A 2-year-old child develops a rapidly spreading blistering eruption that starts around the nose and mouth. The blisters are flaccid, rupture easily leaving honey-colored crusts. Gram stain of blister fluid shows gram-positive cocci in clusters. The causative organism and the most appropriate treatment are:
- A Staphylococcus aureus — topical mupirocin or oral cloxacillin ✓
- B Group A Streptococcus — oral phenoxymethylpenicillin
- C Herpes simplex virus — topical acyclovir
- D Candida albicans — topical nystatin
Correct answer: A. Staphylococcus aureus — topical mupirocin or oral cloxacillin
Explanation
Bullous impetigo in young children is caused by S. aureus phage group II (exfoliative toxins A and B cleave desmoglein 1), producing flaccid, thin-walled bullae that rupture to form honey-colored crusts. Non-bullous impetigo may be caused by S. aureus or Streptococcus pyogenes. For bullous impetigo, the causative organism is specifically S. aureus, and treatment is topical mupirocin for limited disease or oral cloxacillin/amoxicillin-clavulanate for extensive disease. Penicillin does not cover penicillinase-producing S. aureus.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.