238 RELATION tsETWEEN THE INTESTINAL FLORA AND DIAPER

'lrupicul
238
undGcogLuplricul
tvlcdicinc
RELATIONtsETWEEN
THE INTESTINALFLORAAND DIAPER
DERMATITISIN INFANCY
A Y l i u s l j v t M ( i 0 K A l . t ' r , c l i M A L A t . t ) l R M A U . . ,A Y N U R O o U Z . r ,A S I M ( l 0 L , n i K t N r
anrl M.
zAHIR BAKtCt2
rDepartmcntof Pediatricsand rMicrobiology,
Faculryof Medicine,CumhuriyetUniversity,Sivas/Turkcy
ReccivcdJanuary5, l9E9
'Acceptedfor publicationJune2?, 1990
Absftqct. In this study, 4O patients with diaper dermatitis and 20 healthy infants
wcre investiE-aicd.
Mycologicul{nrl bscteriologicalculturcs were obtaincd from
allcctcd and healthyskin aicas and stool speciriens.caniitta oilbiton,was isolated
simultaneously
in 37 out of.40 patientssubjectedto mycologicalexaminationof
skin lcsionsund stool spccinrencullurcs.Of 34 Cruristuin-edumcorsfrom the
skitt lcsiotts,27 rcvculcdCundiduin lryphullbrnr. In rtrcciiuiroigroup, C. albtcint
wa$ not Srown ltont the diapcr arca. No signilicant dillerence wai observeclin
thegrowthof bactcriattonr thCskin with or wiiirourlesions(p > 0.05).In conclusion,
C. olbicons-infection
originating liom the gastrointestinaliiact, pliys a mulo.roti
'l'hus,
in diilpcr.dcrmutili$.
tt Crlrnr-rtlirrcd-snrclr
cun bc usedur 1 pilcticgl mcthod
in ourlydiugncrrll,
Key words:Diaper dermatiris;cantritraurbicans;Gram-stained
smear;Turkey
Introduction
Diaper dermatitis is an
-ubiquitousproblem in inl'antsand is mostly seen in rhe
first two monthsof life I l, 2l- It can be regardedas the prototvpeof irritant contaci
dermatitis.As a reactionto friction, macJrarion,and piolong.'J.ontu.t wirh urine
and faeces,retained soap, and topicar_pr"pa.aiions, ths sk'in of the di;p.r;;;;
may becomeerythemato^usand scaly,often with papulovesicular
or bulloui f.sioni
fissurcsand erosions-[3-6].The eruption can'be patchy or confluent, but
thi
genitocruralfold is often spared.Secbndaryinfecrionwiih bacteria
and'v.".t, i,
common;discomfortmay be nr:trkeclbccauicof intcnscinflammation.Co-ndirions
such as allergic conta-ctdermatitis, scborrheictlermatitis,candidiasis,utopi"
,f"imatitis,histiocytosis
X and acrodermatitis
enteropathica
shouldbe considered
when
the eruption is persistentor does not respondtb simple dherapeutic..urui.r-i+
61.
The incidenceof diaper dermatitis is reported to 6e 47oof all children from
u,r..ltlq the age of threeycars[5]. lt is found to be t0 toZio/oamongrhe chilclren
with skin lesions[7]. lt is o commondiscascin nearlyalt childicnwea-ring
a cliaper.
In this study, wc a.rc_showing
how oltcn canclidalinfccrionscan brifounti as
a secondaryinfcct,ionin inlirntswitlr diirpcrdcrm;rtitis.
Mstcrials und Methrds
40puticntswitlt diupcrtlcrnrutitiuuntl 20hculthyirrl'untrwcrcinvcstigatcr|Mycologicrrl
and bactcriglogical
culturcswereobtainedlionr afltctcd und hcllthy skin arcasand stool speciorcnsl
Trop. Oeogr.Mul.,42 (1990)2Ji-240
ri!
Diaperdermatitis
andintestinal
flora,Turkey
239
Beforeobtainingthe cultures,skin lcsionsand hcalthyarcaswcre
clcancdwith sterilesalinesolution.
when they had dried the specimenswerc obtainsd by scraping
thc skin. stool specimensuerc takcn
using sterilecotton swabs'.Theywere immctliarclyinoculatcdon saborau4,s
dextroscmedium, blood
:tgar nntl liMll pllrlcs by thc singlc colony tnclhrxl. (illnr-stlinctl
snrcurswcrc pcrlirr'rctl lr.nr brth
affcctcdand healthyrkin arcas.
Infnrmationon prcdisponing
fnclorswns collcctcdfronr thc mothcrs.
Results
,
Candidaalbicanswas isolatedsimultaneouslyfrom 3? out of 40 patients
subjected
to^mycologicalexaminationof skin tesions-andstool rp""i..n-"ultures (9i,5qo).
of 34 Gram-staincdsmcars from the skin lcsions, zl riveitii candicta
i; hypir;i
torm (79,4vo).ln thc conrrol group, c. albicans
nor t;;"
from the dild;
.*u*
arcannd wasnot scenin Gram-stuincdsmcars(tuhtc ll.
coli, Enterobacter
- ln bactcriologicalcultures,staphylococci,.Esc'herichii
aerogenes,
Pt'oteus,Klebsiella,enterococciand diphtheroid bacilli were isolated frorn-both
affectedand healthyskin areasand stoot ipecimens(tabte2). No significantdifference
I'rblc l.'l'hc rcstlltsof ntycol<tgicll
culttrcs nntl (irnnr-stlincdsrncursof inlantswith untJwithout
diapc dcrmatitis
|l ith iliup<'rlernatitis
Without dioperdermatiti.,
trtethod
Microorganism
Dioper oraa
Stool
Diaper oreo
Srcol
Mycological
Culturc
Candida Albicons *
Candido Albicons-
37
3
37
3
0
20
6
t4
Total
40
40
20
20
Candidat
Candida-
27
7
.30
4
0
20
5
t5
Total
34
34
20
20
Gram
Staincd
Smcar
Trble 2' Thc resultgof bactcriologicalculturcsin infantswith and without diapcr dermatitisr
In/ants vith diopar dermatitis
withoutdiaperdermatitis
Microorganisms
Diaper oreu
Stool
Diaper area
Staphylococcuscoagulasc f
St aphylococcus coagulase Enterococci
| )iplrtlrcroitls
I')tcheri<
hit <ttli
Iin terohu<'tcr aerogencs
Itroteus
Klchsiello
8
26
2
2
l7
3
l3
2
2
9
t3
5
2
It{
5
Total
77
I
25
It
6
I
'Mixed infcctionswercisolutedin somc
cascs
I
,i
lt
9
I
?8
Stool
I
:
llt
39
240
AygeSevimGdkalperct
was observedin thc growth of bacteriafrom thc skin with or without lcsionr
(p>0.0s).
Dinrrhoeal disease,oral moniliasis and antibiotic therapy were found to be
predisposing
facrors.oral moniliasiswas found in 3l out of-a0 patients(77,5%t),
diarrhoea was found in 2l out of 40 patients(52,50/o),
rrearmeni"ittr aniiUioiics
wasfound in 23 out of 40 patients(57,So/t),
Topicalantifungalagentswcrc uscdto trcat thc paticnts.Satislactory
clinical
rcsponc€
wucobscrvctlin 8ll.
Discussion
Canclidal
diapcrdcnnatitisis u nrorcscvcroltlrnr ol'diupcrtlcrnrutitis
lrrtl oltcn
fntstruting.tonl.ttlitgcbccauscol'its tcndcrrcylo rccur. Itrcdisposccl
infuntsusuillly
c'arryc. albicunsin their intestinal tract, and the warm, moist, occludedskin of
fhe diaper area providesan optimal environmentfor its giowttr 1i-S1.
Thc skin becomesan intenselyerythematous,confluint plaque-with a sharply
demarcatededge.It is formed by numerouspapulesand vesiiopirstules,
which aiso
havesatellitepustules,a halhnarkof loculizcdiancliclarinfcctions[s, 91.
. Dvcry dirrpcl dclrttutitisis ulnrostulwuys inlbctcdscconclarilyiith CundidaJ
daysaftcr ir hasstarted[5, 9-12].
The results of our study show that C. olbicans-infections
originating from the
gastrointestinul
truct, plly u nrajorrolc in diuperclcrmatitis,ThuI, a Gr-am-stained
snrearcan bc usedas a practicalnrethodin carly diagnosis.
Wc wish to thank Mr. SerlatTdrel for English rcduction and Mr. Nazim Balyemezfor secrerarial
hclp in thc writing of rhis paper.
Correspondcncs
to: Aytic Scvim C0kalp MD, AssociatcProl'essorof Perliatrics,Faculryof Me4icine,
CunthuriyctUnivcrsity,58040Sivus/[urkcy,
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