Streptococcal skin diseases in children.

Infections with streptococcal bacteria continue to be a common problem in children. They can produce cutaneous manifestations via three main mechanisms: (1) direct infection of the skin; (2) toxin-mediated disease; and (3) immunologically mediated disease. This review updates a variety of streptococcal diseases involving the skin. The changing bacteriology of impetigo is addressed, as well as the resurgence of rheumatic fever. A new manifestation of invasive streptococcal infection, termed streptococcal toxic shocklike syndrome, is also presented. Many changes in the epidemiology of streptococcal infections during the 1980s can be traced to the reemergence of more virulent strains of the organism. The impact of this natural occurrence is discussed. Therapeutic recommendations are presented for each disease, and the value of rapid streptococcal tests is reviewed.