world where hygiene is poor. Impetigo can be bullous or nonbullous. Bullous impetigo comes from staphylococcus, which releases a toxin that cause skin exfoliation. In nonbullous impetigo, there can be pustules or vesicles that can easily rupture. Figure 16 shows what impetigo often looks like:
Figure 16.
Ecthyma is simply a type of impetigo that has ulcerations that have thick crusts and surrounding reddened areas. Most impetigo can be treated with mupirocin, although there are other topical antibiotic treatments. Some patients, especially those with recurrences, will do better with oral antibiotics to eradicate the carrier status.
ACUTE OTITIS MEDIA Acute otitis media can be viral or bacterial and involve the middle ear cavity that has accumulated fluid from an upper respiratory infection and because of eustachian tube dysfunction that prevents drainage of the fluid. It is seen most commonly in infants and
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