DOCSLIB.ORG

Pediatric Cutaneous Bacterial Infections Dr

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pediatric Cutaneous Bacterial Infections Dr PEDIATRIC CUTANEOUS BACTERIAL INFECTIONS DR. PEARL C. KWONG MD PHD BOARD CERTIFIED PEDIATRIC DERMATOLOGIST JACKSONVILLE, FLORIDA DISCLOSURE • No relevant relationships PRETEST QUESTIONS • In Staph scalded skin syndrome: • A. The staph bacteria can be isolated from the nares , conjunctiva or the perianal area • B. The patients always have associated multiple system involvement including GI hepatic MSK renal and CNS • C. common in adults and adolescents • D. can also be caused by Pseudomonas aeruginosa • E. None of the above PRETEST QUESTIONS • Scarlet fever • A. should be treated with penicillins • B. should be treated with sulfa drugs • C. can lead to toxic shock syndrome • D. can be associated with pharyngitis or circumoral pallor • E. Both A and D are correct PRETEST QUESTIONS • Strep can be treated with the following antibiotics • A. Penicillin • B. First generation cephalosporin • C. clindamycin • D. Septra • E. A B or C • F. A and D only PRETEST QUESTIONS • MRSA • A. is only acquired via hospital • B. can be acquired in the community • C. is more aggressive than OSSA • D. needs treatment with first generation cephalosporin • E. A and C • F. B and C CUTANEOUS BACTERIAL PATHOGENS • Staphylococcus aureus: OSSA and MRSA • Gp A Streptococcus GABHS • Pseudomonas aeruginosa CUTANEOUS BACTERIAL INFECTIONS • Folliculitis • Non bullous Impetigo/Bullous Impetigo • Furuncle/Carbuncle/Abscess • Cellulitis • Acute Paronychia • Dactylitis • Erysipelas • Impetiginization of dermatoses BACTERIAL INFECTION • Important to diagnose early • Almost always curable • Serious complications if delayed Rx or if Rx is inadequate • Septicemia, nephritis, carditis, arthritis PTS PRONE TO BACTERIAL INFECTIONS • Immunocompromised pts • Babies /Children • Pts with chronic skin conditions BACTERIAL INFECTION • Localized • Spreading • Superficial • Deep • Rash is secondary to the infection SKIN REACTION TO BACTERIAL INFECTION • Guttate psoriasis • SSSS • TSS • Scarlet fever/scarlatina • Beaus lines and onychomadesis FOLLICULITIS • Infection of the hair follicles • Superficial or deep • Staph most common pathogen but Strep Gram negative and even dermatophytes • Folliculitis barbae (sycosis barbae) • Pseudomonas Folliculitis (hot tub folliculitis) FOLLICULITIS FOLLICULITIS IMPETIGO • Superficial infection • Bullous or nonbullous • Erythematous papules with honey yellow colored crusting; peripheral collarettes • Multiple lesions due to autoinoculation • S Aureus , GABHS or both • Topical antibiotics if localized , oral if spreading IMPETIGO IMPETIGO IMPETIGO IMPETIGO BULLOUS IMPETIGO FURUNCLE CARBUNCLE • Boils • Painful deep perifollicular abscesses with central necrosis suppuration; fluctuant • S aureus • Carbuncles larger deeper seated abscess aggregates • I and D and oral antibiotics. FURUNCLE/CARBUNCLE FURUNCLE/CARBUNCLE CELLULITIS • Acute infection of the skin sub q • Erythema swelling tenderness • Borders not elevated or sharply defined • Follows skin trauma • Can have constitutional sx • S aureus and GABHS and under 2 H influenza type b,strep pneumoniae PERIORBITAL CELLULITIS • Erythema and periorbital swelling • Can spread thru orbital septum • Orbital cellulitis: proptosis ophthalmoplegia decreased visual acuity • Need CT and consult to ophthalmology. Need to rule out meningitis • Complication: abscess formation and cavernous sinus thrombosis • Used to be due to Hib now more Staph and strep CELLULITIS ERYSIPELAS • Superficial cellulitis with marked lymphatic involvement • GABHS • Direct inoculation thru break in skin • Warm shiny bright red infiltrated plaque distinct border ERYSIPELAS PERIANAL STREPTOCOCCAL DERMATITIS PSD • Frequently overlooked • Sharply circumscribed perianal erythema • Fissuring and purulent discharge and or functional disturbances • Strep /staph. PERIANAL STREP INFECTION BLISTERING DACTYLITIS • Bullous manifestation of strep or staph infection • Painful tense one finger or several • DDx herpetic whitlow DACTYLITIS/ACUTE PARONYCHIA SKIN REACTIONS TO BACTERIAL INFECTION • SSSS • TSS • Scarlet fever/scarlatina • Guttate psoriasis • Beaus lines and onychomadesis STAPH SCALDED SKIN SYNDROME • Blistering skin disease caused by epidermolytic toxin producing S aureus • Exfoliative toxin ETA ETB • Generally starts with infection of the conjunctiva or the nares perioral region perineum or umbilicus/ • Initial nidus can be from pneumonia septic arthritis endocarditis or pyomyositis • Fever malaise lethargy irritability poor feeding • Erythema crusting denudation and tender skin. • Nikolsky sign is positive SSSS SSSS SSSS STAPH SCALDED SKIN SYNDROME SSSS SSSS SSSS NEWBORN SSSS NEWBORN TOXIC SHOCK SYNDROME • Acute febrile illness • Fever rash hypotension multisystem organ involvement • Classic history : use of superabsorbent tampons. • Non menstrual cases : nasal packing postpartum state and a variety of staph infections TSS Temp >38.9 Diffuse macular erythroderma Desquamation and 1-2 weeks after onset , esp palms and soles Hypotension Multisystem involvement of 3 or more:GI , MSK, renal , hepatic , hematologic, CNS Negative tests on blood throat or CSF cultures, or serologic tests for RMSF leptospirosis or measles. TSS DESQUAMATION TSS DESQUAMATION SCARLET FEVER/SCARLATINA • Caused by GABHS • Fever chills sore throat headaches • Tonsillopharyngeal erythema exudate or petechial macules of the palate • Tongue with white strawberry appearance then red strawberry tongue • Circumoral pallor • Asstd cervical lymphadenopathy • Sandpapery • Pastia’s lines: petechial component in the flexural areas • Desquamation SCARLET FEVER /SCARLATINA SCARLET FEVER SCARLET FEVER DESQUAMATION POST SCARLET FEVER ONYCHOMADESIS SECONDARY TO STREP INFECTION GUTTATE PSORIASIS IMPETIGINIZATION OF DERMATOSES • Atopic dermatitis • Tinea capitis • Psoriasis IMPETIGINIZED ECZEMA IMPETIGINIZED ECZEMA IMPETIGINIZED ECZEMA IMPETIGINIZED ATOPIC DERMATITIS IMPETIGINIZED TINEA CAPITIS APPROACH TO TREATMENT • Empirical treatment • Cultures to determine sensitivity • Topical antibiotics • Systemic antibiotics • Pediatric considerations • I and D • Prevention TOPICAL ANTIBIOTICS OTC options: neosporic polysporin bacitracin Mupirocin Fusidic acid Silvadene Clindamycin Gentamicin SYSTEMIC ORAL ANTIBIOTICS • Cloxacillin • Augmentin • Cephalexin. First generation , second generation • Clindamycin • Sulfa • Ciprofloxacin • Doxycycline SPECIAL PEDIATRIC CONSIDERATIONS • Allergies • Safety in children: Doxy, cipro • Palatability • Dosing • Cost • Drug Interactions SURGICAL TREATMENT • I and D abscess TREATMENT OF SKIN BACTERIAL INFECTIONS • Cultures important. • Important to know WHERE to culture. • Good complete physical exam • Recognize yellow crusting, wet lesions. • Don’t forget to look in the groin perianal area eyelids external ear canals, folds • Don’t forget to treat contacts. Contacts may include FIDO the family dog PREVENTION • Disinfectants: Bleach baths, hibiclens wash, mupirocin to nostrils and to body folds • Disinfect surfaces. • No toys in bathtubs, no loofahs etc • Change blades from shavers • WARN PTS INFECTION CAN BE RECURRENT! • Treat family pets too! CA-MRSA • Usually presents as deeper furuncle/carbuncle • More aggressive • Common in community not just hospital setting CA MRSA ERADICATION SUGGESTIONS: • Treat affected areas with topical antibiotics Mupirocin • Prone areas : nares folds • Bleach baths • Hibiclens • Treat contacts including Fido • Mouthwash to treat pharynx and soak toothbrushes combs in mouthwash • Clorox wipes vs Saniwipes • Change linens daily • Change razors PRETEST QUESTIONS • In Staph scalded skin syndrome: • A. The staph bacteria can be isolated from the nares , conjunctiva or the perianal area • B. The patients always have associated multiple system involvement including GI hepatic MSK renal and CNS • C. common in adults and adolescents • D. can also be caused by Pseudomonas aeruginosa • E. None of the above PRETEST QUESTIONS • Scarlet fever • A. should be treated with penicillins • B. should be treated with sulfa drugs • C. can lead to toxic shock syndrome • D. can be associated with pharyngitis or circumoral pallor • E. Both A and D are correct PRETEST QUESTIONS • Strep can be treated with the following antibiotics • A. Penicillin • B. First generation cephalosporin • C. clindamycin • D. Septra • E. A B or C • F. A and D only PRETEST QUESTIONS • MRSA • A. is only acquired via hospital • B. can be acquired in the community • C. is more aggressive than OSSA • D. needs treatment with first generation cephalosporin • E. A and C • F. B and C .
Load more

Recommended publications
  • Bacterial Skin Infections an Observational Study
    RESEARCH Geoffrey Spurling Deborah Askew David King Geoffrey K Mitchell MBBS, DTM&H, FRACGP, is Senior PhD, is Senior Research Fellow, MBBS, MPH, FRACGP, is Senior Lecturer, MBBS, PhD, FRACGP, FAChPM, Lecturer, Discipline of General Practice, Discipline of General Practice, Discipline of General Practice, University is Associate Professor, Discipline University of Queensland. g.spurling@ University of Queensland. of Queensland. of General Practice, University of uq.edu.au Queensland. Bacterial skin infections An observational study Bacterial skin infections such as impetigo and boils are Background common, contagious, often painful, and have the potential to We aimed to determine the feasibility of measuring resolution rates of recur. They are caused by Staphylococcus aureus and bacterial skin infections in general practice. occasionally by Streptococcus pyogenes, and are transmitted Methods by skin-to-skin contact, fomite contact or contact with nasal Fifteen general practitioners recruited patients from March 2005 to carriers.1 In the United Kingdom, incidence of skin infections October 2007 and collected clinical and sociodemographic data at in children in 2005 was approximately 75 per 100 000.2 Skin baseline. Patients were followed up at 2 and 6 weeks to assess lesion infection rates are likely to be higher in warmer climates. The resolution. only Australian data we found were for one Northern Territory Results Aboriginal Medical Service (Danila Dilba), which recorded 7.5 Of 93 recruited participants, 60 (65%) were followed up at 2 and 6 per 100 consultations for localised skin infections.3 weeks: 50% (30) had boils, 37% (22) had impetigo, 83% (50) were prescribed antibiotics, and active follow up was suggested for 47% Suggested risk factors for impetigo include: household crowding, (28).
    [Show full text]
  • Current Microbiological, Clinical and Therapeutic Aspects of Impetigo Lior Zusmanovich, Lior Charach and Gideon Charach*
    ISSN: 2378-3656 Zusmanovich et al. Clin Med Rev Case Rep 2018, 5:205 DOI: 10.23937/2378-3656/1410205 Volume 5 | Issue 3 Clinical Medical Reviews Open Access and Case Reports CASE REPORT Current Microbiological, Clinical and Therapeutic Aspects of Impetigo Lior Zusmanovich, Lior Charach and Gideon Charach* Department of Internal Medicine “C”, Affiliated to Tel Aviv University, Israel *Corresponding author: Gideon Charach, Department of Internal Medicine “C”, Tel Aviv Sourasky Check for Medical Center, Sackler Medical School, Affiliated to Tel Aviv University, 6 Weizman Street, Tel Aviv updates 6423906, Israel, Tel: +972-3-6973766, Fax: +972-3-6973929, E-mail: [email protected] nonpurulent and purulent cellulitis, and treatment is Abstract based on extent of infection and risk factors. Abscesses Impetigo is a highly contagious infection of the epidermis, involve the dermis and deeper skin tissues as a result of seen especially among children, and transmitted through direct contact. Two bacteria are associated with impetigo: pus formation. S. aureus and GAS. Over 140 million people are suffering Impetigo is observed most frequently among chil- from impetigo at each time point, over 100 million are chil- dren. Two forms of impetigo exist, namely impetigo conta- dren 2-5 years of age and is transmitted through direct giosa, known as the non-bullous form and the second one contact [1]. Risk factors for impetigo include poor hy- being bullous impetigo which presents with large and fragile giene, low economic status, crowding and underlying bullae. Treatment options for impetigo include systemic an- scabies [2,3]. Important consideration is carriage of tibiotics, topical antibiotics as well as topical disinfectants.
    [Show full text]
  • Inflammatory Or Infectious Hair Disease? a Case of Scalp Eschar and Neck Lymph Adenopathy After a Tick Bite
    Case Report ISSN: 2574 -1241 DOI: 10.26717/BJSTR.2021.35.005688 Adherent Serous Crust of the Scalp: Inflammatory or Infectious Hair Disease? A Case of Scalp Eschar and Neck Lymph Adenopathy after a Tick Bite Starace M1, Vezzoni R*2, Alessandrini A1 and Piraccini BM1 1Dermatology - IRCCS, Policlinico Sant’Orsola, Department of Specialized, Experimental and Diagnostic Medicine, Alma Mater Studiorum, University of Bologna, Italy 2Dermatology Clinic, Maggiore Hospital, University of Trieste, Italy *Corresponding author: Roberta Vezzoni, Dermatology Clinic, Maggiore Hospital, University of Trieste, Italy ARTICLE INFO ABSTRACT Received: Published: April 17, 2021 The appearance of a crust initially suggests inflammatory scalp diseases, although infectious diseases such as impetigo or insect bites should also be considered among April 27, 2021 the differential diagnoses. We report a case of 40-year-old woman presentedB. Burgdorferi to our, Citation: Starace M, Vezzoni R, Hair Disease Outpatient Service with an adherent serous crust on the scalp and lymphadenopathy of the neck. Serological tests confirmed the aetiology of while rickettsia infection was excluded. Lyme borreliosis can mimic rickettsia infection Alessandrini A, Piraccini BM. Adherent and may present as scalp eschar and neck lymphadenopathy after a tick bite (SENLAT). Serous Crust of the Scalp: Inflammatory Appropriate tests should be included in the diagnostic workup of patients with necrotic or Infectious Hair Disease? A Case of Scalp scalpKeywords: eschar in order to promptly set
    [Show full text]
  • Coexistence of Antibodies to Tick-Borne
    Mem Inst Oswaldo Cruz, Rio de Janeiro, Vol. 98(3): 311-318, April 2003 311 Coexistence of Antibodies to Tick-borne Agents of Babesiosis and Lyme Borreliosis in Patients from Cotia County, State of São Paulo, Brazil Natalino Hajime Yoshinari/+, Milena Garcia Abrão, Virginia Lúcia Nazário Bonoldi, Cleber Oliveira Soares*, Claudio Roberto Madruga*, Alessandra Scofield**, Carlos Luis Massard**, Adivaldo Henrique da Fonseca** Laboratório de Investigação em Reumatologia (LIM-17), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo 455, 3º andar, 01246-903 São Paulo, SP, Brasil *Embrapa Gado de Corte, Campo Grande, MS, Brasil **Universidade Federal Rural do Rio de Janeiro, Seropédica, RJ, Brasil This paper reports a case of coinfection caused by pathogens of Lyme disease and babesiosis in brothers. This was the first case of borreliosis in Brazil, acquired in Cotia County, State of São Paulo, Brazil. Both children had tick bite history, presented erythema migrans, fever, arthralgia, mialgia, and developed positive serology (ELISA and Western-blotting) directed to Borrelia burgdorferi G 39/40 and Babesia bovis antigens, mainly of IgM class antibodies, suggestive of acute disease. Also, high frequencies of antibodies to B. bovis was observed in a group of 59 Brazilian patients with Lyme borreliosis (25.4%), when compared with that obtained in a normal control group (10.2%) (chi-square = 5.6; p < 0.05). Interestingly, both children presented the highest titers for IgM antibodies directed to both infective diseases, among all patients with Lyme borreliosis. Key words: lyme borreliosis - lyme disease - spirochetosis - borreliosis - babesiosis - coinfection - tick-borne disease - Brazil Babesiosis is a tick-borne disease distributed world- The first case of babesiosis in a healthy person, with wide, caused by hemoprotozoans of the genus Babesia, intact spleen, was reported in 1969 in a woman from Nan- which infects wild and domestic animals, promoting eco- tucket Island (Massachusetts, USA)(Wester et al.
    [Show full text]
  • Nonbacterial Pus-Forming Diseases of the Skin Robert Jackson,* M.D., F.R.C.P[C], Ottawa, Ont
    Nonbacterial pus-forming diseases of the skin Robert Jackson,* m.d., f.r.c.p[c], Ottawa, Ont. Summary: The formation of pus as a Things are not always what they seem Fungus result of an inflammatory response Phaedrus to a bacterial infection is well known. North American blastomycosis, so- Not so well appreciated, however, The purpose of this article is to clarify called deep mycosis, can present with a is the fact that many other nonbacterial the clinical significance of the forma¬ verrucous proliferating and papilloma- agents such as certain fungi, viruses tion of pus in various skin diseases. tous plaque in which can be seen, par- and parasites may provoke pus Usually the presence of pus in or on formation in the skin. Also heat, the skin indicates a bacterial infection. Table I.Causes of nonbacterial topical applications, systemically However, by no means is this always pus-forming skin diseases administered drugs and some injected true. From a diagnostic and therapeutic Fungus materials can do likewise. Numerous point of view it is important that physi¬ skin diseases of unknown etiology cians be aware of the nonbacterial such as pustular acne vulgaris, causes of pus-forming skin diseases. North American blastomycosis pustular psoriasis and pustular A few definitions are required. Pus dermatitis herpetiformis can have is a yellowish [green]-white, opaque, lymphangitic sporotrichosis bacteriologically sterile pustules. The somewhat viscid matter (S.O.E.D.). Pus- cervicofacial actinomycosis importance of considering nonbacterial forming diseases are those in which Intermediate causes of pus-forming conditions of pus can be seen macroscopicaily.
    [Show full text]
  • WO 2014/134709 Al 12 September 2014 (12.09.2014) P O P C T
    (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date WO 2014/134709 Al 12 September 2014 (12.09.2014) P O P C T (51) International Patent Classification: (81) Designated States (unless otherwise indicated, for every A61K 31/05 (2006.01) A61P 31/02 (2006.01) kind of national protection available): AE, AG, AL, AM, AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, (21) International Application Number: BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, PCT/CA20 14/000 174 DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, (22) International Filing Date: HN, HR, HU, ID, IL, IN, IR, IS, JP, KE, KG, KN, KP, KR, 4 March 2014 (04.03.2014) KZ, LA, LC, LK, LR, LS, LT, LU, LY, MA, MD, ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, (25) Filing Language: English OM, PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, (26) Publication Language: English SC, SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, (30) Priority Data: ZW. 13/790,91 1 8 March 2013 (08.03.2013) US (84) Designated States (unless otherwise indicated, for every (71) Applicant: LABORATOIRE M2 [CA/CA]; 4005-A, rue kind of regional protection available): ARIPO (BW, GH, de la Garlock, Sherbrooke, Quebec J1L 1W9 (CA). GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, SZ, TZ, UG, ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, RU, TJ, (72) Inventors: LEMIRE, Gaetan; 6505, rue de la fougere, TM), European (AL, AT, BE, BG, CH, CY, CZ, DE, DK, Sherbrooke, Quebec JIN 3W3 (CA).
    [Show full text]
  • Isotretinoin Induced Periungal Pyogenic Granuloma Resolution with Combination Therapy Jonathan G
    Isotretinoin Induced Periungal Pyogenic Granuloma Resolution with Combination Therapy Jonathan G. Bellew, DO, PGY3; Chad Taylor, DO; Jaldeep Daulat, DO; Vernon T. Mackey, DO Advanced Desert Dermatology & Mohave Centers for Dermatology and Plastic Surgery, Peoria, AZ & Las Vegas, NV Abstract Management & Clinical Course Discussion Conclusion Pyogenic granulomas are vascular hyperplasias presenting At the time of the periungal eruption on the distal fingernails, Excess granulation tissue and pyogenic granulomas have It has been reported that the resolution of excess as red papules, polyps, or nodules on the gingiva, fingers, the patient was undergoing isotretinoin therapy for severe been described in both previous acne scars and periungal granulation tissue secondary to systemic retinoid therapy lips, face and tongue of children and young adults. Most nodulocystic acne with significant scarring. He was in his locations.4 Literature review illustrates rare reports of this occurs on withdrawal of isotretinoin.7 Unfortunately for our commonly they are associated with trauma, but systemic fifth month of isotretinoin therapy with a cumulative dose of adverse event. In addition, the mechanism by which patient, discontinuation of isotretinoin and prevention of retinoids have rarely been implicated as a causative factor 140 mg/kg. He began isotretinoin therapy at a dose of 40 retinoids cause excess granulation tissue of the skin is not secondary infection in areas of excess granulation tissue in their appearance. mg daily (0.52 mg/kg/day) for the first month and his dose well known. According to the available literature, a course was insufficient in resolving these lesions. To date, there is We present a case of eruptive pyogenic granulomas of the later increased to 80 mg daily (1.04 mg/kg/day).
    [Show full text]
  • Bacterial Infections Diseases Picture Cause Basic Lesion
    page: 117 Chapter 6: alphabetical Bacterial infections diseases picture cause basic lesion search contents print last screen viewed back next Bacterial infections diseases Impetigo page: 118 6.1 Impetigo alphabetical Bullous impetigo Bullae with cloudy contents, often surrounded by an erythematous halo. These bullae rupture easily picture and are rapidly replaced by extensive crusty patches. Bullous impetigo is classically caused by Staphylococcus aureus. cause basic lesion Basic Lesions: Bullae; Crusts Causes: Infection search contents print last screen viewed back next Bacterial infections diseases Impetigo page: 119 alphabetical Non-bullous impetigo Erythematous patches covered by a yellowish crust. Lesions are most frequently around the mouth. picture Lesions around the nose are very characteristic and require prolonged treatment. ß-Haemolytic streptococcus is cause most frequently found in this type of impetigo. basic lesion Basic Lesions: Erythematous Macule; Crusts Causes: Infection search contents print last screen viewed back next Bacterial infections diseases Ecthyma page: 120 6.2 Ecthyma alphabetical Slow and gradually deepening ulceration surmounted by a thick crust. The usual site of ecthyma are the legs. After healing there is a permanent scar. The pathogen is picture often a streptococcus. Ecthyma is very common in tropical countries. cause basic lesion Basic Lesions: Crusts; Ulcers Causes: Infection search contents print last screen viewed back next Bacterial infections diseases Folliculitis page: 121 6.3 Folliculitis
    [Show full text]
  • Ingrown Nail/Paronychia Referral Guide: Podiatry Referral Page 1 of 1 Diagnosis/Definition
    Ingrown Nail/Paronychia Referral Guide: Podiatry Referral Page 1 of 1 Diagnosis/Definition: Redness, warmth, tenderness and exudate coming from the areas adjacent to the nail plate. Initial Diagnosis and Management: History and physical examination. In chronic infection appropriate radiographic (foot or toe series to rule out distal phalanx osteomyelitis) and laboratory evaluation (CBC and ESR). Ongoing Management and Objectives: Primary care should consist of Epsom salt soaks, or soapy water, and antibiotics for ten days. If Epsom salt soaks and antibiotics are ineffective, the primary care provider has the following options: Reevaluate and refer to podiatry. Perform temporary avulsion/I&D. Perform permanent avulsion followed by chemical cautery (89% Phenol or 10% NaOH application – 3 applications maintained for 30 second intervals, alcohol dilution between each application). Aftercare for all of the above is continued soaks, daily tip cleaning and bandage application. Indications for Specialty Care Referral: After the reevaluation at the end of the antibiotic period the primary care provider can refer the patient to Podiatry for avulsion/ surgical care if they do not feel comfortable performing the procedure themselves. The patient should be given a prescription for antibiotics renewal and orders to continue soaks until avulsion can be performed. Test(s) to Prepare for Consult: Test(s) Consultant May Need To Do: Criteria for Return to Primary Care: After completion of the surgical procedure, patients will be returned to the primary care provider for follow-up. Revision History: Created Revised Disclaimer: Adherence to these guidelines will not ensure successful treatment in every situation. Further, these guidelines should not be considered inclusive of all accepted methods of care or exclusive of other methods of care reasonably directed to obtaining the same results.
    [Show full text]
  • Sexually Transmitted Diseases
    Sexually Transmitted Diseases by John H. Dirckx, M.D. significant proportion of the modern practice of adult using condoms and avoiding high-risk behaviors such as anal gynecology and urology is devoted to the prevention, intercourse—and by limiting the number of sex partners. Adiagnosis, and treatment of sexually transmitted dis- The overall incidence of sexually transmitted infections eases (STDs), because of both the high prevalence of these has increased substantially during the past generation, and diseases and their almost exclusive involvement of the repro- some diseases have shown a marked increase. Several factors ductive systems in both sexes. have contributed to these changing statistics. The discovery in A sexually transmitted disease is any infectious disease the 1940s that penicillin could cure syphilis and gonorrhea and that is transmitted from one person to another through sexual the development during the 1950s of safe and effective oral contact, taking that phrase in its broadest sense. Venereal dis- contraceptives paved the way for the sexual revolution of the ease (VD), a synonymous term, has now largely fallen out of 1960s. Against a background of civil unrest, widespread drug use, as has the euphemism social disease. It is worth empha- abuse, and radical feminism, that revolution led to social sizing that the only thing all STDs have in common is their acceptance of sexual promiscuity, popularization of oral and mode of transmission. In other respects they vary widely anal sex, and definition of overt homosexuality as normal among themselves. The common tendency to lump them all behavior. together yields a biologically invalid concept that invites con- Other factors favoring sexual promiscuity have been the fusion and misunderstanding.
    [Show full text]
  • Onychomycosis/ (Suspected) Fungal Nail and Skin Protocol
    Onychomycosis/ (suspected) Fungal Nail and Skin Protocol Please check the boxes of the evaluation questions, actions and dispensing items you wish to include in your customized protocol. If additional or alternative products or services are provided, please include when making your selections. If you wish to include the condition description please also check the box. Description of Condition: Onychomycosis is a common nail condition. It is a fungal infection of the nail that differs from bacterial infections (often referred to as paronychia infections). It is very common for a patient to present with onychomycosis without a true paronychia infection. It is also very common for a patient with a paronychia infection to have secondary onychomycosis. Factors that can cause onychomycosis include: (1) environment: dark, closed, and damp like the conventional shoe, (2) trauma: blunt or repetitive, (3) heredity, (4) compromised immune system, (5) carbohydrate-rich diet, (6) vitamin deficiency or thyroid issues, (7) poor circulation or PVD, (8) poor-fitting shoe gear, (9) pedicures received in places with unsanitary conditions. Nails that are acute or in the early stages of infection may simply have some white spots or a white linear line. Chronic nail conditions may appear thickened, discolored, brittle or hardened (to the point that the patient is unable to trim the nails on their own). The nails may be painful to touch or with closed shoe gear or the nail condition may be purely cosmetic and not painful at all. *Ask patient to remove nail
    [Show full text]
  • 022291S015 Eltrombopag Clinical BPCA
    CLINICAL REVIEW Application Type sNDA Application Number(s) 022291, S-015 Priority or Standard Priority Submit Date(s) December 19, 2014 Received Date(s) December 19, 2014 PDUFA Goal Date June 19, 2015 Division / Office Division of Hematology Products/OHOP Reviewer Name(s) Lori A. Ehrlich Review Completion Date May 26, 2015 Established Name Eltrombopag Trade Name Promacta® Therapeutic Class Thrombopoietin Agonist Applicant Glaxo SmithKline Formulation(s) Tablet Dosing Regimen 50 mg once daily Indication(s) Chronic ITP Intended Population(s) Pediatric patients ≥6 years old with chronic ITP Template Version: March 6, 2009 Reference ID: 3765521 Clinical Review Lori A. Ehrlich, MD, PhD NDA 022291, S-015 Promacta® (eltrombopag) tablets Table of Contents 1 RECOMMENDATIONS/RISK BENEFIT ASSESSMENT ......................................... 8 1.1 Recommendation on Regulatory Action ............................................................. 8 1.2 Risk Benefit Assessment.................................................................................... 9 1.3 Recommendations for Postmarket Risk Evaluation and Mitigation Strategies . 11 1.4 Recommendations for Postmarket Requirements and Commitments .............. 11 2 INTRODUCTION AND REGULATORY BACKGROUND ...................................... 11 2.1 Product Information .......................................................................................... 12 2.2 Tables of Currently Available Treatments for Proposed Indications ................. 12 2.3 Availability of Proposed Active Ingredient
    [Show full text]