How to identify staphylococcus in the body in a child. Staphylococcus in children: causes infection, symptoms and treatment

Golden Staphylococcus - conditionally pathogenic bacterium, which is regularly discovered in 70% of people across the planet. This is a ball-shaped microorganism capable of producing carateinoids, staining its shell in a golden shade. Under the microscope, it looks like a bunch of honeymoon berries.

Staphilococcus in children is revealed much more often than in adults, and the child's regular visits to the pediatrician becomes the cause of regular visits.

With the normal function of the immune system, the bacterium does not show pathogenicity and can be hidden for a long time in the media body. But with the slightest immunodeficiency, staphylococcus is activated and provoked the development of infection. At the same time, any authority may suffer.

What is dangerous "Amber Surrusko"

- This is the most dangerous view among all staphylococci, which can cause severe diseases. Pneumonia, furunculez, enteritis, sepsis - not the entire list of possible problems. Active bacterium highlights a number of dangerous toxins that quickly poison all organs and sacrifice systems. In addition, there are diseases that appear only due to the activity of staphylococcus - it is barley, purulent acne, purulent osteomyelitis, staphylococcal meningitis and others.

Get rid of bacteria is very difficult.

She feels great in an aggressive environment. Rape, alcohol or hydrogen peroxide do not represent any danger to it. Antibacterial drugs on golden staphylococcus affect weakly, the bacterium is quickly adapted, and it becomes extremely difficult to get rid of it.

The greatest cases of staphylococcal infection occur in the walls of the hospital hospital. "Ordered" permanent quartzing procedures, treatment of disinfectants of bacteria easily attack loose patients of medical institutions. According to WHO, about 35% of all cases of infection with golden staphylococcus occur in the walls of hospitals. Breast children head risk group.

Ways of infection

Staphylococcus aureus appears in a child's contact-domestic way. Children often sick with colds, neglect hygiene rules are injured. Weakened immunity is not able to withstand the attacks of microorganism, and small cuts, wounds and abrasions open the direct path of infection to internal organs.

Newborn and children under the year, golden staphylococcus may appear as a result of intrauterine pathologies and generic injuries. Such cases are most dangerous, because the less child, the more difficult it is to cope with infection. And without immune resistance, the infection spread instantly.

Among other reasons:

• Premature childbirth, as well as the appearance of a cesarean section.
• Violation of the minorial care protocol in the hospital.
• Non-compliance with hygiene rules.
• Selfless weight in the period of newborn.

All listed situations provoke a decrease in immunity, a single efficient barrier from the spread of golden staphylococcus a child.

Important! Be sure to distinguish the concept of "staphylococcus" and "Staphylococcus infection".

The first means the inert presence of bacteria in the body, which does not require medical intervention. The second is a serious reason for the start of treatment. Determine the amount and activity of bacteria can only be laboratory.

Types of infections in children

As already mentioned, absolutely any organ can attack bacterium. The most common options for the localization of golden staphylococcus in children:

Mucosa of intestines

The disease is characterized by acute enterocolitis with typical features:

• stomach wandering pains, a sense of strong cutting, bloating;
• tangible discomfort in the epigastric zone;
• chair disorders, purulent greenish impurities in feces, tenesmas.

Mucous throat

Manifests itself in the form of acute tonsillitis, stomatitis, catarrhal angina with basic symptoms:

• pain and redness of the throat;
• mind Fatherland;
• punching rashes on mucous throats and oral cavity;
• high temperature, weakness.

Nose mucosa

Manifests a typical symptoms with typical symptoms:

• nasal congestion, edema;
• purulent discharge of yellow-green color from the sinuses;
• symptoms of general intoxication.

This is how staphylococcus is most often manifested, because it is the simplest ways of penetrating bacteria into the body.

Other specific signs of the appearance of staphylococcus in children appear in stages. At an early stage (a few hours after infection), the body temperature rises, the child becomes sluggish, diarrhea and vomiting may occur. After 3-5 days, the late form develops. It is characterized by purulent rashes on the skin and mucous membranes, the development of meningitis, sepsis, the defeat of the internal organs. In babies, golden staphylococcus can provoke a "scalding skin syndrome" - severe condition in which the baby's skin is covered by wounds, externally resembling burns. Late form without timely treatment can end to death.

Probable factors provoking the development of staphylococcal infection are viral diseases, for example, herpes. If the child fell ill with herpes and at the same time it was revealed by Staphylococcus, the doctors focus on the treatment of herpes. The virus is very oppressed by immunity, while the activity of Staphylococcus Aureus is as a result.

Diagnostic methods

Only a qualified children's doctor can determine the staphylococcus, based on the results of laboratory research. Since bacterium is very dangerous for newborns, the first material for analysis takes right in the hospital.

Depending on the localization of the bacteria, diagnostic bakpospases are prescribed:

• In suspected of an intestinal infection, a sample of feces is examined at staphylococcus.
• During the defeat of the ENT organs, the scraping from the mucous nose and throat is taken.
• If the development of sepsis is suspected for analysis, blood is taken.

Samples are placed under the microscope and manually consider the number of bacteria. The resulting number is compared with the norm and the preliminary diagnosis is made.

It is not worth it to decipher the results, since in different laboratories the norm may have unequal values. For example, by the industry standard (91500.11.0004-2003), a healthy person of any age bacteria should not be in the analysis. But most modern laboratories are focused on the staphylococcus content indicator 10⁴. This limit is considered the norm for all age groups, with the exception of children up to the year. Infectious disease in children with an inconsected immune system can cause such a number of bacteria.

A lot of important factor is the growth of staphylococcular colony. To determine it, repeated analyzes will come.

Abundant growth of bacteria speaks of the ineffectiveness of therapy and the spread of infection. Weak or moderate growth should not cause anxiety. Most likely, therapy works or the body copes with the disease independently.

Having studied all the results of research by analyzing the symptoms of Staphylococcus the child, the doctor prescribes treatment.

Anti-infection methods

Since the activity of golden staphylococcus is directly related to the work of the immune system, it is necessary to take measures to stimulate it. For this purpose, the course of vitamin therapy is prescribed, and immunostimulants and immunomodulators are used.

To get rid of toxins with which bacteria etching internal organs, you need to put the course of enterosorbents and hepatoprotectors.

In dermatological manifestations of golden staphylococcus, children are appointed with sterile compresses. In some cases, they are resorted to blood transfusion.

Antibiotics are prescribed at high temperatures and in cases of purulent inflammation.

Other methods:

• Treatment of mucous nasopharynx means containing silver, iodinol. Sometimes mazi type mazi is prescribed.
• Surgical intervention. The extreme measure to which is resorted in cases of a protracted purulent infection of the skin, as well as in chronic purulent angina (almonds are removed).
• If staphylococcus is found in a pregnant woman, hospitalization is produced into a special box. There are medical therapy under the constant control of the doctor.

One of the most simple ways to combat staphylococcal infection of the throat is rinse with the drug called chlorophyllipt. Its use is usually highly effective in the treatment of bacterial pathologies, when the use of antibiotics is not advisable. The medicine is an alcohol or oil solution. The first worship the mouth and throat, the second - lubricate the glands and other inflamed areas. Also, oil chlorophyllipte can be buried in the nose. Treatment usually lasts 10-15 days.

Home pharmacy

To cure the golden staphylococcus at the child can be both folk remedies. There are many ancient recipes, more than once proven their effectiveness. For example, for therapy of a bacterial infection in the throat, a decoction of pharmacy calendula (marigolds) is used. To cook it, you need a teaspoon of dry raw materials to pour 250 ml of steep boiling water, insist of half an hour, strain. Decoction rinse the throat every 2 hours.

Another recipe is the decoction of Salfa and the Hyperician. Dry herbs are taken on a teaspoon, fit into enameled dishes, poured a glass of boiling water. The cooled fluid is filled and used for rinsing.

In staphylococcal intestinal infections, apply a decoction of pharmacy chamomile. 10 g of flowers in 250 ml of boiling water are brewed, insist for half an hour, filter. Take 50 ml 4-6 times a day.

For the treatment of purulent skin inflammations, ragners are used from a mixture of leopa leaves and a socket. Dry raw materials are mixed in equal proportions. 2 tablespoons of grass poured 100 ml of steep boiling water and insist 20-30 minutes. Fluid fluid processes inflammation areas.

Propolis tincture is a universal agent. On the one hand, it has a powerful antimicrobial effect, on the other, it helps strengthen the immune system. To prepare a medicine yourself, you need to grind a few small pieces of propolis and fold into the dark jar. Pour the raw materials with 50% alcohol or high-quality vodka, close and put it in the dark cool place. A few days later there will be a great remedy for rinsing at tonsillites, sinusitis and other manifestations of staphylococcal infection.

Skin infections treat apple vinegar well. To prepare the healing bath, you need 50 ml of vinegar to dissolve in warm water. Take a bath for 15 minutes three times a day. To make acetic compress, 2 spoons of the means dissolve 2 spoons of water.

It is necessary to remember - the self-medication is dangerous! Especially when it comes to children's health, so in front of any manipulations with the body of the child you need to consult with the doctor.

Preventive actions

Treat staphylococcus is difficult, it is much easier to follow simple preventive rules:

1. Observe the principles of personal hygiene and teach them a child from an early age. It is necessary to explain that licking the fingers is dangerous, especially on the street, how often wash your hands with soap.
2. In no case do not eat unwashed vegetables and fruits, do not take into the mouth that accidentally fell to the floor. In the intestine, Staphilococcus falls precisely in an oral way.
3. Always handle wounds, even the smallest. Although golden bacterium is not afraid of alcohol and peroxide, but does not survive under the influence of green and fuccin.

The most important thing is to take measures to strengthen immunity. Balance the diet of the child, add to it more seasonal vegetables, fruits, vitamin C. Increase the number and duration of the outdoor walks, active games, sports. Hard the baby from an early age and no infection to it closes.

Staphylococcus infection - a large group of purulent-inflammatory diseases of the skin, internal organs, mucous membranes, CNS caused by pathogenic strains of staphylococci.

According to the international classification, staphylococcal infection happens such species:

Staphylococcal food poisoning;

Septicemia caused Staphylococcus. aureus.;

Septicemia caused by other refined staphylococcus-kami;

Septicemia caused by unspecified staphylococci;

Staphylococcus infection is unspecified.

The infection is distributed among the population patients and carriers of pathogenic stamps staphylococcus. The highest chance to become infected with patients with open purulent foci (such as relentless bruunkula, angina, purulent conjunctivitis, ventilated wounds), with inflammation of the lungs and with intestinal disorders. In these cases, the infection is distributed in the environment, where it is dangerous for adults and children.

At the peak of the disease, children allocate the maximum mass into the external environment. The mass is significantly reduced after recovery, but in frequent cases, the child after the disappearance of symptoms becomes the carrier, continuing to infect others. Healthy carriers also represent a greater threat, especially if they work in the field of medicine, in the maternity hospitals, branches for newborns, premature babies or in food products.

Staphylococcus infection is transmitted by such paths: contact, food, air-drip. Most of the victims recently born and babies are infected with contact path. This can happen through mother or medical staff, through care or lingerie. Children up to 12 months in frequent cases are infected with an alimentary way - infection enters the body through milk, if the mother has mastitis or cracks on the nipples. Also dangerous in the mixture infected with staphylococcus.

Children of preschool and school age are infected often by using infected products, such as sour cream, other dairy products, cakes, etc. When staphylococcus falls into the food, it breeds in a beneficial medium, highlighting. Airborne droplets can be infected if the child is close to the patient or carrier. Staphylococcus in such cases colonizes the cavity of the nose and the rotoglot.

In the risk group there are novorogen-bottom and infants. The causes of their high susceptibility to staphylococcus are a weakly pronounced local antibacterial immunity of the respiratory tract and the gastrointestinal tract. As you know, the newborn does not highlight a secretory, which plays an important role in the local defense of the body. The saliva of the saddle has a very weak bactericidal action, mucous membranes and skin of the wound. It is also the causes of the high sensibilities of the infections to staphylococcal infection.

Susceptibility contributes to the weakness of any diseases, exudative diathesis, hypotrophy, artificial feeding of the infant, long-term intake of antibiotics and corticosteroid hormones.

The actual number of cases are not known as localized forms, unlike heavy, are usually not recorded (for example, infected wounds, piedermium).

Staphococcalous diseases have sporadic nature, but there are group, family diseases, as well as epidemics in maternity hospitals, branches for newborns, etc. Also, the outbreaks may also happen due to the use of infected food in schools, summer camps and other similar organizations. Acute gastrointestinal diseases caused by staphylococci are characteristic of the warm pore threshold, but they can happen in the cold months.

What provokes / reasons for staphylococcal infection in children:

Staphilococci - Gram-positive microorganisms having a ball shape. Rank Staphylococcus. It is divided into 3 types: epidermal, golden and saprofitic. Golden Staphylococcus is divided into 6 biovars. For a person, pathogenic type A, he excites the majority of staphylococcal nature diseases, the rest of the bows are striking birds and animals.

Because of the above-toxic and allergic processes described above, immunity is sharply reduced, the permeability of the membranes and walls of the vessels increases, which contributes to the septic process. It is symptomatically, it manifests the metastasis of purulent foci and the formation of sepsis.

The course of food toxicoinfection depends on how much causative agent and enterotoxin fell into the child's body. Staphylococcus in large quantities are found in such a biological material taken from a patient as vomiting masses and feces, as well as in food residues, due to which there was infection. But with food toxicoinfection, the pathological process depends mostly from enterotoxin received with eating.

Patomorphology.A local focus of inflammation appears at the site of the staphylococcus in the field, which consists of staphylococci, serous-hemorrhagic exudate, uncritical tissues, which are surrounded by leukocyte infiltration. Next, micro-passages are formed, which can merge, forming foci.

If the infection fell on damaged skin, the formation of boils, carbunkulov begins. If the entrance gate is the mucous membrane of the child's rotogling, angina, stomatitis, etc. Primary changes can be observed in the lungs - serial-fibrinous exudate and leukocyte infiltration appears there. But in frequent cases, small, sometimes merging foci of abscessive pneumonia are formed, and rarely large foci, which are subluibular.

Staphylococcal diseases of the gastrointestinal tract are characterized by ulcerative, catarrhal or necrotic damage. Morphological changes occur in the intestinal tone, although the pathological process can affect the colon. Epithelial fabrics are necrotized, and sometimes necrosis affects the deeper layers of the mucous membrane. It is noted infiltration of sinic and submucosal shells with pronounced blood circulation disorders. Ulcers are formed.

When (and if) infection is generalized, sepsis occurs, then staphylococcus through blood reaches various organs and systems, for example, bones, CNS, liver, etc. Metastatic foci of inflammation appear there. Morphologically, abscesses are determined in various organo-nah.

Symptoms of staphylococcal infection in children:

With staphylococcal infection, many symptoms may appear. It depends on the place of infection in the body and on the severity of the primary inflammatory hearth. Staphylococcal infection in children in shape can be generalized or localized.

Most cases are localized light shapes, for example, Naphorgin or Rhinitis. There are minor inflammatory changes, no intoxication. In infants, these forms can manifest themselves poor appetite and inadequate weight gain. Sowing blood allows you to highlight staphylococcus.

But localized forms do not always pass easily, they may be accompanied by severe symptoms, pronounced intoxication and bacteremia, therefore, the differentiation of them with sepsis may be required.

The disease can occur in asymptomatic or erased form. They are not diagnosed, but are dangerous for the child and others, because the infected child is raparty infection. In some cases, otherwise joins the disease, for example, which leads to the exacerbation of staphylococcal infection and complications, in some cases it is extremely difficult.

With staphylococcal infection, the incubation period lasts from 2-3 hours to 3-4 days. The shortest incubation period with a gastrontscrolitic form of the disease.

Most often, staphylococcus infection in children is localized on the skin and in the subcutaneous cell. Under the skin stafy-locked infection, an inflammatory focus is rapidly developing with incoming to the suppuration and reaction of regional lymph nodes along Ti-PU lymphoamite and lymphangitis. In children, staphylococcal lesions of the skin, as a rule, have the form of folliculites, boils, pyodermia, phlegmons, carbun-kula, hydragenite. Newborn can be exfoliative, bubble of newborns ,. If the infection affects the mucous membranes, the symptoms of purulent conjunctivitis, angina appear.

Staphylococcus angina in children as an independent disease - the phenomenon is quite rare. This is usually happening against the background of ARVI, in some cases due to the exacerbation of chronic tonsillitis or as a result of sepsis.

In case of staphylococcal sinking, children appear solid overlapping in palast almonds, sometimes they also affect the alignment and tongue. In some cases, angina is follicular. Overlay in staphylococcal sinks In most cases, purulent necrotic, whiteish-yellowish shade, loose. Remove them relatively easy, as well as to be lost between the subject glasses.

Cases are extremely rare when the staphylococcal infections are dense, it is difficult to remove them, the removal causes the bleeding of the tonsils. For staphylococcal angina, a characteristic spilled bright hyperemia hyperemia of the mucous membranes of the oz without clear gras. From a child, complaints of severe pain in swallowing can be received. The reaction of regional lymph nodes is pronounced. Staphylococcus agnus passes for quite a long time. About 6-7 days are preserved inxication symptoms and elevated body temperature. Zev is cleaned by 5-7 days or on the 8-10th. Without laboratory methods, it is impossible to understand without laboratory methods.

Staphylococcal laryngitis and laryngotracheitsinherent in mostly children of 1-3 years. They develop on ARVI. The disease is characterized by acute beginning, the stenosis of the larynx appears quickly. Morphologically, there is a necrotic or peptic necrotic process in the larynx and trachea. Staphylococcal laryngotracheitis often passes with obstructive bronchitis and - in non-essential cases - pneumonia. According to symptoms, staphylococcal laryngotrachitis in children is almost no different from laryngotrachites caused by another bacterial flora. The disease is very different only from the diphtheria cereal, which develops slowly, with a gradual change of phases, parallel with the increase in symptoms (spelliness of voice, afony, dry, coarse cough and gradually increasing stenosis).

Staphylococcus pneumonia - A special form of lung damage with a ha-racker tendency to abscess. Diseases are more than other children of young children. It begins in most cases during the flow or after ARVI. As an independent, non-accompanied by other disease, staphylococcal pneumonia is extremely rare.

The disease begins sharply or violently, the body temperature is strongly increased, expressed symptoms of toxicosis are observed. In more rare cases, staphylococcus pneumonia in children can begin gradually, first follow small catarrhal phenomena. But in these rare cases, the patient's condition is rapidly deteriorating sharply, heavily "jumps" the temperature, intoxication is enhanced, the breathing is increasingly increasing. There is a lethargy and pallor of the child, he drowshed, does not want to eat, jumps, often happens. Fix the shortness of breath, shortening the percussion sound, a moderate amount of fine moist wet wheezing on one side and weakened breathing in the damage zone.

In staphylococcal pneumonia, bulls are formed in the lungs. These are air cavities, the diameter of which is 1-10 cm. They can be revealed by making a radiograph. Bulla's infection threatens the lung abscess. The breakthrough of the purulent focus leads to purulent pleuritis and pneumothorax. With staphylococcal pneumonia, fatal outcomes are frequent.

In the primary staphylococcal focus of any localization may appear scarlantine-like syndrome. Most often it happens with the stafilo-coccal infection of the wound or burn surface, lymphoenate, phlegmon ,.

The disease is manifested by a scarlantine-like bulk. It occurs on a hyperemic (red-in) background, formed from small points, located, as a rule, on the side surfaces of the torso. When the rash disappears, there is an abundant lamellar peeling. In the child during this form of the disease, the temperature of the body is high. Rash appears on 2-3 days after the start of the disease and later.

The lesions of the gastrointestinal tract staphylococcus can be located in various places (in the stomach, intestines, on the mucous membranes of the mouth, in the bile system). The severity of such diseases is also different.

Staphilococcal Stomatitis Confused mainly children of early age. There is bright hyperemia of the mucous membrane of the mouth of the mouth, the appearance of AFT or ulcers on the mucous membrane of the cheek, in the language, etc.

Staphylococcal gastrointestinal diseases - It is gastroenteritis, enteritis, enterocolitis that occur when infected through food. In children under 12 months, enteritis and enterocolites often occur as secondary diseases against other staphylococcal disease. If the path of infection is contact, and enteritis or enterocolitis occurs, there is a small amount of pathogen in the body. Staphilococci cause local changes in breeding in the intestine, as well as general symptoms of intoxication when toxin enters the blood.

With gastritis or gastroenteritis of staphylococcal nature, the incubation period lasts 2-5 hours, then a sharp beginning of the disease. The brightest symptom is multiple, often indomitable, sharp weakness, severe pain in the field of epigastria, dizziness. Most of the patients have elevated temperatures. The skin is pale and covered with cold later, the tones of the heart are muffled, the pulse is weak and frequent. In most cases, an defeat of the small intestine occurs, which leads to a violation of the stool. Feling occurs from 4 to 6 times a day, a stool of liquid consistency, water, is impurities of mucus.

The most severe manifestation of staphylococcus infection is staphylococcal sepsis. It meets more often in young children, mainly in newborns, in a special group of risk - premature children. The pathogen can get into the body through the umbilical wreck, gastrointestinal tract, skin, almonds, lungs, ears, etc. This causes the type of sepsis.

If the staphylococcal sepsis proceeds sharply, the disease develops violently, the patient's condition is characterized as very heavy. The body temperature is strongly increased, the symptoms of intoxication are expressed. Peeticient or other rashes can be observed on the skin. In different organs, secondary septic foci (abscesses, abscessive pneumonia, purulent arthritis, phlegmon leather, etc.) appear. The blood test detects neutrophilic leukocytosis with a shift of the formula to the left, the EE is increased.

It happens (very rarely) the lightning course of the disease, which is ends with a fatal outcome. But in most cases, the flow is sluggish, with a subfebrile temperature, non-timber expressed symptoms of intoxication. Children of the thump, the lubility of the pulse is noted, the bloating is happened, the liver and can be increased, on the anterior abdominal wall and the chest, they note the expansion of the veins, among the symptoms, the stool disorder is often. Sepsis in early age children can manifest themselves with various symptoms, which is thinking of his diagnosis.

Staphylococcal infection in newborns and children of the 1st year of lifeconnected, above all, with a mother's disease. The child's infection occurs at any stage of pregnancy, during childbirth and after them.

Diagnosis of staphylococcal infection in children:

Staphylococcal infection is diagnosed on the basis of the detection of purulent foci of inflammation. Resort mainly to laboratory research methods, since with other diseases there may be similar symptoms.

A microbiological method is used to detect pathogenic staphylococcus in the lesion focus and especially in the blood. For se-rological diagnostics, RA is used with autoshtamm and museum strain staphylococcus. The increase in the titer of antibodies in the dynamics of the disease undoubtedly indicates its staphylococcal nature. The titer of agglutinins in RA 1: 100 is considered diagnostic. Diagnostic titles are detected on the 10-20th day of the disease.

Among the laboratory methods apply the neutralization reaction to the toxin antitoxin. Today, instead of traditional methods, RLA is often used.

Treatment of staphylococcal infection in children:

Treatment of patients with staphylococcal infection depends on each specific case. If in older children, the infection proceeds in a light form, doctors prescribe symptomatic means. For the treatment of severe and medium-eyed disease forms, complex therapy is needed: antibiotics and specific anti-staococcal drugs (such as anti-stococcal plasma, anti-stilococcal immunoglobulin, staphylococcal bacteriophage,).

Surgical methods, nonspecific disinoxicing therapy can be applied. Doctors often appoint the reception of vitamins.

To cure or prevent dysbacteriosis, baked preparations are used, such as bificol and others. Stimulating therapy may also be needed, which will increase the protective functions of the child's body.

Patients with severe formas of staphylococcal infection are subject to hospitalization at mandatory. Also hospitalized necessarily newborns, even if the form of the disease is light.

Antibacterial preparations are used as semi-synthetic penicillinase-resistant penicillins, cephalosporins of the 3rd and 4th generation.

Acute sepsis, abscessive destructive pneumonia, meningoencephalitis is treated with the simultaneous two antibiotics in the maximum dose corresponding to the patient's age.

Heavy and generalized forms of staphylococcal infection, especially if an early child is treated with hyperimmous antistaphococcal immunoglobulin.

Staphylococcal gastroenteritis and enterocolites are treated with the same principles as other acute intestinal infections. Hospitalization is needed if there are appropriate clinical and epidemiological testimony. Newborn and infants under 12 months are placed in a separate boxing.

If the child has become infected through maternal milk, the breastfeeding should be stopped. A child in such cases should feed on donor milk, lactic acid or adapted mixtures in accordance with age and severity of the lesion of the gastrointestinal tract.

Food toxiconinfection is treated with a stomach wash with a 2% sodium bicarbonate solution in the first day from the beginning of the disease. If the toxicosis is expressed with dehydration, you first need to carry out infusion therapy, and then oral rehydration (restoration of the water balance in the body).

Prevention of staphylococcal infection in children:

In children's institutions to prevent staphylococcal infection, sanitary-anti-epidemic regime should be observed. This means that the disinfection of the items of the consideration is carried out, the proper cleaning of the premises, etc. The patients should be detected in a timely manner and isolate so that they do not distribute the infection.

It is also necessary to identify carriers of pathogenic poly-resistant strains of staphylococci among carporting personnel in maternity hospitals and branches for newborns and remove them from work, control the observance of the per-sonal of sanitary and hygienic rules for the child, the aseptic content of individual nipples, care objects and dishes, etc.

At least 2 times a year of the maternity hospital should be closed for disinfective measures and cosmetic repairs. In children's institutions, inspection of kitchen workshops should be inspected daily. The work is not allowed to work with any form of staphylococcal infection - whether staphylococcal diseases of the upper respiratory tract, the mouth of the hands, or any other form.

Children with staphylococcular diseases are hospitalized into individual boxing, so as not to make an infection in the hospital department. All objects of care for a sick child must be strictly individual.

Babes become less susceptible to staphylococcal infection at (provided that the mother is healthy). The measures for the specific prevention of staphylococcal infection today is not.

What doctors should be pleased if you have a staphylococcus infection in children:

Infectious

Gastroenterologist

Dermatologist

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Cryptorchism in children

Croup in a child

Brewing pneumonia in children

Crimean hemorrhagic fever (kgl) in children

Ku-fever in children

Labyrinthitis in children

Lactase deficiency in children

Larygitis (acute)

Pulmonary hypertension of newborns

Leukemia in children

Drug Allergy in Children

Leptospirosis in children

Lethargic Encephalitis in children

Lymphogranulomatosis in children

Lymphoma in children

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Malabsorption in children

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Meningococcal infection in children

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Metabolic syndrome in children and adolescents

Miastations in children

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Mycoplasmosis in children

Myocardiodistrophy in children

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MyocLonic Early Children's Epilepsy

Mitral Stenosis

Urolithiasis (ICD) in children

Fiberglass in children

Outdoor otitis in children

Speech violations in children

Neuroses in children

Mitral valve failure

Incorrected intestinal turn

Neurosensory hearing loss in children

Neurofibromatosis in children

Nonachar diabetes in children

Nephloral syndrome in children

Nose bleeding in children

Ossessive-compulsive disorder in children

Obstructive bronchitis in children

Obesity in children

Omsk hemorrhagic fever (ogl) in children

Opistorhosis in children

Herpes Sheers in Children

Brain tumors in children

Tumors of the spinal cord and spine in children

Tumor Eha

Ornithosis in children

OSP Rickeciosis in children

Acute renal failure in children

Children's sharp

Acute hymoritis

Acute herpetic stomatitis in children

Acute pancreatitis in children

Acute pyelonephritis in children

Children's swelling in children

Otitis Middle Ear in Children (Chronic)

Otomycosis in children

Otosclerosis in children

Focal pneumonia in children

Paragripp in children

Parakoclush in children

Parroids in children

Paroxysmal tachycardia in children

Parotitis in children

Pericarditis in children

Pylorostenosis in children

Child food allergy

Content

For kids, especially at the age of 2-3 years, the diagnosis of staphylococcus infection is one of the most common, but this is not alarming of parents. It can manifest in different ways, because it affects the skin and internal organs, but not all strains of this pathogenic microorganism are equally dangerous. In what situation infection requires immediate serious treatment, and when can I do without antibiotics?

What is staphylococcus in children

Among the gram-positive bacteria causing infectious diseases, staphylococcis are one of the most common, especially if they affect diseases affecting young children. They belong to the genus Staphylococcaceae, and the name was obtained thanks to round shape and division in several planes, due to which the bacteria resemble a bunch of grapes (Greek "Cokkos" is "grain", and "Statil" - "grapes"). The main characteristics of staphylococcus:

• The diameter of the bacteria cell ranges in the range of 0.6-1.2 microns.
• The danger of staphylococci is to produce endotoxins and exotoxins, which negatively affect the vital activity of cells in the human body.

Most of the pathogenic microorganisms of the type of Staphylococcaceae if the child has strong immunity, does not provoke severe consequences if staphylococcus in the child has been found in the child, which increases the risk of brain lesions, nervous system, toxic shock. The high incidence of staphylococcal infections in infections is due to the absence of IGA immunoglobulin (not synthesized in the first years of life).

As transmitted

Infection predominantly arises in view of the weakening of the body's protective forces, which leads to an increased morbidity in children who have a low immune response. Risk factors capable of weakening the protective forces of the body, doctors add non-compliance with the rules of hygiene, viral diseases (ARVI, flu), improper power. The infectious agent is distributed not only to patients, but also healthy carriers of pathogenic strains. Particularly often staphylococcal infection is transmitted from individuals with pneumonia, open foci of purulent inflammation. Main transmission paths:

• Airborne-drip - in any public place and even at home when the carrier talks, sneezes, coughs, and a healthy person inhales infected air.
• Contact-household - through the touch of the skin to the skin (it is especially dangerous if there are purulent foci of infection on the skin) with handshakes, kisses, embraces, or through common items: toys, dishes, etc.
• Alimentary (for staphylococcal infection - food) - when using infected products, to which the infection fell from a sick person or an animal, through dirty hands.
• Intrauterine - if a woman during pregnancy has become infected with staphylococcal infection, or has already had pathogenic bacteria in the amount of above normal, the fetus can be infected with the placenta in the process of the mother's roostening.

Views

In modern medicine, there are 27 strains of bacteria by Staphylococcaceae, but serious danger to children and adults represent only 4. When a staphylococcal infection is diagnosed in children, doctors priority check the pathogen to belong to one of these species:

• Saprophytic (Staphylococcus saprophyticus) is not the most common children's staphylococcus, also affecting the mucous membranes, but only organs of the urogenital system. It is the causative agent of urethritis, cystitis. It does not represent much danger to children: with competent and timely treatment, the disease can be eliminated in a few days.
• The epidermal (staphylococcus epidermidis) is striking the skin, mucous membranes of the eyes, respiratory system. With a strong immunity for a child, it is not dangerous: the pathogen becomes for premature babies or undergoing surgery. The activity of this strain leads to the development of conjunctivitis, endocarditis, sepsis, complications of the postoperative period.
• Hemolytic (staphylococcus haemolyticus) - called the name for its hemolysis ability (destruction), refers to the number of conditionally pathogenic bacteria. It is characterized by increased resistance to antibiotics, pine inflammatory processes provokes, affecting the internal organs (especially the urinary system) and endocard (the inner layer of the heart wall). In the absence of treatment, it causes sepsis (systemic inflammation flowing throughout the body due to blood infection).
• Golden (Staphylococcus aureus) - the most pathogenic strain, the people are called "Golden Death", the name received due to the ability to form a pigment of the same name. The majority of organs and tissues amazing, provoking the beginning of purulent inflammatory processes in them. An important biochemical feature of this strain is the development of coagulase: enzyme that stimulates the coagulation of blood plasma.

The greatest danger for breast-age children due to the reduced local immunity is golden staphylococcus, which has increased virulence (sickness), resistance (stability) to antiseptic, high temperatures, UV radiation. The treatment is particularly difficult if the meticillin-resistant strain is revealed to the extensive group of antibacterial drugs (beta lactams: cephalosporin and penicillin rows).

Symptoms

The clinical picture of the disease depends on several factors, among which the age of the child, the zone of the defeat, the state of the immune system, the path of infection, the strain of the microorganism. Golden Staphylococcus in children provokes severely more often than the other varieties of this bacterium. By the nature of manifestations, doctors divide the symptoms on:

• Local: rash on the skin and mucous membranes (in the nose) - furunculae, narya; The appearance of purulent mucus from nasal moves or throat, stomatitis.
• General: symptoms of intoxication to which are nausea and vomiting, headaches, temperature rise (subfebrile and high), pallor of skin or hyperemia, general weakness. The manifestations of infection on the part of the GTS (diarrhea, gas formation), allergic reactions to toxins produced by bacteria are not excluded.

Separately, it is important to take into account the stages of the development of the disease: the earlier is the development of clinical symptoms, after a few hours after infection. Under late stage, the signs of staphylococcus in children will appear only 2-5 days after the infectious agent hit. Recognize a specific strain of pathogenic microbe difficult, although they have distinctive features:

• Epidermal - the main blow will have to skin cover, so furunculae, eczema, pyodermium, dermatitis, blepharitis, conjunctivitis will appear.
• Hemolytic - general symptoms reminds manifestations of angina: cough, throat pain, tonsil swelling.
• Sapportic - pain at the bottom of the abdomen, urination disorders (the clinical picture of cystitis).
• Golden - severe course of the disease with purulent inflammation in any domestic organ. Among the most common states caused by this strain in children is the catarrhal angina, furunculosis, strong intoxication.

In nose

The sinusitis is the most common state caused by the activities of staphylococcal infection in nasal strokes. Against the background of inflammation and swelling, the mucous membrane is having difficulty breathing (both unilateral and double-sided), which can cause permanent attempts to breathe solely mouth (in a light form is characterized by a strong nozzle). Additionally, the following symptoms may be present:

• purulent mucous membranes from nasal moves;
• infringement of sense of smell;
• swelling;
• manifestations of general intoxication and ailment - nausea, weakness, lethargy, loss of appetite;
• raising temperature (acute stage or the beginning of the development of complications).

In the intestines

The active activity of pathogenic bacteria on the walls or in the intestinal cavity leads to the reaction of the digestive tract in the form of symptoms of acute colitis, which after moving into enterocolitis. Against the background of the general deterioration of well-being will appear:

• loss of appetite;
• nausea, vomiting;
• diarrhea or constipation;
• blood or purulent inclusions in feces;
• false urges for intestinal emptying;
• driving pain in the stomach of a wandering nature;
• gas formation, bloating;
• the feeling of gravity in the epigastric zone.

In the mouth

More than half of the cases of staphylococcal infection in children (48-78%) are characterized by damage to the respiratory tract and here with high frequency are developing ulcerative stomatitis, catarrhal angina (acute form), tonsillitis. The child appears the classic signs of intoxication, the temperature can increase and will be observed:

• redness of the oz;
• sore throat;
• redness and swelling of the agent;
• whitish yazens in the mouth;
• discomfort when swallowing.

In kidneys

The defeat of the urogenital system of staphylococcal infection in children is rarely observed, local symptoms are mainly like cystitis (bladder inflammation) or pyelonephritis (kidney inflammation). The child will complain about pain at the bottom of the abdomen, lower back, frequent urge to urination. Parents can observe an increased body temperature from the baby, and in the urine - bloody streaks, pus particles.

Staphilococcus in children up to year

Newborn and infants often receive infection from the mother of intrauterine, or during the appearance of the light (less often through underwear, doctors, care objects). Due to the lack of immunoglobulins that can withstand pathogenic microorganism, children up to a year are especially vulnerable to staphylococcus and the disease they are difficult. It can appear as:

• vesikopustulosis;
• exfoliative dermatitis (ritter disease);
• multiple abscesses;
• epidemic bubbles (highly affordable disease).

In most cases, the infectious agent strives for skin and subcutaneous tissue, the disease develops quickly, the suppuration areas appear, which are gradually replaced by multiple abscesses. The main blow falls on the skin of the head, neck, back and chest, after the inner surface of the hips, buttocks may affect. Symptoms can be based only on local rashes or accompanied by manifestations of intoxication (with ritter disease), high temperatures. The defeat of staphylococcus is not excluded:

• mucous membranes of the mouth;
• lungs (mainly pneumonia against a viral infection);
• GCC (food toxicoinfection, secondary enterocolitis and enteritis).

Diagnostics

An independent definition of a specific causative agent of staphylococcal infection is not possible: all checks are carried out by laboratory research. Diagnostics can be assigned not only to the child, but also the mother, if there is an assumption that the infection went from it. The following methods are primarily used:

• Bacteriological sowing is the most effective way to identify the strain of the pathogen, implies the study of the mucous membranes (eye - with conjunctivitis), pus, feces, skin (wounds on their surface). The material fence is carried out when the disease is at an acute stage, since the activity of pathogenic microorganisms at this point is increased. Additionally, bacteriological sowing helps to determine what antibiotics can be affected by a specific type of staphylococcus.
• Serological blood test - a traditional study aimed at identifying antibodies (Ig, immunoglobulin) to a specific pathogen, the presence of which indicates an infectious disease.
• The PCR method (polymerase chain reaction) is assigned to identify DNA molecules pathogenic bacteria, is an additional diagnostic method.
• Survey of breast milk mothers - if the child is on natural feeding and pathogenic microorganisms were found in the feces in excess quantities, the writing maternal milk is investigated to determine the source of infection. With a positive result, the kid is transferred to artificial mixtures.
• Endoscopy, laryngoscopy - with the appearance of complications, when ulcerative colitis or pathology develops the larynx. These diagnostic measures are optional.

Treatment of staphylococcus in children

High resistance to chemical exposure and drugs requires to take the antibiotic therapeutic scheme as a basis, especially if the doctor diagnosed Staphylococcus Aureus in a child not only in the cartoons. Thanks to the bacteriological crop, it is possible to establish which specifically drugs will effectively affect the causative agent of the disease. Antibiotics are used both orally and injectable. In addition, the treatment scheme of staphylococcal infection includes:

• The local impact on rashes, wounds, gunnocks (if available), including those that are on mucous nasal, eye (not only on skin cover). Among aniline dyes, a diamond green (Zelenka) is recognized as the most productive. Additionally applied alcohol (70%), hydrogen peroxide, Vishnevsky's line.
• Washers of nasal moves, oral cavities and throat with antiseptic solutions are prescribed as an element of additional therapy and the prevention of a new infection. It uses silver preparations, chlorhexidine, furacilin, or bacterial lysates (IRS-19, IMUDON).
• Reception of immunoglobulins that enhance the protective forces of the children's body and preventing the transition of infection into the chronic stage.
• The course of vitamins and minerals is also in order to overall immunity strengthening as supporting the main therapeutic course.

In the acute situation, the selection of bacteriophage, affecting a specific strain of bacteria, is necessary: \u200b\u200ba doctor comes to such a decision in the absence of an effect from antibiotic therapy. The heavy stages of stages of staphylococcal infection can also mean the surgical intervention at which a sanitation (cleansing) of the focus of purulent inflammation, and hemotransphus (blood transfusion and plasma) is carried out in the case of a generalized infection. After recovery, it is important to pay attention to the prophylactic measures.

Antibiotics

Self-treatment is not recommended at any stage of the disease, especially with regard to the selection of antibacterial therapy, which is necessary when defeating the entire body with infection or severe local current. Appoint specific tablets (injectable antibiotics are used primarily in the hospital) must be a doctor after bacteriological sowing. Preferably, children use a penicillin series drugs, and for some strains, drugs of macrolides groups, cephalosporins, lincoosamides are shown. The most appointed antibiotics:

• Clarithromycin - macrolide on the substance of the same name is prescribed during staphylococcal infections of the respiratory system, skincodes, has a bactericidal and bacteriostatic effect. Not recommended for diseases of the heart, kidneys, sensitivity to macrolides. The dose is selected individually, children under 12 years old - no more than 15 mg / kg per day (divided by 2 times). The lack of the drug lies in a large number of adverse reactions (from rash to anaphylactic shock).
• Fusidin - antibiotic reserve on fusidic acid. Bacteriostatic, affects strain-resistant strains, is prescribed during sepsis, endocarp, pneumonia, skin infections and soft tissues. Children are given in the form of a suspension, the dose is calculated by weight individually. The drug is not used in hyperprotombinemia, liver failure. It can provoke adverse reactions from the gastrointestinal tract.

Folk remedies

If an infectious disease is at the initial degree of development and manifestation of weak, in the therapeutic course you can introduce recipes of traditional medicine. Advantageously, these are tools for local use (for rinsing and washing), or a liner, which only complement the basic treatment regimen, and do not replace it. Some simple recipes:

• Boil on a water bath 1 tsp. Aspen bark in a glass of water (10 minutes), to give half an hour. Take 1 tbsp. l. 3 R / day for 2 weeks.

Attention! The information presented in the article is familiarized. Article materials do not call for independent treatment. Only a qualified doctor may diagnose and give recommendations on treatment, based on the individual characteristics of a particular patient.

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Discuss

Staphylococcus in children - symptoms and treatment

The very philateentity of "Staphilococcus in children" causes anxiety from parents, and sometimes panic. Meanwhile, specific conditions are required to develop a hazardous staphylococcal infection, which, oddly enough, most often arise in medical institutions. So, what is this "beast" so terrible - staphylococcus, and how does it threaten to children's health?

Some types of staphylococci are extremely dangerous to children's health, long and "mutually" are treated. Therefore, parents are very important to know with which conditions of staphylococcus "turn" into staphylococcal infection.

What kind of "beast" - Staphilococcus?

Staphylococcus is a bacterium, a special microbe. She neighboring a person as closely as hundreds of other microorganisms. The varieties of staphylococcus a great set - today the doctors know about 27 species of this microbe. Of these, about 14 are constantly living on the skin and in the human body, and from these 14 only 3 are considered potentially dangerous to human health. And there is no such organ in the human body (and in particular - a child), where Staphilococcus could not live and multiply .

Staphylococcus in children can cause an impressive number of all kinds of diseases - from a banal acne on the skin to the inflammation of the kidneys, from intestinal infection to purulent meningitis, and so on. There are also "sores", which are caused only by staphylococcus (and most often precisely golden staphylococcal) and no other microbe - for example, barley in the eye, boil on the skin and others.

But there is no reason to be afraid of time. Since (repeat!) Only three types of staphylococcus are really dangerous to the health of adults and children. Moreover, even their detection in the human body does not yet mean the development of infection - for the start of the disease, special conditions are required. The main thing of which is weakened immunity.

According to the data that the World Health Organization (WHO) reports, at least 65% of the urban population (including children from a newborn age) staphylococcus is constantly present on the skin. Even about 20%, this microbe appears episodically.

Moreover, according to the same WHO, one of the types of hazardous staphylococcus - namely golden staphylococcus - most often causes an infectious disease in people who are in the hospital (about 35% of all cases of golden staphylococcus in children are registered in hospitals).

Simply put, most of all chances to pick up the golden staphylococcus arises not somewhere, but in the hospital ward. After all, one of the conditions for the potential development of infection is a weakened low immunity organism. And where are the people (and including children!) With weakened immunity? Of course, in medical hospitals ...

Staphylococcus and staphylococcus infection in children - fundamentally different things!

The presence of staphylococcus in the body of the child is far from a reason for panic and running on pharmacies in search of the most expensive antibiotics. As we have already mentioned, Staphilococcus wears more than 80% of the population on themselves or in itself, and at the same time most of them are never in life and not "binds" to get a staphylococcal infection.

The real development of staphylococcal infection in children is not a positive analysis on staphylococcus, but arising from this symptoms of staphylococcal infectious disease:

• heat;
• the appearance of purulent mucus;
• redness;
• the painful feeling (as a rule, it appears in the place where the inflammatory process arises).

The typical manifestation of staphylococcal infection is purulent inflammations that can develop anywhere in the children's body (although the most common arises in the nasophaling). And if, when analyzing staphylococcus, it was found, but no purulent processes in the body of the child are not observed - it means that there can be no question of any staphylococcal infection.

This situation indicates that your baby and staphylococcus coexist peacefully with each other, and the child's immune system successfully controls this "settlement" of microbes in its body.

Staphylococcus and herpes: What is the connection?

Alas, but in children quite often, the background and incentive for the development of staphylococcal infection is the course of herpetic infection. The thing is that it has an extremely pronounced ability to catch immunity.

Therefore, children against the background of herpetic infection, a staphylococcus infection occurs. If this trouble happened to the child once - against the background of herpes, a staphylococcal infection arose - in this case, experienced doctors advise parents to send the main forces not to fight staphylococcus, namely, to fight recurrent herpes, so that in the future just do not give "soils" to Development of staphylococcal infection.

The most dangerous staphylococci for children: Golden and company

So, in the company of those 14 species of staphylococci, which are constantly present in most people (and children including), most relative to peaceful. And only 3 species are potentially able to cause serious and dangerous diseases. It:

• golden Staphylococcus;
• epidermal staphylococcus;
• saprofit Staphylococcus.

Children most often observed the malicious activities of the first two microbes, and here is the activity saprofit Staphilococcus - a rare event. The habitat of saprophilic staphylococcus - leather in the field of genital and mucous blade, so most often it causes the inflammation of the bladder or kidney.

Epidermal Staphylococcus Lives exclusively on the skin, but - here is a paradox! - At the same time it never causes any skin uluses. Most often, the microbe from the surface of the skin seeps inside the body (as well as the "senedla" any medical equipment like drainage tubes and the like) and causes inflammatory processes in the vessels, joints, may cause blood infectness, etc.

But the saddest known among this Trinity is golden Staphylococcus. This microbe is one of the most harmful and alive types among all other varieties of potentially dangerous staphylococci. In the process of its life, this microbe creates a huge amount of poisons and toxins, and multiplying is capable of almost any medium (even in salt solution, in ethyl alcohol or in hydrogen peroxide solution). This microbe survives at a temperature of 150 ° C. In addition, golden staphylococcus rapidly produces antibiotic resistance and for the effective treatment of golden staphylococcus infection as a rule, it is difficult to choose the "murderous" drug. Therefore, often the treatment of this kind of infection in children is delayed for several months.

The most malicious and persistent are "hospital" golden staphylococci. Not as an example of "home", survived after numerous San Processings, Quartzers and air products acquire literally "iron-concrete" resistance to most drugs.

Any doctor will confirm that it is infected with golden staphylococcus in a hospital or outside its walls - these are two huge differences. The most terrible and prolonged purulent infections cause a golden staphylococcus in a child, whom the baby "picked up" in the hospital.

Golden Staphylococcus is able to live and multiply in any organ of the child body and causes about a hundred of the most dangerous diseases (most of these diseases are only caused by golden staphylococcus and any other microbes). Among the most terrible diseases caused by gold staphylococcus: osteomyelitis (bone inflammation), lesion of heart valves, staphylococcal sepsis, and others.

Moreover, golden staphylococcus produces the strongest poisons and toxins in the process of its lively. One of these toxins sometimes amazes newborn babies, causing inflammation on the skin in the form of numerous bubbles (both in burns). In a medical and parental environment, this disease is more often referred to as "diseases of scratched babies." And the culprit of all this nightmare is precisely Golden Staphylococcus!

Treatment of staphylococcus in children

Staphylococcal infections in children are treated, as a rule, long and difficult. And since the staphylococcus itself by nature is a microbe, then the majority of diseases caused by them imply antimicrobial therapy (taking antibiotics). At the initial stage of this therapy, the doctor should not just clarify the type of staphylococcus attacking the child's body, but also to determine its sensitivity to various kinds of antimicrobial drugs - in order to choose the most effective.

In addition, in the treatment of staphylococcal infection in children, of course, special attention is paid to purulent foci, located in the internal organs - usually they are usually removed by surgery.

If the emergence of staphylococcal infection affected the presence of another disease that had an immunity (as already in the case mentioned, when the staphylococcus) is instantly developing on the background of herpetic infection), then the treatment is also involved in preventing this disease.

Finally, in the treatment of any staphylococcal infection, various activities are usually carried out to strengthen general immunity - because it is weakened or "undermined", the risk of the next staphylococcal infection is quite large.

Prevention of staphylococcal infection in children: you need to live in neighborhood

And yet! Whatever terrible and dangerous staphylococcis (and even the most terrible of them are golden staphylococcus), most healthy people and children peacefully adjacent to him throughout life. Our immune system, being in a normal "working" condition, is able to fully block any activity of staphylococci.

And only a serious weakening of immunity (against the background of injury, any disease, long-term depletion of the body, etc.) gives real chances of dangerous staphylococcus attack the child's body. Thus, an alone preventive measure is really effective against any staphylococcal infections - maintaining immunity in sample order.

What, as a rule, contribute to systematic, outdoor activities, frequent and long-lasting walks in the fresh air. And this list of "events" any responsible parent - and knows himself by heart!

The content of the article

The concept of " staphylococcus infection»Combines any diseases caused by staphylococcus, that is, it is based on the unity of etiology.
Staphilococci Create almost all tissues and organs of the human body. The clinical manifestations of staphylococcal infection are very diverse and obtained the names mainly on the localization of the process: rhinitis, tonsillitis, native phyrangitis, lymphadenitis, otitis, laryngitis, arthritis, meningitis, etc.
In this regard, the diseases of staphylococcal etiology are considered dismissed. However, these diseases have general patterns: a single etiological principle, close epidemiological, pathogenetic ties, the generality of morphological changes and clinical manifestations. They can occur in the form of independent diseases and are very frequent as additional layers, as a secondary infection, such as mixed infection with different pathological processes, especially in young children. Therefore, it is necessary to consider a group of staphylococcal infection as a whole with the characteristic of general provisions, general patterns that are directly related to infectious diseases, to the differential diagnosis of infections, to epidemiology.

The combination of different staphylococcal processes in the group of staphylococcal infection as a whole turned out to be progressive, fruitful and in terms of their study. Thus, the concept of "staphylococcus infection" includes any staphylococcal diseases and the so-called pathogenic staphylococcal care, which represents the same danger in an epidemic attitude as a disease.
It is necessary to keep in mind the difficulty of distinguishing the carriage of the lightest, subclinical inapparaced forms of staphylococcal processes, whose frequency is large.

Etiology of staphylococcal infection in children

Causative agents of diseases combined into a group of staphylococcal infection are staphylococcirelated to the micrococcus group (Mycrococcus pyogenes), they obtained their name from the characteristic location in a microscopic preparation in the form of a clinment; From the Greek Words - "Staphilion" - a bunch and "Kokkos" - grain.
Staphylococci have a spherical shape, they are well painted in gram and all aniline paints, immobile, disputes do not form, are aerobs and optional anaerobes. Staphylococcis are well growing on conventional nutrient media with a slightly alkaline reaction at a temperature of 35 - 37 ° C. On the broth first form a uniform torch, and then a loose cade-like precipitate, later turning into a hard mass. On solid media (agar) staphylococci grow in the form of large opaque colonies.
Of the hard media, the most commonly used the yellow-salt (cleaned medium), blood and meat-beep agar.

It is customary to distinguish pathogenic strains and saprophytes. In the past pathogenic, only golden staphylococci was considered, in the future it turned out that among white and yellow can also be highly pathogenic and toxic cultures. Pathogenic staphylococcis are distinguished by the ability to distinguish toxins and enzymes that violate the vital activity of macroorganism cells and the tissue destroying it.
Pathogenic staphylococcis are distinguished by soluble exotoxin, it consists of many components that may be in different ratios:

1. fully toxin with the introduction of the rabbit causes death;
2. necrotic toxin or dermontoxin with intradermal administration causes skin death;
3. leukocidine causes leukocyte death;
4. stafilolysin destroys red blood cells (when heighting on the blood agar, hemolysis area around the colonies).

Many authors believe that the toxin of mortality, dermontoxin, leukocidin and stafilolysin are one, a single toxin, manifesting different effects depending on the nature of staphylococcal and the patient's condition. In order to better express the unity of his action, V. G. Fighters calls it cytolytic toxin.
This is the main toxin allocated by all toxigenic stamps of staphylococci. In addition to it, there are toxins allocated only by some staphylococci: enterotoxin and erythrogenic toxin.

Enterotoxin Little studied, isolated from crops, intensively seized food products, mainly milk and cream products.
Erythrogenic toxin Severe a few hemolysis staphylococcis, according to the nature of the action, it is close to the streptococcal dika toxin. With the introduction of its volunteers, it causes the same symptoms of intoxication and scarlet syndrome, as well as dick toxin (point rash). An intradermal reaction with staphylococcal erythrogenic toxin is the same as the dick reaction with streptococcal toxin.
In addition to exotoxin, pathogenic staphylococcis are distinguished by enzymes that contribute to the rapid spread of the microbe in the body - the enzymes of "protection and aggression" (N. Chistovich):

1. coagulaz - contributes to the coagulation of plasma;
2. hyaluronidase - dissolves collagen interlayers and contributes to the spread of the microbe (factor of distribution, hyaluronidase);
3. proteinases - dissolve proteins;
4. lipase;
5. phosphatase - dissolve fats and lipoids;
6. lecithinase - dissolves lecithederylin;
7. stafiloagglutinin - agglutinizes red blood cells;
8. antifhagin - inhibits the action of the phage;
9. penicillinase-inactivates penicillin.

Thus, signs of pathogenicity of staphylococcus a lot, but the whole complex is rarely found; Different strains have their combinations. In practical work, 3 tests are usually used to judge the pathogenicity of the allocated stamps: the presence of stafilolysin, coagulase and lecitinase activity. The distinction of staphylococci on pathogenic and saprophytes is largely conditional, as there are intermediate and transitional forms (G. N. Chistovich). Signs of pathogenicity are most sharply expressed in staphylococcis allocated from pathological foci.
Pathogenic and toxic properties do not always coincide. In the pathological process, different enzymes and toxins usually have a comprehensive effect, individual clinical forms can develop with the prevailing effects of certain mechanisms of staphylococcal aggression.

In the external environment of staphylococci, drying, high and low temperatures, direct sunlight, are resistant to many chemicals, durable in dust, on things, underwear and toys. With the change in the conditions of their life, both in the tube and in a living organism, staphylococcis may vary morphologically and culturely, can change serological types, from virulent becomes saprophytes and transformed into high-pathogenic and toxic. The adaptation ability of staphylococci to drugs and, in particular, to antibiotics is very high. In hospitals from personnel and from long hospitalized patients, it is often distinguished by poly-resistant to strain antibiotics. They got the name of hospital strains.

Epidemiology of staphylococcal infection in children

The source of staphylococcal infection is man - Sick any form of staphylococcal infection or carrier. The most dangerous patients with the defeat of the respiratory tract and the language, as they can allocate staphylococci and spread them around at a considerable distance with droplets of infected sputum and mucus, especially when coughing. Patients with abundant purulent discharge from wounds are also dangerous. Pump in impregnates the dressings and, firing on them, turns into a dry dust that extends to the air over long distances.

Epidemic hazard is often more pronounced with the lungs, the easiest forms of infection, and they are rarely made by security measures, they often maintain a chain of infection, may be the cause of a death infection at the recipient.

The duration of the infection of patients in most cases is great even after recovery. Staphylococci can be stored for months and even years. With intensive therapy with active antibiotics, the sanitation of the microbial focus can appear fairly quickly, but often the carriage or chronic infection often remains with the presence of a dormant focus.

The carrier is the main place of localization of staphylococcus the nasal cavity and leather. As the sources of infection, carriers play an extremely large role, as they usually remain in the collectives, where they dispel infection. To the isolation of pathogenic staphylococcus metering in children, especially breast age, and it should be treated very carefully. It usually means not the carriage, but the presence in the body of a staphylococcal inflammatory hearth.
In newborns, children of the first year of life, children who are weakened by any other diseases, surrounding blood and non-pathogenic strains (with proper blood take), also indicates the presence of a staphylococcal process. This is also indicated by the repetition of the seeding of a microbe from the blood, massive infection.

Ways of distribution Staphylococcal infection is different, but basically it is air-drip and dust.
The contact-household transfer path is also very important, infection can occur through objects, hands, dressing material, dishes, underwear, etc. There is also a food transfer path through infected foods when eating them into food.
Finally, an injection method of infection is possible, while staphylococcus falls into the body in medical manipulations, due to insufficient processing of instruments, defects of injection techniques, the introduction of poor-quality drugs. In this respect, glucose solutions are particularly dangerous, which are a good nutrient medium for staphylococci, they can easily be infected with preparation or storage defects.
Pets can be a source of infection, but their epidemiological significance is negligible. In the external environment of independent tanks of pathogenic staphylococci, apparently does not exist.

Susceptibility The staphylococcal infection is different and depends on age and state. It is highest in newborns, infants, old people, as well as in patients.
Patients with acute viral diseases (influenza, measles, viral hepatitis), blood diseases, diabetes, postoperative patients and patients with extensive lesions of the skin (eczema, burn) have particularly susceptible to staphylococcus. Susceptibility to staphylococcus rises with prolonged use of corticosteroids and cytostatics.

Morbidity Staphylococcal infections are very large, but the exact data does not exist. Staphylococcal infections often arise sporadically, but may be family, group diseases and significant epidemic outbreaks that occur most often in hospitals - in the children's homes, maternity hospitals, etc.; There may be outbreaks of staphylococcal food toxicoin intakes.
Mortality in staphylococcal infection is kept on significant figures and as mortality decreases with other diseases, the share of staphylococcal infection among the causes of death is high.
According to hospitals of different countries and different cities, staphylococcus infection as the immediate cause of death is in the first place.

Staphylococcal infections have always been dangerous as in-hospital diseases, they can take out the nature of disasters that are sometimes striking even good well-maintained institutions.

Insufficient identification and elimination of disease sources (patients with light staphylococcal processes and carriers, including personnel), recurrence, sanitation, insufficient sterilization of tools, dressing, insufficient sterilization of tools, dressing material, etc.

G. N. Chistovic Using Phagotyping revealed the spread of staphylococcus among newborns, where installed the following chains of infection:
Among the newborn parts of the infection by pathogenic staphylococcus through Mother's milk, especially in the presence of mastitis mothers.
Staphylococcal infections in hospitals are, as a rule, an exogenous infection.

Pathogenesis and pathological anatomy of staphylococcal infection in children

Staphylococci are introduced into the body through the skin, the mucous membranes of the oz, the oral cavity, the respiratory tract, genitals; through conjunctiva. The pathological process is deployed as a result of the interaction of the causative agent and the child's body. Thus, there are as if two sides of the process deploying under the conditions of the external environment.

The impact of the pathogen. The pathogenic activity of staphylococci corresponds to the processes of their livelihoods: nutrition, breeding, growth, development. In the process of this vital activity of staphylococci, enzymes and toxins, destructive tissues, absorbing, absorb these products of tissue decay. In the body due to the effects of toxins, enzymes, the destruction of tissues of staphylococci appear pathological changes, affecting the violation of the function of tissues and organs. In the body, in addition, compensatory, protective reactions occur.
The whole bilateral process is complicated and very dynamic: the child's body changes, are subject to changes in staphylococcus, the external environment changes in which the pathological process is developing.

To deploy a process, in addition to infection, a number of additional conditions are required: the pathogenic activity of staphylococci, their virulence; sufficient dose of infectation (sufficient amount of staphylococci); Tissue disorder and decrease in the specific protection and non-specific resistance of the child's body.

The normal epithelium of the skin and mucous membranes with their secretion serves as good anatomical protection against the introduction of staphylococcus in the body, and the staphylococcus infection occurs as a result of the violation of this barrier. That is why staphylococcal infection is widespread among the patients with OVRI. Patomorphologically confirmed the pattern of development of staphylococcal infection after an acute viral, infection, which is established by appropriate changes in the epithelium, the release of the virus, immunological data, or the presence of viral inclusions in the affected tissues (O. I. Bazan, V. A. Zinzerling, etc.). The defeat of the epithelial cover at OSRI creates as it were, as it were, a wound surface in the respiratory tract, which serves as one of the main reasons for frequent subsequent development of tracheites, laryngitis, bronchitis, pneumonia, bronchiolites.

The value of specific protection and nonspecific resistance is confirmed by the age distribution of staphylococcal diseases and their occurrence in the presence of aggressive factors.
Newborn children, young children, weakened by previous diseases, are most often ill. Staphylococcal infections are frequent in children with blood diseases due to the defeat of them the functions of the reticulosendothelial system and other violations; in power disorders, against the background of treatment with corticosteroids, overwhelming immunological reactions; In newborns who have undergone generic injuries. In such cases, a malicient staphylococci can be etiological factor.

Various localization of the pathological process, combined with different conditions of infection, determine the extremely large variety of staphylococcal infection clinics - from the easiest lesions to the hardest deaths. Viruble strains of staphylococcus in high concentrations in healthy children in older can lead to the emergence of the lightest, subclinical forms. Along with this, a weakened child at an early age and strains of small virulence can cause severe forms of infection.

At the site of introducing staphylococci in the body there is a local inflammatory focus, most often in organs related to the external environment (leather, nasopharynx, almonds, respiratory tract, intestines). In the focus of the lesion, the accumulation of staphylococci is observed, circulatory disruption, swelling, tissue infiltration, hemorrhage, stakes, blood clots in capillaries and small vessels, fibrin formation, tendency to suppuration, to tissue necrotization. Several basic forms of inflammation are distinguished: catarrhal, purulent, necrotic, fibrinous.

In the catarrhal forms in the inflammation, infiltration of the mucous membrane, the subliminate layer, full-row, stasis, serous exudate with admixture of mucus and leukocytes, cellular exudate, phagocytosis are observed; The same changes in the surrounding tissues.

For purulent forms In places of accumulation of staphylococcus, the decay of tissues, purulent, catarrhal-purulent, serous-hemorrhagic exudate, phagocytosis processes, around the focus of effusion.

For necrotic forms Inflammation is characterized mainly necrotic, serous-hemorrhagic disintegration of the fabric in the lesion focus.
Non-critical changes in the respiratory tract (laryngotrates) are also manifested by necrosis of mucous membranes and submembratus shells with the formation of ulcers covered with white dull plates. In case of necrotic pneumonia, there is a decay of bronchi tissue, pulmonary fabric, connecting partitions. Multiple degradation foci lead to the formation of thin-walled cavities, the dimensions of which are labils due to engagement in the process of new parts of the pulmonary fabric.
Fibrinous inflammation in severe processes may acquire a dominant character, based on which fibrinic (diphtheritic) form is isolated. Fibrinous tonsillites are described with the formation of almonds on the affected surface of thick gray-white films. Separated by the diferitical form of laryngotracy with the formation of fibrinous films in the larynx and especially in the trachea; Often there are fibrinous pleurisites. Non-critical, fibrinous-necrotic inflammation can occur in the intestine and other organs.

The distinction of different forms of inflammation on predominantly pronounced changes, acquiring paramount importance, is quite conditionally. And during catarrock, surface necrosis, suppuration, fibrin loss can be. However, with necrotic, purulent, fibrinous forms, these changes are particularly significant.
One form of inflammation can go to another. The catarrhal form is essentially the initial form of inflammation, in many patients at this stage the process ends, is localized and resolved with phagocytosis and other protective reactions. For clinician, it is very important in time to prevent its progression.

Special attention. Delivered pneumonia, as a rule, in all children who are dead from staphylococcal infection. Staphilococci penetrate the respiratory tract to the bronchogenic pathway. At the place of the introduction of microbes, foci of inflammation, often purulent, purulent-necrotic nature with a decay of fabric, promoting the occurrence of cavity. Purulent foci - abscesses can be multiple. Pleverra is also often involved in the process with the development of fibrin-purulent pleuritis, empynesses. Sublemental abscess can be revealed to the pleural cavity with the subsequent popenevox. In some cases, a bullous emphysema is determined. Air cavities are considered pathognomonic for staphylococcal pneumonia.

Among the staphylococcal pneumonia, a group of pneumoniums without destruction and decay of tissues is distinguished, in the clinic they prevail sharply. Among the pneumonium without destruction of the pulmonary fabric, processes are observed in the very initial stage of development - focal or drain bronchopneumonia without necrotic damage and peripocal toxic changes.

Protective reactions of the body in the focus of inflammation, in regional lymph nodes are carried out by a local tissue barrier, phagocytosis of the staphylococci leukocytes. Many patients have no tendency to progressive distribution of staphylococcal foci; The phagocytosis reactions is fixed as a local process. Changes are eliminated by resorption of exudate.

Along with this, with incorrect treatment, when exposed to any additional factors that reduce the resistance, especially at the infection, the generalization of infection from the local focus can occur. The intracanalicular spread of the infection causes inflammatory phenomena in the applied cavities of the nose, the middle ear, respiratory tract. Staphylococcus can penetrate the blood to spread the hematogenic way, cause osteomyelitis, arthritis, endocarditis, etc. Transferring infection from a local focus can occur lymphogenically - usually this is the path of the occurrence of lymphadenitis, peritonitis. The generalization of infection is carried out by different paths of the same patient. For example, at the same time, it propagates from the nasopharynx intracanalicular to the apparent cavities, lymphogenic pathway in the lymph nodes and hematogenically into any joints.

Due to the generalization of infection, sepsis, septicopyiamia can be formed, especially often emerging in children early ingredients, and of them in children of the first 3 months of life, in newborns.

In staphylococcal diseases, bacteremia is very often detected, the most characteristic of breast-age children. Staphylococci in the blood does not multiply, therefore bacteremia indicates the presence of a staphylococcal inflammatory hearth in the body.

Microbes, falling into the blood, partially die, partially removed from the body through the respiratory tract, the urinary system, the gastrointestinal tract.
In the local inflammatory focus of staphylococci produce toxins, which, sucking, have a general toxic effect on the body. The process involves the reticulosendothelial system, which is illustrated by changes in the spleen (reproduction of reticular cells) and liver (dystrophic changes). There are changes in the lungs (reinforced blood flow, focal atelectases, emphysema, etc.), dystrophic changes in myocardium (protein rebirth, sometimes degenerative obesity of muscle fibers). Changes in the kidneys can appear in intermediate tissue, leukocyte infiltrates, brain solid, interstitial serous jade.

Microbial decay products have a sensitizing effect. Allergic changes contribute to re-staphylococcal infections, constant staphylococcal care. It is allowed to participate staphylococci in the development of allergies with the occurrence of jade, rheumatism.
The following syndromes are distinguished in the pathogenesis of staphylococcal infection: infectious septic, toxic and allergic. Their combination and determines the entire infectious process as a whole.

For infectious septic syndrome Characteristic is the presence of inflammatory foci, always available in any form of staphylococcal infection. The degree of their severity ranges from minimal minor to deep violations.

Toxic syndrome is peculiar. A huge number of local light staphylococcal processes passes without noticeable signs of intoxication, in other cases they can manifest themselves with subfebilitis, a non-timbble violation of general well-being, appetite; With long flow, they can lead to anemia, to changes in characteristic of hemolytic disease; In breast-age children, they may cause insufficient add-on.
With severe inflammatory lesions, toxic syndrome with its usual manifestations (fever, often vomiting, cardiovascular disorders) is already pronounced quite brightly; Inxication can be violently with a rapid legal outcome.

Allergic syndrome arises due to the sensitizing effect of microbial decay products, it is MMHIIlHcicm with skin samples; Clinical manifestations of his almost IC have been studied.

In recent years, the chronic forms of staphylococcal infection have become much attention. Their occurrence binds mainly with incorrect, insufficient treatment during acute forms and with the adaptive ability of staphylococci, as a result of which they can acquire the same properties as they possess the human proteins. Due to this, they lose the CTU of the IOP irritation, the production of antibodies decreases and the process acquires a sluggish, protracted or chronic course.

Immunity studied not enough. Antibacterial immunity is absent or miseles, does not protect against diseases during re-infection of staphylococcus even the same phageotype. Antitoxic immunity is produced mainly after the suffering of the disease in severe toxic form. The presence of antitoxic antibodies (antigenolysins and anti-leiccidins) in the blood) even in high titers does not prevent the development of subsequent purulent processes. A major role in staphylococcal immunite is played by phagocytic reaction.

Staphylococcal infection clinic in children

Staphylococcal infection is characterized by exceptional clinical diversity, very difficult for classification. Generally generalized and predominantly localized forms can be isolated, although this separation is very conditional.

To generalized forms Fees sepsis, septicopemia. Preferably localized forms are distinguished by the presence of lesion in any particular area of \u200b\u200bthe body. During localized forms, metastatic foci is often observed, such as, for example, with lymphadenitis tonsillites, Otitis. However, as opposed to generalized forms, these foci retain local character and therefore can be attributed to localized with the reservation "mainly". Localized forms can also be severe, for example osteomyelitis, but relate to this category due to a certain local location of the staphylococcal process. Sometimes to carry out a face between generalized and localized forms is very difficult.

Localized forms are usually diagnosed at the location of the inflammatory process, depending on the defeat of one or another organ: rhinitis, tonsillitis, lymphadenitis, otitis, pneumonia, etc.

It is impossible to allocate characteristic forms due to the lack of typical clinical signs for staphylococcal diseases, with the exception of the formation of air cavities in pneumonia. You can only talk about pronounced clinical forms, about subclinical and inapparantional forms.

Staphylococcal process can be primary and secondary. The primary is called the one from which the disease begins, the process developing in the presence of an already occurring focus is considered. Eliminate light, moderate gravity and severe forms of staphylococcal infection. For flow, distinguishes sharp, protracted and chronic forms. Below are the scheme for the localization of the staphylococcal inflammatory process and the clinical manifestations associated with it.
The most frequent localization of staphylococcal diseases is the skin and subcutaneous fiber, zev, nose, nasophack and respiratory tract. Often there are diseases of the digestive tract (enterocolite), bone damage, etc.

The incubation period lasts from several hours to 3-4 days. The beginning of the disease is sharp. In the local inflammatory focus, catarrhal changes occur (hyperemia, usually localized swelling due to swelling of the tissues of tissues); Non-expressed pain. With more severe lesions, a purulent inflammatory process is formed, finally, in the local focus can be fibrinous-necrotic changes. Hyperemia becomes intense, infiltration of affected tissues is expressed, impositions in the form of dirty, loose, gray-sowed raids located on an ulcene surface appear. When the fibrin deposits, raids are formed in the form of dense films on infiltrated hypereminated tissues. The process often carries a mixed purulent-necrotic, fibrinous necrotic character.

Lymphatic regional nodes increase in different ways, sometimes reaching the size of the chicken egg; The contours are preferably vague due to the infiltration of the surrounding fiber, but they can be sharply contigated. In addition, soreness appears, the skin over the glands is blocked, the fluctuation begins to determine in the depth.

In many patients with catarrhal changes in the local focus, the disease passes without symptoms of intoxication. With more significant local inflammation, intoxication appears without any specific features for staphylococcus. The temperature in staphylococcal infection may be normal, subfebrile or reach 39-40 ° C and more, mainly in accordance with the severity of inflammation.

When studying blood, leukocytosis is detected, neutrophilee with a shift to the left, elevated ESO. The degree of changes and intoxication corresponds to the severity of the disease, the severity of inflammation. With severe processes, leukocytosis reaches sometimes 20 - 30-109 in 1 liter, the neutrophilic shift can be up to myelocytes, the EE increases to 30-40 mm per hour or more. It is characteristic of the development of hypochromic anemia, especially in young children.

To light shapes Diseases occurring without disturbance or with a minor disorder of general well-being, with a normal or subfebrile temperature, without special functional disorders in the body. Among staphylococcal diseases, these light shapes are most frequent in the form of rhinitis, noodopaling, catarrhal tonsillitis, insignificant diarrhea, skin lesions with non-timber expressed inflammatory changes and a healer of the leukocyte blood formula. Such forms are difficult to diagnose, meanwhile, they represent a risk of a number of reasons. Concorpicient with another disease, especially OSRI, a slight harmless disease can determine the heavy process. Without treatment, such a disease can continue for a long time (weeks, months), forming a chronic process. Patients suffering from light shapes can be a source of infection for others. Light forms can be observed at any age, in weakened children in the form of sluggish skin lesions, rhinitis, tonsillitis; At breast age - in the form of minor stool disorders.

Subclinical forms Staphylococcal infections proceed without visible local inflammatory foci. They can be manifested only by subfebilite, moderate leukocytosis, sometimes neutropylosis, especially the increase in ESP. In childhood children, with such forms, there can be only a flat weight curve, a violation of appetite, sometimes tightening, anemia. The presence of such forms is confirmed by bacteriological data, immunological reactions, in children becomes a positive reaction of agglutination with staphylococcus. Breast children often sow staphylococcus blood.

Inappraven forms Clinically do not manifest and detected only on the basis of immunological shifts.

Heavy forms Staphylococcal infections are characterized by high temperature, anxiety, disturbance, may be vomiting, increasing pallor, cyanosis. The pulse is expensive, may be filamentous, blood pressure drops. With severe forms, various rashes often appear, hemorrhage is not uncommon. Heavy forms with intoxication are usually developing with a sharply expressed exudative component, with fitting, necrotic, fibrinous changes in the local focus. These include laryngotracytes, bronchiolites, abscessive pneumonia, plerites, meningitis, sepsis, etc. Heavy septic changes are developing slowly, since to appear sufficiently pronounced anatomical changes in the form of a significant inflammatory purulent, purulent-necrotic, fibrinous focus or even multiple foci required. Time, usually a few days. In some cases, there is an acute principle, but it only apparent, as a rule, is preceded by a little pronounced, viewed, undiagnosed changes. I am Pito, with a rapid increase in intoxication, toxic forms arise in the form of acute gastroenterocolitis and scarlatine-like syndrome, which can develop with relatively moderate local changes, the main importance of the central nervous system becomes the main importance.

Currently, in the presence of effective therapeutic agents, severe forms with septic syndrome in very many patients can be attributed to the launched cases that appear as a result of the underestimation of the initial changes, improper assessment of the dynamics of changes, improper treatment.

Middle severity are cases with moderately pronounced intoxication. The body temperature is increased to 38-39 ° C, the general condition is impaired, but nonresko. Heart changes are limited to moderate tachycardia, muffled heart tones. Headache has been noted, reduced appetite. Local local processes with medium gravity forms have predominantly purulent, necrotic, fibrinic nature, but are more limited to the spread and depth of the defeat. Violation of the functions of affected tissues, the organs are also expressed less sharply. In the form of medium-free forms, tonsillites, phlegmons, pneumonia, enterocolites, etc. often occur.

The course of staphylococcal diseases may be sharp when the process ends in the first weeks or 1-2 months, protracted - when the recovery is delayed for several months and chronic if the process lasts not only months, but also years. During the disease, exacerbations are often observed, repeated temperature waves, temperature "candles", subfebelitet. The tendency towards long-term flow is large, especially in weakened children, in children of the first months of life. The protracted and chronic flow can acquire both light shapes in the form of rhinitis, tonsillitis, otites and heavy forms, in particular osteomyelitis. Exceitations may occur, especially during sharp viral infections, when staphylococcus infection can manifest itself with the rapid development of pneumonia, sepsis.
It is characterized by bacteremia, which appears under any form (with subclinical, inapparantant), but still predominantly with severe or chronic forms. In childhood children, weakened children bacteremia can be held not only for weeks, but for months and even years. It is usually supported by sluggish dermatitis, rhinitis, tonsillitis, sinusitis, otitis, process in bile and urinary tracts, etc.

Separate clinical forms of staphylococcal infection in children

Diverse lesions of the skin, subcutaneous tranquils are more frequent in children, especially early age, newborns. Staphylococci can be the cause of infection of the diameter, causing paronychia, panaria, phlegmon, impetigo, etc. Any of these processes can flow insulated or in a complex with others, occur during sepsis or be the primary septic focus.

Defense of nose

Under the damage to the nose, the groove, the nasopharynxes arise rhinitis, pharyngitis, noodopharyngitis, tonsillites, which contribute to the formation of paratronzillary abscesses, otites, lymphadenitis, sinusitis. The defeat of the respiratory and digestion organs is often associated with the damage of the nose and the digestion.

Best lesions

The defeat of the respiratory organs is very diverse. Depending on the localization of the infection, laryngitis, tracheites, bronchitis, bronchiolites, pneumonia, plerites appear, and they are often combined.

The clinical manifestations of the defeat of the respiratory organs are primarily cough, a violation of general well-being, mainly with temperature reactions. Larygitis, laryinghotracies are among the common, often severe forms of staphylococcal infection. Due to the predominant combination with OVRI, cough often appears against the background of other catarrhal phenomena (runny nose, Chihanye).
The disease is developing mainly within 1-2 days, stenosis of the larynx (croup) is often joined. Singing laryngitis, laryngotrates are among the severe forms of staphylococcal infection due to severe functional disorders. In the emergence and development of the colrom of staphylococcal nature, there are no patterns. At some disease begins immediately with stenosis phenomena, other difficulty breathing develops later against the background of the preceding benign laryngitis. Just as with diphtheria crook, 4 degrees of stenosis are isolated. However, the stenosis in the criterion of staphylococcal etiology develops not strictly in a certain sequence. It may arise suddenly at the beginning of the disease and carry a pronounced character, it can develop in a later date.

Larygitis, Laringhotracies often proceed with pneumonia, with croups it is observed almost in all cases.

Pneumonia Staphylococcal nature can be primary and secondary, proceed either in the form of an isolated process, or are one of the foci of infection, localized in the body. In recent years, Staphilococcus is the main etiological factor in the occurrence of pneumonia in young children.

Staphylococcal pneumonia proceeds mainly in the form of conventional small-scale pneumonia, often with the catar of the upper respiratory tract. The disease can quickly end, can delay and proceed quite sluggish or acquires a more pronounced character, accompanied by hyperthermia (39-40 ° C and higher). The resolution of pneumonia usually occurs gradually, the subfebrile temperature remains long. The most difficult to flow the destructive forms of pneumonia. Sometimes they develop pretty quickly, abscesses are formed in the coming days, piopnemothorax. In other cases, the disease develops more gradually against the background of the tightened Qatar of the upper respiratory tract. Against this background, the condition deteriorates sharply, the clinic of acute pneumonia is developing. "Explosion" can be against the background of the prior nonsense finely food pneumonia, it would seem during the recovery period. In the future, the development of these different processes occurs equally. In this case, intoxication, respiratory, heart failure is usually pronounced. For heavy staphylococcal pneumonia, radiological data is characterized: in the lungs with destructive pneumonia, small foci of blackout is determined, then they reach large sizes. After 1-2 days, sections of enlightenment appear (rounded, but irregular shapes) or cavity with well-visible circuits of oval shape, in some cases with a horizontal level.

Beaming bones and joints

With damage to bones and joints, osteomyelitis and arthritis arise, which are described in detail in the Surgery manuals. Osteomyelitis in newborns, early and chest children is developing mainly due to the generalization of purulent infection in the body, it is very difficult to diagnose.
This is a serious illness that requires earlier treatment as possible to prevent heavy forms. The defeat of the bones at this age is often multiple, the osteomyelitis of the bones of the pelvis, spine proceeds. At the older age, the processes are predominantly isolated character and leak more favorably.

The defeat of the central nervous system

The defeat of the central nervous system of staphylococcal nature can be in the form of meningitis and brain abscess, which differ in the most difficult flow.
Staphylococcal meningitis, as a rule, the secondary process arising from the generalization of infection. The primary focus can be localized in the ears, apparent sinuses, in the bones of the skull, etc.
The disease proceeds with pronounced intoxication and rapidly developing meningeal symptoms (the rigidity of the occipital muscles, the symptom of Kernig-Brudzinsky). As a result of intoxication, patients often appear on the body, which is generally characteristic of severe staphylococcal diseases.

In the children of the breast, the disease proceeds the most difficult, as a rule, with a general septic state. In the spinal puncture, the spinal fluid flows under high pressure, it is muddy, greenish gray color. The protein content is increased, pronounced neutrophilic cytosis.
During the disease, process exacerbations, repeated temperature waves are often observed. Inflammatory purulent changes from cerebral shells are transferred to the brain substance, causing brain abscesses. They can also be with osteomyelitis of the bones of the skull, as metastatic foci during septicopemia. These are rare, but extremely severe processes, difficult to diagnose. When they are arranged in a mute zone, focal symptoms may be absent, the main diagnostic method is x-ray.

Defeating urinary tract

With the defeat of the urinary tract, cystitis occurs, pyelit, pyelonephritis, focal jade. These diseases are often observed with severe forms of staphylococcal infection, and above all during sepsis. With light shapes, they contribute to the duration, the repetition of diseases, chronic processes are very unfavorable in this regard.

Defeat of the cardiovascular system

The damage to the cardiovascular system can be in the form of endocardits, pericarditis, phlebitis. Endocardits are very difficult to diagnose and are often detected only posthumously. They are also observed at present with long-term diseases of the early, chest age. Pericarditis in recent decades is extremely rare. Fleaters belong to the private forms of staphylococcal infection, arising as a complication of skin, subcutaneous inflammatory processes. Fleaters may worsen the current process, cause the occurrence of new lesions. This is one of the ways to develop sepsis with multiple purulent foci, especially in the joints, in the kidneys.

Sepsis

Sepsis is predominantly the lot of young children. Entrance gates, as in other forms, there may be leather with disorders of its integer.
the mucous membranes of the respiratory tract, the gastrointestinal tract, the umbilical wound in newborns. Sepsis can develop latent, slow and low, but often rapidly, lightning. Secondary septic foci can be in any site of the body, but most often they are localized in the lungs, in the ears. In early age, in most cases, diarrhea arises; Frequently accurate bone, hearts (septic endocardits). Inxication is manifested by conventional changes, it is often a rash of different character: a finely melted, finely purified, urticar, hemorrhagic. The course of sepsis Currently, with proper treatment, mostly favorable, but complete recovery occurs still slowly.
In the bacteriological examination, a pronounced sampling of patients with staphylococcus is determined, bacteremia remains for a long time.

Mixed infection

Staphylococcal infection is detected by almost all infectious diseases. The release of pathogenic staphylococcus was discovered from patients when entering the hospital and non-evaluable infection in the subsequent. From staphylococcal processes, rhinitis, noodopharygitis, sharp tonsillites, exacerbations of chronic tonsillitis are most common. The manifestations of staphylococcal infection, in addition, are temperature reactions, especially subfebrile, blood changes without visible local processes, pneumonia, including in the form of destructive forms, sepsis. Staphylococcal cholangitis, cholecystitis are observed. The maximum frequency of the staphylococcus infection reaches with OWRI, especially in breast-age children.
The diagnosis of mixed infection should be installed in possibly earlier deadlines for timely treatment, while the formation of heavy forms can be sharply reduced. Heavy forms are predominantly launched due to late diagnosis and improper treatment of the disease of the infection. Signs of staphylococcal infection with other diseases (as mixed infection) are the same as during monointing.

Diagnosis, differential diagnosis of staphylococcal infection in children

The main feature of the staphylococcal infection is inflammation with the tendency to the suppuration with the formation of a thick pus with a greenish tinge, a tendency to fibrinous layers. It is very important to take into account the absence in staphylococcal infection of any pronounced patterns both at the beginning and during the disease. This is an indefinite nature of the temperature response with temperature returns, temperature "candles", subfeberbylitis, etc. The most constant blood changes (leukocytosis, neutrophilez. Elevated EE). Differential most often falls from sharp viral and microbial, mainly streptococcal infections, which is extremely difficult. Streptococci cause rhinitis, tonsillitis, lymphadenites, otitis, pneumonia, etc. Streptococcal and staphylococcal infections relative to the similarity of pathogenesis and pathological changes. With streptococcal, as in staphylococcal, infection in the pathogenesis, infectious, toxic, allergic syndromes are isolated. For both infection, the appearance of purulent, purulent-necrotic inflammation is characterized, the form of a form with a pronounced action of erythrogenic toxin may occur.

From clinical differential signs, it can be noted only by a few more severity of hyperemia and other inflammatory changes in streptococcal lesions, which is clearly revealed with tonsillitis. In staphylococcal processes, hyperemia often has a cyanotic tint, characterized by the preemptive lesion of the nasopharynx in the form of an increase in the rear lymph nodes.
Streptococci do not cause bruunkulov, carbuncles, lesions of the intestinal tract in the form of diarrhea. Streptococcal lesions of the oz, ears, lymph nodes are more acute, more dynamic, characterized by greater speed of development of the process, but all these differences are not sufficient enough and require greater experience to identify. Streptococcal processes are quickly resolved after the very first injections of Penicillin even in moderation dosages, at the same time, penicillin's stroquococcal lesions acts in large dosages and not always.

With staphylococcal infection with scarlet syndrome, the basis in differential diagnostics is not so many separate symptoms as the sequence of their development, the combination of individual symptoms. In the presence of fibrinous inflammation in Zev differentiated. It falls with the localized form of the diphtheria of the oz. For diphtheria, the small severity of inflammatory changes is characterized, the presence of dense fibrinous films of a grayish-white color without suppuration protruding above the almond surface, moderate pain. The temperature with such forms of diphtheria increases moderately and in the next 2 - 3 days decreases.
Changes inherent in staphylococcal tonsillites may be observed in infectious mononucleosome.

It depends mainly from the layering during the mononucleosis of the staphylococcal process. In these cases, there are other signs inherent in mononucleosis: polyadenitis, an increase in the size of the liver and spleen, a pretty resistant temperature reaction, the slow disappearance of the specified changes. The final diagnosis of mononucleosis is established on the basis of hematological changes. The layering of staphylococcal infection is determined as a result of bacteriological examination.

The main difference between staphylococcal lesions from acute laryngitis, laryngotracheits, diphtheria etiology croupiers is the absence of any patterns in the development of the process. The disease can develop and acutely, and gradually. Immediately there may be hoarseness of the voice, the cough and the difficulty of breathing. Stenosis can immediately reach II and III degrees; It raises rapidly, interfere with the calm periods. The voice becomes hoarse, but Afonya usually does not occur. In addition, laryngotracytes of staphylococcal etiologists are developing, as a rule, against the background of a septic state, at high temperature and pneumonia. Zev hyperemic, swollen, juicy mucous membranes. In contrast to this, during diphtheria, the process develops naturally, one stage gradually, for 3-4 days, goes to another. With an isolated diphtheria damage to the larynx in the zev of special changes, it may not be, and with a combined form (diftere larynx and zoom), tonsillitis with tight-tight fibrinic, film flushes are determined by tonsillitis.

Laboratory methods for diagnosing staphylococcal infection

The diagnosis of staphylococcal infection is determined primarily on the basis of clinical changes, but with lungs, subclinical forms, laboratory data is especially necessary. However, under explicit forms, currently without laboratory confirmation, a clinical diagnosis, with rare exceptions, is not considered to be eligible.
Laboratory survey includes bacteriological and serological methods. The bacteriological method is of paramount importance. Both methods are simple, easily accessible to conventional laboratories.

Bacteriological research. Depending on the localization of the inflammatory hearth, the mucus from the nose, the oz, the oral cavity, from the larynx, examine the skin, wounds, closed purulent foci, etc. When damaged to the gastrointestinal tract, the material, wash waters, feces may be the resulting material. As widely as possible, sowing blood should be carried out, since bacteremia during staphylococcal infection is often observed.
A complete study should be subject to sectional material from lesion foci, and besides, regardless of the localization of the lesion, the tissue of almonds, lungs, liver, spleen, thin and colon, stomach, their contents, leaf fabric, lymph nodes.

A prominent survey must be carried out at the greatest time from the onset of the disease, better before the use of etiotropic treatment, which helps reduce the sample. In addition, the study must be multiple.

Sewing staphylococcus has not only diagnostic value, but allows to judge the progress of the pathological process. Long massive dissemination reflects the severity of the pathological process and requires further resistant treatment, it is desirable to complete bacteriological cleansing. When maintaining a massive seeding, the process can exacerbate. Next, you need to examine children with an already established diagnosis of diseases of unstaphylococcal nature (measles, dysentery, cell infection, viral hepatitis, etc.), having an atypical course of the disease, a subfebrile temperature, blood changes in the form of leukocytosis, increased EEE, anemia.

The mucus from the zea, nose, the larynx take on an empty stomach to therapeutic procedures, which can also affect the seeding. Among the day it can be taken no earlier than 2 hours after eating, drinking, drug intake.
Separated from the wound examine before it is processing.

Blood for sowing is taken with, strict compliance with the range of aseptics and antiseptics in the amount of 3-5 ml, sowing is produced on 50 ml of sugar broth. Cool broth for 5 days are kept in the thermostat: daily made from the broth on the blood agar.
In bile, research is subject to each portion separately (A, B and C).
The nursing mother's milk is collected in sterile dishes after pretty thorough treatment of the breast with sterile breasts and after prior compression. For the study, they take 3-5 ml of milk separately from each breast ,.centrifugation and seed on the blood agar and Wednesday.
During seizures of the studied materials, the pathogenicity of staphylococcus is determined.
In the serological examination, the reaction of agglutination by the type of Reaction type is used.
The most evident is the survey of the patient in the dynamics: at the beginning of the disease and subsequent with a break in 10-14 days. In many patients, the titer in the dilutions of agglutinating serum occurs in these deadlines. Perhaps a single examination of the patient; Diagnostic titer of agglutination reaction 1: 100 and higher. The reaction of agglutination is not only diagnostic value, but to a certain extent reflects the course of the disease. A positive reaction is long done, as the titers improve it, it can quickly decline quickly, and later, when recovery, it goes into a negative one. It is also valuable that the reaction of agglutination gives good results in weakened children, young children and newborns.

In recent years, the alpha antitoxine is determined in the blood serum. In the reaction, the serum of the patient and alpha-toxin is used, erythrocytes add as an indicator. The presence of antitoxic properties of serum is judged by braking hemolysis in the test tube. The diagnostic value of the increase in the titer of antistaphyl and allergic reactions is studied.

In conclusion, it is necessary to indicate that the diagnosis of staphylococcal infection is based on a thorough assessment of clinical changes. Despite the absence of pathognomonic symptoms, clinical manifestations of staphylococcal infection are strongly expressive in order to establish or suspect its presence not only with the lungs, but often even with subclinical forms of the disease. The diagnosis is determined by a complete complex of clinical changes and the results of laboratory surveys.

Features of staphylococcal infection in modern conditions

Staphylococcus infection in its distribution is currently occupied by one of the first places among microbial infections. There are constantly talking about a significant increase in the number of diseases of staphylococcal etiology, but there are no accurate data, because they were not registered earlier and now accounting is imperfect. Along with this, it was significantly established that the proportion of staphylococcal infection was dramatically increased among severe forms of microbial processes and among the causes of death; In this regard, she came out in the first place and this is especially noticeable in relation to pneumonia. Until the 40s of our century, with pneumonia, the leading etiological significance had pneumococci, the frequency of streptococcal processes was significant. After introducing sulfonilamine drugs into the practice, streptococcal lesions of the lungs, often abscessive nature occupied the first place. Further changes occurred mainly from the beginning of the 50s, after introducing penicillin into practice. It has a fast bubble action both on pneumococcal and streptococcal processes, and they have become a big rarity.

Staphylococci due to the ability to quickly adapt quickly acquired resistance to penicillin and occupied the first place among severe purulent inflammatory lesions. The situation with staphylococcal infection has become improved since the 60s with the introduction of a wide range of action to the practice of antibiotics using large doses of penicillin, with the development of pathogenetic treatment methods, preparation of specific preparations. All this together, made it possible to significantly reduce mortality in staphylococcal infection, but staphylococcal processes in all their diversity in the pathology of children belongs to one of the leading places.

Treatment of staphylococcal infection in children

In the complex treatment of staphylococcal infection, the basis is the impact on the causative agent, that is, to eliminate the cause, without which the disease would be impossible at all. With timely, effective elimination of the causative agent, the remaining tasks of treatment (impact on the body, on the inflammatory hearth) often become unnecessary. It is the main thing in the prevention of the development of heavy forms.
The impact on the causative agent of the disease is carried out by etiotropic means.

Treatment of acute light shapes (catarrhal tonsillites, rhinitis at high age) is not required. Antibacterial therapy must be applied in cases where the process acquires a prolonged character, the blood changes are kept, a subfebrile temperature appears, a tendency to grow local changes with suspicion of pneumonia, a tendency to generalize inflammatory processes. All patients with severe and medium severity are subject to treatment with forms, any forms of staphylococcal infection, which occurs in children with any other diseases.
Staphylococcal infection worsens the course of the main disease, and it in turn affects the course of the staphylococcal process. In hospital conditions, in the presence of a mixed staphylococcal infection, antibacterial therapy is necessary and because the patient is a source of infection for others.

Currently, there are many antibiotics affecting staphylococcus, the choice of one or another drug for each patient is carried out individually. For full-fledged treatment, a number of rules set forth in the total part are necessary.

With the lungs, moderate severity of the forms in older children is just one antibiotic, in more severe cases, two, with particularly severe forms and three antibiotics, taking into account their synergistic action, are used simultaneously. With severe, generalized forms of staphylococcal infection, new antibiotics must be applied, wide range antibiotics.

In childhood, in patients with multiple lesions, especially with mixed infection, antibiotic treatment with separate courses with changing the drug often have to be carried out within a few weeks until the elimination of pathological changes, eliminating subfebrile temperature and blood changes.

From the large arsenal antibiotics retains its value of penicillin, which is shown only in elevated and large doses. The daily dose (from 200,000 to 500,000 units / kg or more) is administered intramuscularly after 3-4 hours. Penicillin can be used in combination with monomitin, canamicin and other antibiotics.
The semi-synthetic preparations of Penicillin are very effective in cases where Penicillin does not have actions in the presence of pathogens resistant.

Penicillin can be used with lungs, moderate severity of the diseases, leaving a wide range of action as a reserve for heavy forms, for those cases under which Penicillin does not give effect. The use of a group of tetracycline and leftomycetin is currently limited, and in children of the first months of life contraindicated due to their greater toxicity.

To prevent the development of dysbacteriosis during treatment with antibiotics, it is necessary to simultaneously assign nastatin, levels, vitamins of group B, Vitamin C.
Direct influence on Staphilococcus have phages, they are able to lyse pathogenic strains; They are mainly used in the lesions of the outer covers (stafilodermia, the suppuration of the Russian Academy of Sciences). Locally used in the form of a mow.

The impact on the patient's body is achieved both specific and pathogenetic means. Specific funds are aimed at strengthening specific immune protective forces. They are used in the complex with antibiotics. Widespread recognition received a hyperimmune anti-staphylococcal gamma globulin, which is used in severe, generalized forms of staphylococcal infection, especially for the treatment of young children. It is injected intramuscularly at 5-6 AE / kg per day daily or every other day - 5 - 7 times. Daily dose in particularly severe cases increase to 20 AE / kg. Hyperimmune antistaphococcal plasma is administered intravenously daily or after 1-3 days at 5-8 ml / kg, only 3-5 times. The blood of immunized donors is used mainly with direct overflow from the donor to a child of 4-8 ml / kg several times at an interval of 3-4 days.

Native staphylococcal anatoksin is used to increase products in the body of staphylococcal antitoxine with a protracted, sluggish forms. There are two schemes of using anatoksin, which is administered subcutaneously under the blade. According to the first diagram, 7 injections are made at the interval of 2-3 days (0.1-0.2-0.3-0.4-0.6-0.8-1.0), only 3.4 ml. According to the second scheme, 5 injections are made at interval in the 1 day (0.1-0.5-1.0-1.0-1.0), only 3.6 ml.
In order to increase the production of antibodies (mainly in dermatological practice), staphylococcal antifagin is used.

Pathogenetic means

Pathogenetic means are prescribed by testimony. With severe, toxic forms of staphylococcal infection, conventional disinflowing therapy is used. Recommended the use of corticosteroids. Cortisone, hydrocortisone, prednisolone is prescribed as a short course (5-7 days) with a gradual decrease in the dose as the patient's condition improves. In particularly severe cases begin with intramuscular or even intravenous administration of drugs. When the corticosteroid is introduced, potassium salts are shown.
For the purpose of disintellation, an intravenous drip infusion of a 5% glucose solution with saline solutions, plasma solutions, plasma substitutes are used. Diuretic drug adds to this:
laziks, novurit, mannitol. At the same time, large doses of ascorbic acid, cocarboxylase are introduced.
With violations of the cardiovascular system, Corglikon, Stroofantin, are used. Desensitizing drugs are used (diphrolling inward or intramuscularly).

With hyperthermia, usually observed in severe neurotoxicosis, antipyretic drugs (amidopin with analgin), drip, intravertal introduction of chilled glucose solutions, cold on the head and large vessels.
With encephalitic syndrome, meningeal symptoms requires a spinal point, a magnesium sulfate, chloralhydrate in the enema, other preparations with sedative properties (sodium oxybutirate), neuropiles (aminezine, pepolfen) are prescribed. With a vasomotor complex syndrome, vesseloring agents, warming, glucose, plasma-substituting solutions are used. In the phenomena of the excacosis, which is observed mainly in the intestinal forms of staphylococcal infection, it is necessary to abundant injection of fluid intravenously drip - from several hours to several days depending on the state of the patient.

In severe forms of staphylococcal infection, acute respiratory failure can develop. In these cases, it is necessary to suck the mucus from the pharynx and the larynx electrotrososos. Viscous thick exudate is diluted with soda inhalations, proteolytic enzymes (chymotrypsin). For sufficient supply of patients with oxygen is placed in the oxygen tents of DCP-1, where moistened oxygen is supplied.
In the event of a pneumothorax, popenemotrax, empynes need urgent surgical intervention.
With laryinghotrates for removing a crust and mucus from the lumen of the trachea showing laryngoscopy. Resort to soda inhalations, mustard pieces. The phenomena of stenosis II - III degree use prolonged intubation through the nose with a polyethylene catheter. In the absence of an effect, the tightened oxygen deficiency produce tracheostomy.

Symptomatic therapy

Symptomatic therapy provides impact on separate symptoms of the disease. In modern conditions, it is usually carried out taking into account the essence of the pathological process and the mechanism of the drug action, therefore, very close to pathogenetic therapy.

Physiotherapeutic methods

Physiotherapy methods are an integral part of treatment. These are compresses, heatsacks, ice, cold, mustard pieces, mustard wraps, baths, paraffin applications, etc. Ultraviolet rays, diathermy, UHF, etc. are widely used.

Surgical treatment methods

Surgical treatment methods are used mainly under purulent complications.
Acute lungs, moderate shapes are usually well amenable to timely sufficient antibacterial treatment. The temperature is quickly reduced to the norm, the general condition improves;
changes in the focus of inflammation are eliminated slower, often delayed blood normalization. In addition to antibiotics and vitamins, other drugs are used according to indications.

With severe forms of staphylococcal infection, in addition to the means above the means of specific therapy, the means to combat heavy toxicosis, the good effect is given to repeated blood transfusions (5-7) after 4-5 days. The best is a direct blood transfusion. According to indications use symptomatic means.
In patients with protracted; Chronic forms In recent years, biological preparations are proposed for treatment: colibacterin, lactobacterin, bifidumbacterin, bificol. They are used to combat dysbacteriosis in order to normalize intestinal flora, especially in the intestinal forms of staphylococcal infection. Biological preparations are prescribed according to special schemes set forth in Prospects.

Mother of breast children with any staphylococcal diseases are necessarily subject to treatment with antibiotics. Otherwise, the child's infection almost inevitably occurs. Preventive measures must be strictly observed. Under the defeat of the oz and the respiratory tract, feeding and care for the child is made only in masks; Under the lesions of the skin, limit communication with the child, etc. In case of staphylococcal damage to the breast, local means and antibiotics should be used in the nursing mother. Milk from the chest needs to be stacked and giving only in boiled or pasteurized form.