A Case Report on Impetigo Treated by Tarentula

A Case Report on Impetigo Treated by Tarentula

Abstract

Impetigo is a contagious local superficial bacterial infection involving the epidermis. Impetigo affects more than 160 million children in low to middle income countries.In  India, it affects 5.96% of the population of children Conventional medicine treats these cases by topical application and anti-steroidal drugs. Hahnemann said in organon of medicine that it is a criminal treasure to treat skin disease by external application. Homeopathy has a great role in treating these kinds of cases. Here I’m presenting a case of impetigo treated by Tarentula.

Case summary: This case was treated with individualised homoeopathic medicine at the OPD of RBTS GOVERNMENT HOMOEOPATHIC MEDICAL COLLEGE & HOSPITAL, MUZAFFARPUR, BIHAR. A 7-year-old child presented with a complaint of a reddish eruption around the mouth and nose which oozes out in a few days and then forms a crust. Homoeopathic medicine Tarentula was given to the patient on the basis of an individualistic approach.

Keywords: Homoeopathy, Impetigo

Abbreviations: OPD: outpatient department.

Introduction

Impetigo is a highly contagious bacterial skin infection characterized by the formation of red sores or blisters that quickly rupture and form honey-coloured crusts. This common dermatological condition primarily affects children, but it can also occur in adults. Impetigo is typically caused by either Staphylococcus aureus or Streptococcus pyogenes bacteria, which can enter the skin through cuts, insect bites, or other breaks in the skin barrier. While impetigo is not usually a serious condition, it can be uncomfortable and socially distressing for those affected, especially children. The incidence of impetigo varies geographically and temporally, with higher rates often observed in overcrowded and underprivileged communities. Factors such as poor hygiene, warm and humid climates, and close contact with infected individuals contribute to the spread of impetigo. Additionally, individuals with compromised immune systems or pre-existing skin conditions are at an increased risk of developing impetigo. 

Types of impetigo
–Two forms exist: Non bullous impetigo and bullous impetigo. 

Impetigo contagiosa

Etiological agents

• Staph. Aureus: in developed countries
• Strep. Pyogenes: in developing countries 
• Or by both 

Epidemiology

• Prevalence: common, often occurring in epidemics
• Age: preschool and young school children

Clinical Features

Morphology: Multiple, thin-walled bullae with erythematous halo, rupture rapidly to form exudative plaques covered with honey-coloured crusts Spread peripherally, without (or only partial) central healing and often coalesce to form polycyclic plaques Removal of crust reveals erosion. On drying, crust falls, leaving erythema which fades without scarring. Untreated, may evolve into ecthyma.

Distribution of lesions: Face, especially periorificially (mouth and nose), most frequent site of involvement. Extremities and scalp, less frequently.

 Associations:

• Regional lymphadenopathy frequent in extensive lesions (90%).
• Constitutional symptoms occasionally

 Complications:

• Eczematisation, a frequent complication.
• Acute poststreptococcal glomerulonephritis 

Investigations

• Gram stain: Of exudate shows polymorphs with intracellular and extracellular Gram-positive coco in chains (streptococci) or clusters (staphylococci) or both.
• Culture: Of pus to identify etiological agent. (Stapl aureus or/and Strep, pyogenes) and also for antibiotic sensitivity.

Diagnosis

• Points for diagnosis: Diagnosis of impetigo contagious is based on:

• Age: Patient is a child.
• Morphology: Appearance of multiple, crusted (honey-coloured) lesions with an erythematous halo

  Distribution: Predominantly on face (periorificial areas).

  Investigation: Gram stain (Gram-positive coca in chains /clusters) and culture of  exudate (Stap.aureus/and Strep pyogenes) establish etiological agent.

• Differential diagnosis; Impetigo contagiosa should be differentiated from:

Herpes simplex virus differentiated with impetigo contagiosa

Treatment 

General measures

• Measures to prevent spread: Encouraging hand washing and early institution of treatment.
• Local hygiene: Including washing with soap and water. And removal of crusts, often after softening
• Predisposing factors: Need to be addressed.

Bullous Impetigo

Etiological agent

Staph. Aureus (group II, type 55 and 77)

Epidemiology

• Prevalence: Sporadic.
• Age: Neonates and infants.

Clinical Features

Morphology: Bullae, containing turbid fluid and minimal perilesional halo, which gets ruptured in few days to form thin, varnish-like crusts. Centre heals to form annular plaques. Mucous membranes may be involved.

 Distribution: Face. Sometimes extensive lesions, often favouring sites of existing skin diseases

Complications:

• Staphylococcal scalded skin syndrome (SSSS).

Investigations

• Gram stain: Polymorphs with intra- and extracellular Gram-positive cocci in clusters.

• Culture: Staph. aureus, Important to determine antibiotic sensitivity

Diagnosis

Points for diagnosis: it can be diagnosed on the basis of:

• Age: Patient is an infant.
• Morphology: Presence of bullae, which rupture to form plaques surmounted.

• varnish-like crusts.
• Lesions heal in centre to form annular plaques.

• Distribution-face.
• Investigations: Gram stain (Gram-positive cocci in dusters) and pus culture (Staph, aureus) establish the etiological agent.

Treatment

• General measures:
• Local hygiene, cleaning hands properly.
• Crusts can easily be removed. 

Homoeopathic Therapeutics 

1. Mezereum-Formation of thick, dry crusts on the skin. The eruptions are very itchy, and the child continually scratches them. Tearing the scab causes pain and burning sensation. child is irritable and restless.
2. Antim Crud-Eruptions are covered with thick, hard, honey coloured scab, crusty eruption are painful to touch. discharges are greenish in colour. Basically, eruptions present around mouth and nose.
3. Dulcamara–Crusts are surrounded by red coloured border. these bleed on scratching and ooze watery fluid or pus eruption are itchy and sensitive to touch, <washing.
4. Graphitis -The chief character includes eruptions which exudate watery, transparent, sticky, gluey discharges. The eruption is firstly of light colour with itching followed by scab formation. the discharges are may be corrosive
5. Hepar Sulp–Very painful, oversensitive eruption developed here. Pus filled sores on the skin. These tend to turn into ulcers, foul smelling discharges with burning and stinging pain.
6. Rhus Tox -Appearance of blisters filled with yellow watery content blisters were large and appear on the corners of mouth there is burning, biting tingling stinging sensation. Marked redness on the skin. Foul smelling fluid matter.
   

Case History: –

A 7 years old, Hindu male child reported in the paediatrics outpatient department of RBTS Government Homoeopathic Medical College & Hospital, Muzaffarpur, Bihar on 04/12/2023 Complaint of eruption around mouth and nose, crusty, yellowish brown in nature 

Child is physically very restless and obstinate as well. Loves music and dancing.

Past History –Abdominal colic before 1 year for which he has taken allopathic medicines.

Family history– 

Mother- Father – Alcoholic

Personal history – student

Physical General

• Outlook-lean and thin
• Tongue-moist
• Thirst – 1-2 Liter
• Appetite – good
• Perspiration – normal
• Thermal – hot
• Desire – sweet
• Aversion – Not specific
• Stool- constipation
• Urine -clear
• Sleep – Sound
• Dream – Not specific
• Physically patient was very restless

Mental general

Loves music and dance

Provisional diagnosis– Impetigo