Case study. Differential Diagnosis

Case study. Differential Diagnosis
Differential Diagnosis

From the presented scenario, there are several diseases that can lead to the presented symptoms in the clinical presentation above. This paper seeks to address three possible diagnoses that might explain Johnny’s condition.


It is the bacteria infection of the skin and affects infants and children. The infection is spread directly and indirectly through contact. The disease is common in late summer and mid-summer. Its incidence rate is high during the humid and hot climates. The disease is highly infectious among the people who are living in crowded areas with poor sanitary facilities as well as another setting, including the day care facilities (Imanishi et al., 2016). The predisposing factor of the disease includes malnutrition and anemia. It also affects healthy children. The impetigo occurs in two types, the bullous and non-bullous. Both of them start as vesicles characterized with the very thin vesicular room that is made of stratum corneum.

According to Imanishi et al., (2016), Group A Streptococcus pyogenes and Staphylococcus aureus cause the non-bullous impetigo. The microorganisms are usually disseminated through physical contact from individual who are infected, or through insects bites (VanRavenstein, 2017). The lesions normally begin as small vesicles with serum colored as honey. Upon the rupturing of the lesions, yellow to white, brown crust develops. The lesions that are not treated may develop and cover a wider area. The Bullous impetigo, on the other hand, is caused by S. aureus. The regional lymphadenitis is common in this type of impetigo(Imanishi et al., 2016).  The lesions are normally located on the mouth and face and around the nose. The swabs from the lesions are normally taken. The swab is then introduced into the media to determine the bacteria causing the lesion.

Staphylococcal Scalded-Skin Syndrome (SSSS)

It is the most serious form of skin infection caused by Staphylococcus and affects infants and the children who are below five years (Dudley, &Parsh, 2016). SSSs is caused by the virulent group II staphylococci. The pathogenic microorganism produces exfoliate toxin. The toxin attacks the adhesion molecules as well as desmoglein (Dudley, &Parsh, 2016). This causes the skin separation below the epidermis granular layer. The production of the toxin usually occurs at the other sites of the body and arrive in the epidermis via the circulatory system. The pathogenic microorganism responsible for lesions is not present in the lesions.

The immaturity of the component of the immune system of the children and adults put them at a risk of the infection. This is because the immaturity of the immune system makes it difficult to neutralize and eliminate the toxins. The signs and symptoms associated with this form of infection include exquisite tenderness of the skin associated with general erythema, irritability, rhinorrhea, malaise, fever among others (Dudley, &Parsh, 2016). The infection normally begins in the throat or chest. A blood culture can be conducted to determine the pathogenic microorganism causing the infection thus, enabling administer the appropriate antibiotics.


The itch mites are responsible for the cause of this contagious disease. According to Khatoon et al., (2016) Sarcoptes scabies colonize human epidermis causing the disease. In tropical settings, scabies forms one of the most common forms of skin infection. The disease affects people of all ages, but it is mostly it occurs mostly in children. It is spread through infected bending and clothing as well as through personal contact. Scabies is the disease associated with the individuals that are immunocompromised. Johnny may be suffering from scabies, and this could be responsible for lesions in his nose.


The impetigo treatment highly depends on the severity of the infection. Systemic antibiotics are used for non-bullous impetigo with involvement which is extensive (VanRavenstein, 2017). Mild impetigo can be treated through gentle cleansing as well as removing crust in addition to applying the prescription antibiotics ointment mupirocin (Imanishi et al., 2016).  For Bullous impetigo, the disease is more severe and requires the use of antibiotics to treat the disease.

When the student would be allowed to go back to class

Impetigo is normally spread via direct contact from those who are having it. The disease can be spread from objects such as towels, clothing and toys touched by the infected person. Johnny, in this case, should be allowed to go back to class after e has fully recovered from the disease to ensure he doesn’t spread the disease to other school children.


Dudley, M., &Parsh, B. (2016). Recognizing staphylococcal scalded skin syndrome. Nursing, 46(12), 68.

Imanishi, I., Hattori, S., Hisatsune, J., Ide, K., Sugai, M., &Nishifuji, K. (2016). Staphylococcus aureus penetrate the interkeratinocyte spaces created by skin-infiltrating neutrophils in a mouse model of impetigo. Veterinary Dermatology, 28(1), 126-e27.

Khatoon, N., Khan, A., Azmi, M. A., Khan, A., &Shaukat, S. S. (2016). Most common body parts infected with scabies in children and its control. Pakistan Journal Of Pharmaceutical Sciences, (5), 1715.

VanRavenstein, K., Smith, W., O’Connor Durham, C., & Williams, T. H. (2017). Diagnosis and management of impetigo. Nurse Practitioner42(3), 40-44. doi:10.1097/01.NPR.0000508173.18540.51