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Ecological contrasts between bacterial species commonly found in impetigo

An opportunity to study the interrelationships between and the significance of the two bacterial species commonly associated with impetigo was provided by intensive observatins on 38 children in a population with endemic skin infections. Cultures of the respiratory tract, 3 normal skin sites and lesions (when present) were done 3 times weekly from July to October 1969. Impetigo developed in all children. Group A streptococci alone were recovered from 21% of 361 lesions, staphylococci alone from 14% and both from 62%. Lesions in early stages (before crusitng) were more often pure streptococcal (34%) than staphylococcal (8%). Phage type 75 accounted for the majority of the staphylococcal isolates from all sites. 74 lesions were serially cultured at least 3× each (mean 4.9×) over a period of 6 days or longer (mean 12.6 days) until healing occurred. Of 17 initially pure streptococcal lesions 41% remained so, 59% became mixed and none became staphylococcal. Of 54 initially mixed lesions 69% remained so, 24% became streptococcal and only 7% became staphylococcal. Of the 3 initially pure staphylococcal lesions 2 became mixed. In 85% of the instances, the same streptococcal serotype was recovered repeatedly from a lesion. However, staphylococcal phage types changed in 57% of instances. In contrast to the sequence of spread of streptococci from normal skin sites to lesions to respiratory tract, staphylococci from normal skin sites to lesions to respiratory tract, staphylococci spread from the respiratory tract to normal skin to lesions. These studies reveal important differences in the migration of streptococci and staphylococci to various body sites and suggest a subsidiary role for staphylococci in impettiginoous lesions yielding both organisms.