Impetigo Contagiosa. The Association of Certain Types of Staphylococcus Aureus and of Streptococcus Pyogenes with Superficial Skin Infections

Abstract

Impetigo contagiosa may be defined as an acute, superficial infection of the skin characterized by exudation and crusting. In this country it is at present mainly seen in children, although it has been an important cause of minor illness among troops in wartime. It appears to have become much less common in the last 10 years, though a recent increase in incidence has been reported (Sneddon, 1953). In the 90 years since the original clinical description of Fox (1864) there appear to have been repeated fluctuations in the prevalence of the disease, and also differences in frequency, severity and predominant clinical type in different parts of the world. It is not surprising, therefore, that there have been great discrepancies between the bacteriological findings of various workers, and that the controversy between the supporters of the staphylococcal and the streptococcal theories of the aetiology of the diseasehas continued for almost 60 years. Most dermatologists nowrecognize the existence of at least two clinical types of impetigo, associated respectively with haemolytic streptococci and with Staphylococcus aureus, though it is not always possible to make such a clinical distinction in the individual case (Epstein, 1940).The investigation reported here falls into two parts, the first of which was carried out in association with Dr L. C. Martin in Cambridge in the years 1941-2 and was concerned with impetigo in young adult service men. The second was occasioned by an increased prevalence of impetigo in the City of Salford in 1953(Burn, 1954, particularly during the last few months of the year. There was an unusually high proportion of severe cases, many of which were of the bullous type.The Cambridge investigation showed that a large proportion of Staph. aureus strains from impetigo cases (and a much smaller proportion from other sources) had the ability to inhibit corynebacteria. The Manchester investigation showed that most of the impetigo staphylococci belonged to a single unusual phage type, members of which were usually able to inhibit corynebacteria and were penicillinresistant, and that the haemolytic streptococci were largely confined to two particular serological types.

Acute glomerulonephritis in Trinidad: serological typing of group A streptococci

“…The association of members of the 3, 13, B 3264 and of the 8, 25, Imp. 19 T-complex with impetigo was noted in Britain some years ago (Parker, Tomlinson & Williams, 1955), but nephritis secondary to skin sepsis was not observed. At Red Lake, Minnesota, organisms with the 3, 13, B 3264 T-pattern were predominant in skin sores at a time when nephritis was absent (Anthony, Perlman & Wannamaker, 1967 b).…”

“…For some time it has been recognized that group A streptococci from skin lesions seldom have M-antigens that are detectable with the antisera used in routine typing (Parker et al 1955;Barrow, 1955;Dillon et al 1967). Top et al (1967) have shown that this is not because 'skin' streptococci lack M-antigens, but because they belong to previously unrecognized or supposedly rare M-types.…”

Current Problems in Studies of Streptococci Second Griffith Memorial Lecture

“…The specificity of the T antigen did not always agree with that of the M antigen (Lancefield, 1954). Some strains isolated from impetigo were classified by slide agglutination into the three main T-antigen patterns by Parker and others in 1955 (Parker, Tomlinson & Williams, 1955 ; Barrow, I 955). However, these strains gave no recognizable M-precipitin reaction.…”

Reexamination and Characterization of the T‐Agglutination Complex or Pattern of Streptococcus pyogenes: Preparation of Anti‐T Factor Sera

“…19) and (5,27,44) or (5,11,12, 27, 44), Parker et al [4] demonstrated in their surveys, conducted in 1941-42 and 1952-54, a great predominance of these particular 'types' among the isolates from impetigo patients and reported that they 269 were only typable by slide agglutination but not typable by M-precipitation. They regarded these types as patterns and did not attempt, by absorption test, to clarify the antigenic relationships among the types forming the complexes.…”