What is a superinfection?

The term “superinfection” is not clearly defined medically. When doctors talk about a superinfection, they usually mean a bacterial infection based on a previous viral infection. However, the term superinfection is also often used when a chronic disease promotes infection.

Read more on the topic: Virus infection - everything at a glance

A common example of this is an infection of the skin with bacteria in pre-existing neurodermatitis. A secondary infection is often referred to as a secondary infection. The terms are not sharply separated from one another. In virology, a superinfection usually describes an infection of a cell with a virus, which leads to a second infection with another virus or a different strain of the same pathogen.

Causes of superinfection

Superinfection can have various causes. A common example of a superinfection is a bacterial infection of the skin with pre-existing neurodermatitis. The cause is the disruption of the skin barrier caused by the chronic inflammatory skin disease neurodermatitis, which makes it easier for bacteria to spread.

Another cause of a superinfection is diabetes mellitus, in which circulatory disorders can lead to chronic wounds and dead tissue - in short: necrosis - on the feet. There, too, bacteria can easily lead to superinfections.

Read more on the topic: Circulatory disorders in the feet

It is not uncommon for a bacterial superinfection to occur in the lungs after a viral infection, which can even lead to pneumonia.

A classic example from virology is infection with the hepatitis D virus, which is only possible after a previous hepatitis B infection.

What the superinfections have in common is that they need a previous infection or a weakening of the immune defense due to inflammation in order to be able to spread.

Which bacteria often make a superinfection

Superinfections can arise from various pathogens. Bacterial superinfections are mainly caused by so-called staphylococci or streptococci on the skin. An infection by staphylococci is often referred to as one Staphyloderma.

Streptococcal infections of the skin, such as those that can arise from neurodermatitis, are also often referred to as Impetiginization designated. However, other bacteria can also be involved in the development of superinfections, such as Pseudomonas aeruginosa in wound infections or pneumococci and Haemophilus influenza in the lungs.

Read more on the topic:

  • Skin care for atopic dermatitis
  • Wound healing disorder

Superinfections with previous illnesses

Superinfection in herpes

Superinfection is also possible with a herpes infection. It is particularly feared when it comes to the maximum extent of the so-called Eczema herpeticatum. This extensive skin infection is very rare and usually arises as a complication of the damaged skin in neurodermatitis. As a complication of this serious illness, a bacterial superinfection of the eczema herpeticatum can occur, which is associated with fever and general fatigue. The skin is very painful. The superinfection usually arises from staphylococci, which are already on the skin of many affected people and tend to multiply due to the severely damaged skin barrier. Combined antiviral and antibiotic therapy is typically used to combat both the herpes viruses and bacteria.

Read more on the topic: Cold Sores - How To Treat It Right

Superinfection in atopic dermatitis

Neurodermatitis is one of the so-called chronic inflammatory skin diseases. In atopic dermatitis, the structure of the skin barrier is damaged, which is why bacteria can settle more easily. Furthermore, the immune defense is weakened, which is why the skin of a neurodermatitis sufferer is more prone to infections.

Many of those affected have overgrowth with the bacterium Staphylococcus aureus. In the course of acute deterioration of the skin with the formation of eczema, the germ can spread further and lead to a skin infection. Superinfection with herpes viruses or fungi is also possible. Superinfection with so-called papillomaviruses can occur less frequently. This leads to the appearance of warts.

Read more on the topic:

  • Treatment of atopic dermatitis
  • Skin fungus

Superinfection after an insect bite

In many cases, insect bites can be an entry point for pathogens into the skin and thus promote superinfections. Often they also lead to itching, which causes those affected to scratch. Scratching the skin also creates wounds through which bacteria can penetrate the skin.

Such a superinfection can manifest itself as pain at the injection site, reddening or overheating. You may also experience a fever or general symptoms such as chills and fatigue. A doctor should be consulted with such complaints, as antibiotic therapy is often necessary.

Read more on the topic:

  • Insect bite - first aid and emergency measures
  • Inflamed insect bite - what to do and when is it dangerous?

Superinfections - different localization

Superinfection of the skin

The skin is the largest human organ and is in constant contact with pathogens and germs due to its large surface. Superinfection of the skin can occur due to previous damage to the skin barrier. Such previous damage can result from wounds as well as from inflammatory skin diseases.

Superinfections of the skin typically occur in those with neurodermatitis. The skin barrier weakened by the disease tends to be colonized with bacteria, which can lead to a superinfection in the event of an acute attack of neurodermatitis. In addition, an additional infection with a herpes virus can cause a so-called Eczema herpeticatum arise that is characterized by fever and vesicles distributed over the entire body.

Superinfections with papillomaviruses, which lead to the appearance of warts, or with fungi, especially with Trichophyton rubrum, also occur less frequently.

Therapy is adapted to the particular pathogen with antibiotic, antiviral or antifungal agents. Depending on the severity of the clinical picture, inpatient therapy may be necessary.

Read more on the topic: Treat rash with ointments and creams

Superinfection of the bronchi

A superinfection can also develop in the bronchi. This is usually the case after previous viral damage to the bronchi. An infection with the influenza virus has a particularly beneficial effect. A bacterial superinfection can then lead to Pneumonia, i.e. pneumonia.

Read more on the topic: Complications of flu and flu vaccination

In particular, people with previous diseases of the heart or lungs, such as patients with heart failure or COPD, are at risk of developing such superinfections.

Other diseases, in particular cystic fibrosis, lead to recurrent bronchial infections. In cystic fibrosis, these are also germs that are otherwise rarely encountered and that have many resistances, such as Burkholderia cepacia.

Superinfection of the sinuses

The sinuses can also be affected by superinfection. This is especially the case with chronic sinusitis, i.e. an inflammation of the sinuses. Often this is a vicious circle. An infection that already exists at the beginning leads to acute inflammation, which can turn into chronic inflammation as the disease progresses.

Read more on the topic: Treatment of a sinus infection

Allergies and anatomical peculiarities have a beneficial effect here. Chronic inflammation can lead to bacterial superinfections, which in turn drive the inflammation further. Frequent secondary infections are infections with pneumococci or Haemophilus influenza, but less often with the fungus Aspergillus fumigatus. Such a superinfection is treated with antibiotics. Aminopenicillins such as amoxicillin or 2nd generation cephalosporins such as cefuroxime are suitable for this.

Read more on the topic: Therapy for an allergy

Super infection on the eye

In the eye, superinfections with bacteria often develop on the conjunctiva as so-called bacterial conjunctivitis. This disease is often found in young children and school children and usually arises from allergic or viral irritation of the conjunctiva.

Read more on the topic: Reddened eyes in children and infants and eye drops for an allergy

In adults, contact lens wearers in particular are at risk of suffering from such a bacterial superinfection. Typically, there is increased secretion from the eye, which is purulent and sticky. Yellowish crusts can also appear on the lids in the morning. The sometimes highly contagious pathogens are often transmitted from person to person by smear infections. Therapy is carried out with antibiotic eye drops. If the symptoms fail to improve, you should visit the doctor again after a week at the latest.

Read more on the topic: Proper contact lens care and dry eyes from contact lenses

Those affected should always use their own towels and hygiene items due to the infectiousness. In addition, hand-eye contact should be avoided and hand washing should be carried out regularly.


The diagnosis of superinfection is often made clinically. This means that the attending physician will perform a physical examination and use the symptoms to make a diagnosis. This is the case, for example, with superinfections of the skin. Smears for pathogen diagnosis can be made, but they are rarely very groundbreaking.

In the case of bacterial superinfections of the lungs, x-rays and a diagnosis of the sputum can help make the diagnosis.

Read more on the topic: Chest x-ray (chest x-ray)

In the event of a superinfection of the conjunctiva of the eyes, an examination on the slit lamp and a smear to determine the pathogen will continue.

Read more on the topic: Infection of the eye

I recognize a superinfection by these symptoms

Superinfection can cause a variety of symptoms, depending on both the type of infection and the location. A bacterial superinfection of the lungs, which can occur after a viral infection, often manifests itself in a rising fever and a deterioration in the general condition. Furthermore, there may be purulent or greenish sputum when coughing. Typically, those affected complain of a cough that lasts for weeks and a feeling of exhaustion without any significant improvement.

Read more on the topic. Mucous bronchi

A superinfection of the skin often manifests itself in the appearance of yellowish crusts or blisters and a deterioration in the general condition. A fever is also possible here.

Read more on the topic: Skin changes on the face

With a bacterial superinfection of the conjunctiva, it is typical that the initially clear secretion turns into a purulent secretion. The eyes are usually very glued together and there are yellowish crusts on the lids in the morning.

Read more on the topic: Conjunctivitis

In principle, a superinfection can often be recognized by the fact that the condition that existed before has worsened. A renewed worsening of the symptoms after an initial improvement, especially in the case of infections of the lungs, is highly suspect of a bacterial superinfection.

Treatment / therapy

The treatment of a superinfection depends on the one hand on the pathogen, but on the other hand also on the clinical characteristics of the infection.

A bacterial superinfection of the lungs is treated with antibiotic therapy. Depending on the severity of the severity, inpatient treatment of the pneumonia may be necessary. For inpatient treatment, the antibiotic is usually given through the vein. Therapy with an aminopenicillin and a beta-lactamase inhibitor, such as ampicillin / sulbactam, is typically used.

A bacterial superinfection of the conjunctiva is treated with antibiotic eye drops, such as gentamicin drops. The antibiotic is adapted after the exact pathogen determination including a resistance determination.

Read more on the topic: Acyclovir eye ointment

The superinfection of the skin is treated either with antibiotics or antivirals, depending on whether a bacterium or a virus is the underlying cause. In the case of a combined bacterial and viral infection, double antiviral and antibiotic therapy is used. In practice, treatment with the antibiotic cefazolin and the antiviral drug acyclovir is often used.

Duration / forecast

The duration of a superinfection depends on the respective clinical picture. Superinfection of the lungs often turns out to be a lengthy process. Those affected usually complain of an infection and fatigue that have persisted for weeks until antibiotic therapy is initiated.

Read more on the topic: How long does pneumonia last? and entrained pneumonia

A superinfection of the skin, on the other hand, is usually a very acute event that quickly leads to a doctor's visit. The superinfection is usually contained in 10 to 14 days, provided that adequate antiviral or antibiotic therapy is used. However, relapses, i.e. relapses of the disease, can occur if the skin condition, for example in the case of neurodermatitis, is not improved and the skin barrier is not strengthened. So-called eczema herpeticatum is sometimes a life-threatening clinical picture that has to be treated as an inpatient immediately.

Course of disease

The course of a superinfection is very different from person to person. It can be an acute clinical picture or a rather creeping process. This course depends, among other things, on the type of infection and the location of the infection.

Superinfections of the lungs are mostly rather insidious processes that arise from persistent, mostly weeks-long viral infections.

A superinfection of the conjunctiva or skin, on the other hand, is mostly characterized by an acute deterioration of the previous condition. Superinfections of the skin are usually also characterized by acute deterioration. They are easy to treat, but depending on their severity, can sometimes be life-threatening. That is with Eczema herpeticatum the case.

How contagious is a superinfection?

Some superinfections are highly infectious, whereas other superinfections only occur with previous damage.

Bacterial conjunctivitis is mild to highly contagious. It is therefore important to take good hygiene measures in the event of bacterial conjunctivitis. Those affected should always use their own towels and avoid eye-hand contact, as germs can be passed on.

Superinfection with herpes viruses can also be contagious, so you should definitely avoid contact with blisters and the exuding secretion. In general, you should ensure good hand hygiene when dealing with those affected and use your own hygiene articles and towels.

Read more on the topic: How contagious is pneumonia