Seminar: Bacterial rash diseases in children: group A streptococcal and staphylococcal infections.

Clinical classes: Differential diagnosis of pediatric exanthems, recognition of bacterial skin infections, and a clinical quiz on classic childhood rashes.

Time: 4 hours (8:00 AM – 12:00 PM)

Goal

To recognize common bacterial skin infections and toxin-mediated diseases in children, understand their pathogenesis, and distinguish them from viral exanthems and noninfectious skin disorders. Particular emphasis is placed on recognizing severe bacterial infections requiring urgent treatment.

Before the class

Students should revise:

• Basic morphology of dermatological lesions.
• Characteristics of Streptococcus pyogenes and Staphylococcus aureus.
• Mechanisms of bacterial toxin production.
• Principles of antimicrobial treatment.
• Clinical presentations of common viral childhood exanthems.

Topics

1. Group A Streptococcus (GAS) infections

1.1. Streptococcal pharyngitis and scarlet fever.

1.2. Clinical characteristics of the scarlatiniform rash.

1.3. Impetigo, erysipelas, and cellulitis.

1.4. Invasive GAS infections.

1.5. Streptococcal toxic shock syndrome.

1.6. Post-streptococcal complications.

2. Staphylococcus aureus infections

2.1. Impetigo and bullous impetigo.

2.2. Skin and soft tissue infections.

2.3. Staphylococcal scalded skin syndrome (SSSS).

2.4. Staphylococcal toxic shock syndrome.

3. Diagnostic approach

3.1. Clinical examination of bacterial skin lesions.

3.2. Indications for throat swabs, rapid antigen testing, and bacterial cultures.

3.3. Indications for blood cultures and additional investigations.

3.4. Differential diagnosis of bacterial and viral exanthems.

4. Treatment and prevention

4.1. Principles of topical and systemic antibiotic therapy.

4.2. Indications for hospitalization and intravenous antimicrobial treatment.

4.3. Management of severe toxin-mediated and invasive bacterial infections.

4.4. Infection control and prevention of transmission.

5. Clinical quiz

Recognition and differential diagnosis of classic childhood exanthems based on clinical photographs, brief case descriptions, and characteristic symptoms.

Topics' details

Students should be able to explain or discuss:

• Pathogenesis of the rash in scarlet fever.
• Characteristic signs of scarlet fever, including strawberry tongue and Pastia lines.
• Differences between streptococcal and staphylococcal skin infections.
• Clinical differences between nonbullous and bullous impetigo.
• Pathogenesis and clinical manifestations of staphylococcal scalded skin syndrome.
• Differences between SSSS, toxic epidermal necrolysis, and other blistering disorders.
• Clinical features of erysipelas and cellulitis.
• Recognition of severe invasive bacterial disease and toxic shock syndrome.
• Indications for bacteriological investigations.
• Selection of topical versus systemic antimicrobial treatment.
• Principles of antibiotic stewardship in pediatric skin infections.
• Differential diagnosis of petechial and purpuric rashes, including recognition of possible meningococcal sepsis.
• Clinical features differentiating scarlet fever, measles, rubella, roseola, erythema infectiosum, chickenpox, and HFMD.

Clinical skills

During clinical classes, students should practice:

• Describing bacterial skin lesions using appropriate terminology.
• Distinguishing viral from bacterial exanthems based on clinical findings.
• Identifying warning signs of invasive bacterial infections.
• Selecting diagnostic investigations in suspected bacterial skin infections.
• Proposing appropriate initial antimicrobial management.
• Recognizing classic pediatric exanthems during the clinical quiz.