “osobniki”, które są odpowiedzialne za objawy chorobowe. Standardowo diagnozę stawiamy tylko na podstawie objawów skórnych, nie wykonuje się dodatkowych badań. Wielkość pęcherzyków może nas naprowadzić na właściwy patogen. Zasadniczo większe to gronkowiec, mniejsze to paciorkowiec. Z praktycznego punktu widzenia często mamy do czynienia z tzw. mixem, czyli obie te bakterie współtworzą obraz kliniczny, a preparat leczniczy dobieramy, aby działał na oba równocześnie.
ZAKAŹNOŚĆ – duża i problematyczna
Nie ulega wątpliwości, że infekcja jest bardzo zakaźna. Łatwo rozprzestrzenia się szczególnie w skupiskach dzieci. To, że choroba może wystąpić w KAŻDYM WIEKU, a przechorowanie nie chroni przed kolejnym epizodem predysponuje do częstego występowania tzw. “małych epidemii” w żłobkach, przedszkolach czy szkole u dzieci starszych.
Kropelki
KROPELKI o wielkości ( >5um), które bardziej czujemy niż jesteśmy w stanie zobaczyć są środkiem transportu drobnoustrojów z człowieka na człowieka. Wydostają się z jamy ustnej podczas kaszlu czy kichania, ale również podczas mówienia. Dodatkowo przy dzieciach dochodzą nam takie zjawiska ( czasem nie do łatwego opanowania:) jak krzyk czy płacz, gdzie jeszcze z większą siłą zakaźne kropelki się rozprzestrzeniają.
Kontakt
KONTAKT bezpośredni ze zmianą chorobową i przeniesienie drobnoustrojów na własną skórę, ale również w miejsca lub na przedmioty, których potem dotykają inne osoby to również możliwość transmisji zakażenia. W przypadku liszajca zakaźnego, gdzie miodowe strupy znajdują się głównie na twarzy często dochodzi do samozakażenia – dziecko świadomie z ciekawości lub nieświadomie w ramach nawyku, dotyka zmian i roznosi drobnoustroje na inne obszary ciała – najczęściej są to kończyny.
“Otwarte miejsce” – uszkodzenie
ZADRAPANIA, OTARCIA nawet takie najmniejsze mogą być miejscem, w którym cała infekcja się rozpocznie. Liszajec zakaźny to choroba powierzchownych warstw skóry, dlatego nie musi być ona głęboko uszkodzona, aby doszło do nadkażenia bakteryjnego. Dzieci przez swoją nieustanną ruchliwość:) i chęć samodzielnego zbadania każdego zakamarka nierzadko fundują sobie drobne rany na skórze. Może Was zaskoczę, ale nawet lokalizacja po ukąszeniu przez komary i inne insekty latające może być tym “otwartym miejscem” , w którym rozpocznie sie nadkażenie bakteryjne.
Jego prawdopodobieństwo zwiększa się w przypadku bezobjawowego nosicielstwa paciorkowca (S. pyogenes) czy gronkowca ( S.aureus).
żródło: www.enzyklopaedie-dermatologie.de
Dziecko, 18 miesięcy, od 5 tygodni utrzymujące się zmiany skórne POMIMO stosowania terapii zewnętrznej ( pielęgnacyjnej bez sterydów). Podobne zmiany na kończynach górnych i dolnych oraz pojedyncze na brzuchu.
Widzimy tutaj charakterystyczne miodowo – zółte strupki. Brak reakcji na leczenie nawilżająco – natłuszczające daje kolejny powód, aby przypuszczać, że zmiany skórne mogą być nadkażone bakteryjne.
Opryszczka wargowa lub AZS
OPRYSZCZKA i jej pęcherzyki, które ulegają pęknięciu to też uszkodzenie skóry, tyle tylko, że w wyniku procesu chorobowego. Efekt końcowy jest podobny: Naskórek uszkodzony – bakterie mogą się “rozsiewać”. W AZS, szczególnie w zostrzeniach, gdy zmiany skórne są “zadrapane” , świeże, niejednokrotnie sączące się, jest to czas predysponujący do powstania liszajca zakaźnego.
MIODOWO ŻÓŁTE STRUPKI
MIODOWOŻÓŁTE STRUPKI to najbardziej charakterystyczna cecha jeśli chodzi o WYGLĄD zmian chorobowych. Już biegnę z wyjaśnieniem jak się tworzą. Wszak zrozumienie sprzyja zapamiętaniu:)!
Jak tworzy się ten miodowy strupek?
Widzisz jeden lub kilka większych pęcherzy – są one bardzo słabe – szybko pękające – wydzielina, która się w nich znajduje szybko wypływa, a wilgotne podłoże “przysycha” tworząc strupy o barwie miodowo – żółtej. Z kolei opcja “BEZ PĘCHERZA” głównie w momencie zgłoszenia się do lekarza, jest najczęstszą formą liszajca zakaźnego. Napisałam w momencie zgłoszenia się do lekarza, ponieważ one prawdopodobnie SĄ obecne, jednak ich niewielka liczba lub szybkość z jaką “pękają” nie pozwoliły ich nam zarejestrować. Widzimy tylko nasze charakterystyczne strupki. Do nadkażenia “bezpęchechęrzykowego” dochodzi również w przypadku przewlekłych chorób skóry jak np. AZS lub przewlekającej się opryszczki czy zmian skórnych w przebiegu ospy wietrznej.
Liszajec zakaźny, tak jak wspominałam w tekście, może występować w każdym wieku. Tutaj zmiany skórne u osoby dorosłej.
Co robimy?
Leczymy i dbamy o higienę.
W większości przypadków jest to choroba SKÓRY – bez objawów ogólnych takich jak np. gorączka. Ogniska są zlokalizowane, rzadko zajmują więcej niż jeden obszar ciała. W takich przypadkach ograniczamy postępowanie do zastosowania miejscowego antybiotyku. Jest to mupirocyna w maści lub sól sodowa kwasu fusydowego. Badania pokazują, że takie leczenie ma przewagę nad antybiotykoterapią ogólną. Substancje odkażające np. oktenidyna, będąca składnikiem popularnego Octeniseptu, również wypadają gorzej od antybiotyku. Możemy je stosować uzupełniająco.
U starszych dzieci lub osób dorosłych przebieg jest łagodny i możliwe jest samowyleczenie. Jednak aby zapobiec łatwemu rozprzestrzenianiu się bakterii na inne osoby, szczególnie gdy chcemy, aby dziecko chodziło do przedszkola czy szkoły należy wdrożyć leczenie, które przyśpieszy gojenie i ograniczy zakaźność.
Gdy mamy do czynienia z noworodkiem czy mnogimi zmianami u małych dzieci musimy rozważyć antybiotyk podany ogólnie, aby zapobiec ewentualnym powikłaniom, gdyby BAKTERIA dostała się do krwi, a wraz z nią do innych narządów. Nie wykazano związku między skórną postacią zakażenia paciorkowcem a gorączką reumatyczną, a paciorkowcowe zapalenie kłębuszków nerkowych zdarza się bardzo rzadko i zazwyczaj ustępuje bez powikłań u dzieci.
Higienicznie proszę!
Odpowiednie zachowania higieniczne są kluczowe dla odcięcia drogi rozprzestrzeniania zakażenia. Wiadomo, że jeśli mamy bardzo małe dziecko, a zmiany skórne swędzą lub przyciągają uwagę to nie upilnujemy za każdym razem po dotknięciu mycia rąk. Starajmy się jednak zmaksymalizować działania, gdy widzimy, że dziecko dotyka strupków. Ręce myjemy dokładnie wodą z środkiem myjącym. U starszych dzieci zapewne uda nam się mniej lub bardziej dotrzeć tłumaczeniem. Zmiany można “przykryć” jałowym opatrunkiem, pod który nakładamy lek. Nie przyklejamy plastra! ponieważ przylega on zbyt ciasno do zmian skórnych i wraz z jego usuwaniem możemy dodatkowo uszkodzić skórę w otoczeniu – czyli kolejne wrota zakażenia.
Na przedmioty użytkowania też musimy zwrócić uwagę. Ręcznika nie używamy zamiennie. Kubek do picia również powinien być oddzielny, szczególnie gdy zmiany są zlokalizowane przy ustach lub na skórze rąk.
Po zakończonym leczeniu i ustąpieniu infekcji pierzemy ubrania i pościel w temperaturze min.60 stopni C.
Jeśli uważasz, że temat, o którym właśnie przeczytałaś/eś może przydać się innym udostępnij. Dziękuję i do kolejnego artykułu. Na pytania czekam w komentarzach.
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