Abscess Prevention

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ABSCESS PREVENTION

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Chest pains may occur if infection goes to heart or lungs

How do you soak/use compresses?
Avoiding abscesses

• Wash your hands and the injection site.

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Use warm/hot water (that doesn’t burn your skin) Soak in tub of plain hot water or hot water with Epsom salts Use hot, wet, clean washcloth and hold on abscess, if abscess cannot be soaked in tub

What should I do if I get an abscess?

• Use alcohol pads and wipe back & forth (rub hard) over injection site to remove dirt.

▪ Treat at home with warm soaks only if:

Nored streaks

• Then use another new alcohol

Skin not hotandpuffy

pad for the final cleaning.

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Soak abscess 3 to 4 times a day for 10-15 minutes each time, if possible Cover with a clean dry bandage after soaking STOP soaking/using compresses when abscess starts draining

▪ Go to a clinic if abscess:

What is a skin abscess?

▪ Pocket of pus ▪ Often found at injection sites, but can be found elsewhere
▪ More likely with

skin-popping muscling

missingavein

▪ May occur even after you stop injecting

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Notimproving,especially

after5-7days

Getsbiggerand/orvery painful Is hot and puffy
Redstreaksstartspreading

fromtheabscess-goASAP!

What about antibiotics?

▪ Go to emergency room if:

Chest pain Highfever, chills Infectionlookslikeitis

spreading fast

▪

Take all antibiotics, if prescribed, even if you feel better
Take antibiotics after you fix (if using heroin)
Do not take antibiotics with alcohol, juice, or soda because they may upset your stomach
Do not share antibiotics because someone else’s pills may not cure your infection

How do you know it’s an

▪▪▪

abscess?

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Pink or reddish lump on skin Tender or painful Warm or hot to touch Red streaks and/or rapid swelling indicates infection is spreading

Warning

Do not shoot into or near an

▪▪
▪▪

abscess

Do not squeeze or cut into an

abscess yourself - infection could move into blood, then heart/lungs
Do not leave draining abscesses uncovered - the drainage is contagious

Return to the doctor if your infection is not better after taking antibiotics

How can an abscess make you feel?

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▪

▪

Tired or sick Feverish, may have chills

(continued above)

Recommended publications

Abscesses Are a Serious Problem for People Who Shoot Drugs

Where to Get Your Abscess Seen Abscesses are a serious problem for people who shoot drugs. But what the hell are they and where can you go for care? What are abscesses? Abscesses are pockets of bacteria and pus underneath you skin and occasionally in your muscle. Your body creates a wall around the bacteria in order to keep the bacteria from infecting your whole body. Another name for an abscess is a “soft tissues infection”. What are bacteria? Bacteria are microscopic organisms. Bacteria are everywhere in our environment and a few kinds cause infections and disease. The main bacteria that cause abscesses are: staphylococcus (staff-lo-coc-us) aureus (or-e-us). How can you tell when you have an abscess? Because they are pockets of infection abscesses cause swollen lumps under the skin which are often red (or in darker skinned people darker than the surrounding skin) warm to the touch and painful (often VERY painful). What is the worst thing that can happen? The worst thing that can happen with abscesses is that they can burst under your skin and cause a general infection of your whole body or blood. An all over bacterial infection can kill you. Another super bad thing that can happen is a endocarditis, which is an infection of the lining of your heart, and “septic embolism”, which means that a lump of the contaminates in your abscess get loose in your body and lodge in your lungs or brain. Why do abscesses happen? Abscesses are caused when bad bacteria come in to contact with healthy flesh.
Intra-Abdominal Ventriculoperitoneal Shunt Abscess from Streptococcus Pyogenes After Pharyngitis with Scarlet Fever

NEURO ISSN 2377-1607 http://dx.doi.org/10.17140/NOJ-1-107 Open Journal Case Report Intra-Abdominal Ventriculoperitoneal Shunt *Corresponding author Abscess from Streptococcus Pyogenes Edward A. Monaco 3rd, MD, PhD Assistant Professor after Pharyngitis with Scarlet Fever: Case Department of Neurological Surgery University of Pittsburgh Medical Center, Suite F158, 200 Lothrop Report and Review of the Literature Street, Pittsburgh, PA 15213, USA Tel. 412-647-6777 Stephanie H. Chen and Edward A. Monaco 3rd* Fax: 412-647-6483 E-mail: [email protected] Department of Neurological Surgery, University of Pittsburgh Medical Center, Suite F158, 200 Lothrop Street, Pittsburgh, PA 15213, USA Volume 1 : Issue 1 Article Ref. #: 1000NOJ1107 ABSTRACT Article History Received: November 13th, 2014 Objective: Infection is one of the most frequent complications of ventriculoperitoneal shunts. th Accepted: December 15 , 2014 However, Streptococcus pyogenes (Group A Streptococcus, GAS) as a causative agent appears th Published: December 16 , 2014 to be extremely rare. We present an unusual case of a peritoneal shunt infection due to GAS that occurred after pharyngitis with scarlet fever. Case Description: A 31 year-old woman with congenital shunt-dependent hydrocephalus pre- Citation sented with fever, vomiting, and acute abdominal symptoms several weeks after being treated Chen SH, Monaco EA 3rd. Intra-ab- dominal ventriculoperitoneal shunt for pharyngitis and scarlet fever. She was found to have a large intra-abdominal peritoneal abscess from Streptococcus pyo- catheter-associated abscess that grew out GAS. genes after pharyngitis with scarlet Results: The patient’s shunt was externalized at the clavicle and the cerebrospinal fluid (CSF) fever: Case report and review of the was sterile.
Strep Throat and Scarlet Fever N

n Strep Throat and Scarlet Fever n After a few days, the rash begins to fade. The skin usually Strep throat is caused by infection with the bac- begins to peel, as it often does after a sunburn. teria Streptococcus. In addition to sore throat, swollen glands, and other symptoms, some chil- What are some possible dren develop a rash. When this rash is present, the infection is called scarlet fever. If your child complications of scarlet fever? has a strep infection, he or she will need antibio- Strep infection has some potentially serious complica- tics to treat it and to prevent rheumatic fever, tions. With proper treatment, most of these can be pre- which can be serious. vented. Complications include: Strep infection may cause an abscess (localized area of pus) in the throat. What are strep throat and scarlet Rheumatic fever. This disease develops a few weeks after fever? the original strep infection. It is felt to be caused by our immune system. It can be serious and can cause fever, heart Most sore throats are caused by virus, but strep throat is inflammation, arthritis, and other symptoms. Your child caused by the bacteria Group A Strepococcus. Treatment can be left with heart problems called rheumatic disease. of this infection with antibiotics may help your child feel Rheumatic fever is uncommon now and can be prevented better and prevent rheumatic fever. by treating the strep infection properly with antibiotics. Some children with strep throat or strep infections else- where may develop a rash. When that occurs, the infection Acute glomerulonephritis.
A Case of Severe Human Granulocytic Anaplasmosis in an Immunocompromised Pregnant Patient

Elmer ress Case Report J Med Cases. 2015;6(6):282-284 A Case of Severe Human Granulocytic Anaplasmosis in an Immunocompromised Pregnant Patient Marijo Aguileraa, c, Anne Marie Furusethb, Lauren Giacobbea, Katherine Jacobsa, Kirk Ramina Abstract festations include respiratory or neurologic involvement, acute renal failure, invasive opportunistic infections and a shock- Human granulocytic anaplasmosis (HGA) is a tick-borne disease that like illness [2-4]. Recent delineation of the various species can often result in persistent fevers and other non-specific symptoms associated with ehrlichia infections and an increased under- including myalgias, headache, and malaise. The incidence among en- standing of the epidemiology has augmented our knowledge of demic areas has been increasing, and clinician recognition of disease these tick-borne diseases. However, a detailed understanding symptoms has aided in the correct diagnosis and treatment of patients of HGA infections in both immunocompromised and pregnant who have been exposed. While there have been few cases reported of patients is limited. We report a case of a severe HGA infection HGA disease during pregnancy, all patients have undergone a rela- presenting as an acute exacerbation of Crohn’s disease in a tively mild disease course without complications. HGA may cause pregnant immunocompromised patient. more severe disease in the elderly and immunocompromised. Herein, we report an unusual presentation and severe disease complications of HGA in a pregnant female who was concomitantly immunocompro- Case Report mised due to azathioprine treatment of her Crohn’s disease. Follow- ing successful treatment with rifampin, she subsequently delivered a A 34-year-old primigravida at 17+2 weeks’ gestation presented healthy female infant without any disease sequelae.
Skin Disease and Disorders

Sports Dermatology Robert Kiningham, MD, FACSM Department of Family Medicine University of Michigan Health System Disclosures/Conflicts of Interest ◼ None Goals and Objectives ◼ Review skin infections common in athletes ◼ Establish a logical treatment approach to skin infections ◼ Discuss ways to decrease the risk of athlete’s acquiring and spreading skin infections ◼ Discuss disqualification and return-to-play criteria for athletes with skin infections ◼ Recognize and treat non-infectious skin conditions in athletes Skin Infections in Athletes ◼ Bacterial ◼ Herpetic ◼ Fungal Skin Infections in Athletes ◼ Very common – most common cause of practice-loss time in wrestlers ◼ Athletes are susceptible because: – Prone to skin breakdown (abrasions, cuts) – Warm, moist environment – Close contacts Cases 1 -3 ◼ 21 year old male football player with 4 day h/o left axillary pain and tenderness. Two days ago he noticed a tender “bump” that is getting bigger and more tender. ◼ 16 year old football player with 3 day h/o mildly tender lesions on chin. Started as a single lesion, but now has “spread”. Over the past day the lesions have developed a dark yellowish crust. ◼ 19 year old wrestler with a 3 day h/o lesions on right side of face. Noticed “tingling” 4 days ago, small fluid filled lesions then appeared that have now started to crust over. Skin Infections Bacterial Skin Infections ◼ Cellulitis ◼ Erysipelas ◼ Impetigo ◼ Furunculosis ◼ Folliculitis ◼ Paronychea Cellulitis Cellulitis ◼ Diffuse infection of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin – Triad of erythema, edema, and warmth in the absence of underlying foci ◼ S. aureus or S. pyogenes Erysipelas Erysipelas ◼ Superficial infection of the dermis ◼ Distinguished from cellulitis by the intracutaneous edema that produces palpable margins of the skin.
Re: Increase in Scarlet Fever Notifications We Are Writing to Inform You of a National Increase in Notifications of Scarlet Feve

Public Health England South West Re: Increase in scarlet fever notifications We are writing to inform you of a national increase in notifications of scarlet fever to Public Health England, above seasonally expected levels. Scarlet fever is a notifiable disease, and we would like to take this opportunity to remind practitioners of the signs and symptoms and the actions to be taken if you see a case. Signs and symptoms of scarlet fever Scarlet fever is a common childhood infection caused by Streptococcus pyogenes, or group A streptococcus (GAS). The symptoms are non-specific in early illness and may include sore throat, headache, fever, nausea and vomiting. After 12 to 48 hours the characteristic red, generalised pinhead rash develops, typically first appearing on the chest and stomach, rapidly spreading to other parts of the body, giving the skin a sandpaper-like texture. On more darkly-pigmented skin, the scarlet rash may be harder to spot, although the 'sandpaper' feel should be present. Patients typically have flushed cheeks and pallor around the mouth. This may be accompanied by a ‘strawberry tongue’. During convalescence desquamation of the skin occurs at the tips of fingers and toes, less often over wide areas of the trunk and limbs. The differential diagnosis will include measles, glandular fever and slapped cheek infections. Complications of scarlet fever Although scarlet fever is usually a mild illness, patients can develop complications such as an ear infection, throat abscess, pneumonia, sinusitis or meningitis in the early stages and acute glomerulonephritis and acute rheumatic fever at a later stage. Patients, or their parents, should keep an eye out for any symptoms which might suggest these complications and if concerned advised to seek medical help immediately.
Sepsis and Septic Shock: Endothelial Molecular Pathogenesis Associated with Vascular Microthrombotic Disease Jae C

Chang Thrombosis Journal (2019) 17:10 https://doi.org/10.1186/s12959-019-0198-4 REVIEW Open Access Sepsis and septic shock: endothelial molecular pathogenesis associated with vascular microthrombotic disease Jae C. Chang Abstract In addition to protective “immune response”, sepsis is characterized by destructive “endothelial response” of the host, leading to endotheliopathy and its molecular dysfunction. Complement activation generates membrane attack complex (MAC). MAC causes channel formation to the cell membrane of pathogen, leading to death of microorganisms. In the host, MAC also may induce channel formation to innocent bystander endothelial cells (ECs) and ECs cannot be protected. This provokes endotheliopathy, which activates two independent molecular pathways: inflammatory and microthrombotic. Activated inflammatory pathway promotes the release of inflammatory cytokines and triggers inflammation. Activated microthrombotic pathway mediates platelet activation and exocytosis of unusually large von Willebrand factor multimers (ULVWF) from ECs and initiates microthrombogenesis. Excessively released ULVWF become anchored to ECs as long elongated strings and recruit activated platelets to assemble platelet-ULVWF complexes and form “microthrombi”. These microthrombi strings trigger disseminated intravascular microthrombosis (DIT), which is the underlying pathology of endotheliopathy- associated vascular microthrombotic disease (EA-VMTD). Sepsis-induced endotheliopathy promotes inflammation and DIT. Inflammation produces inflammatory response
Life-Threatening Thrombotic Thrombocytopenic Purpura Associated with Dental Foci

J Clin Periodontol 2004; 31: 1019–1023 doi: 10.1111/j.1600-051X.2004.00617.x Copyright r Blackwell Munksgaard 2004 Printed in Denmark. All rights reserved Matthias Fenner1, Roland Frankenberger2, Katharina Life-threatening thrombotic 3 3 Pressmar , Stefan John , Friedrich Wilhelm Neukam1 and thrombocytopenic purpura Emeka Nkenke1 Departments of 1Oral & Maxillofacial Surgery, 2Operative Dentistry and associated with dental foci Periodontology and 3Medicine IV, University of Erlangen-Nuremberg, Germany Report of two cases Fenner M, Frankenberger R, Pressmar K, John S, Neukam FW, Nkenke E: Life- threatening thrombotic thrombocytopenic purpura associated with dental foci. Report of two cases. J Clin Periodontol 2004; 31: 1019–1023. doi: 10.1111/j.1600-051X. 2004.00617.x. r Blackwell Munksgaard, 2004. Abstract Background: Thrombotic thrombocytopenic purpura (TTP) is a rare haematological disease of unknown aetiology. This thrombotic microangiopathy is characterized by microvascular lesions with platelet aggregation. It is found in adults and can be associated with pregnancy, cancer, autoimmune diseases, bone marrow transplantation, drugs and bacterial as well as viral infections. The therapy requires a multi-disciplinary team approach involving dentistry. Even if TTP is immediately treated in an adequate manner, it still shows a mortality of up to 20%. Aim: To deﬁne a speciﬁc treatment concept for periodontal disease and decayed teeth in patients suffering from TTP based on the experiences gained from two cases. Conclusion: The two patient cases revealed a possible association of TTP with dental foci. Because of the severity and mortality of this disease, both prognosis evaluation Key words: dental foci; periodontal disease; and treatment standards of periodontologically compromised or decayed teeth have to systemic disease; thrombotic thrombocytopenic purpura be strictly followed in patients suffering from TTP.
Folliculitis

Folliculitis Common Cutaneous • Inflammation of hair follicle(s) Bacterial Infections • Symptoms: Often pruritic (itchy) Pseudomonas folliculitis Eosinophilic Folliculitis (HIV) Folliculitis: Causes • Bacteria: – Gram positives (Staph): most common – Gram negatives: Pseudomonas – “hot tub” folliculitis • Fungal: Pityrosporum aka Malassezia • HIV: eosinophilic folliculitis (not bacterial) • Renal Failure: perforating folliculitis (not bacterial) Treatment of Folliculitis 21 year old female with controlled Crohn’s disease and history of • Bacterial hidradenitis suppuritiva presents stating – culture pustule she has recurrent flares of her HS – topical clindamycin or oral cephalexin / doxycycline – shower and change shirt after exercise – keep skin dry; loose clothing • Fungal: topical antifungals (e.g., ketoconazole) • Eosinophilic folliculitis – Phototherapy – Treat the HIV MRSA MRSA Eradication • Swab nares mupirocin ointment bid x 5 days • GI noted Crohn’s was controlled but increased – Swab axillae, perineum, pharynx infliximab intensity, but that was not controlling • Chlorhexidine 4% bodywash qd x 1 week recurrent “flares” • Chlorhexidine mouthwash qd x 1 week; soak toothbrush (or disposable) •I & D MRSA on three occasions • Bleach bath: 1/3 cup to tub, soak x 10 min tiw x 1 week, then prn (perhaps weekly) • THIS WAS INFLIXIMAB-RELATED • Oral antibiotics x 14 days: Bactrim, Doxycycline, depends FURUNCULOSIS FROM MRSA COLONIZATION on sensitivities – D/C infliximab • Swab partners – Anti-MRSA regimen • Hand sanitizer frequently – Patient is better • Bleach wipes to surfaces (doorknobs, faucet handles) • Towels use once then wash; paper towels when possible Pointing abscess (furuncle) --pointing requires I & D-- Acute Paronychia Furuncle Treatment Impetigo • Incise & Drain (I & D) Culture pus • Warm soaks • Antibiotics – e.g., cephalexin orally AND mupirocin topically • If recurrent, suspect nasal carriage of Staph aureus swab culture and mupirocin to nares b.i.d.
ABX-2 Newslet: Cystitis & Skin

Antibiotics & Common Infections ABX-2: Uncomplicated Cystitis & Skin Stewardship, Effectiveness, Safety & Clinical Pearls- April 2017 ABX-2 RELATED LINKS RxFILES ACADEMIC DETAILING ON ABX CANADIAN GUIDELINES/REFERENCES We are excited to bring out the ABX-2 topic on the treatment of uncomplicated cystitis Bugs & Drugs: and skin & soft tissue (SSTI) infections. The new charts in this newsletter will support http://www.bugsanddrugs.ca/ our spring academic detailing discussions with providers in Saskatchewan. Our MUMS Guidelines: discussions on ABX-1 were very well received and we know many of you made use of the http://www.mumshealth.com extra support tools such as the “Gone Viral?” office/clinic posters and the patient friendly “Viral Prescription Pad”. These are all available at www.RxFiles.ca/abx. CYSTITIS / UTI U.S. IDSA 2010: ABX-2: A FEW PEARLS FROM INSIDE THAT CAUGHT OUR EYE... Acute Uncomplicated Cystitis and Pylonephritis (UTI) UNCOMPLICATED CYSTISIS - Page 2 - 3 > 60 YEARS https://academic.oup.com/cid/article- lookup/52/5/e103 1) Staying Power: > 60 years & still 96% or better! Susceptibility of E. coli, the most common urinary pathogen, to nitrofurantoin SK MOH 2013: (MACROBID) remains at 96% or better in Saskatchewan (per recent antibiograms). UTI in Continuing Care Settings “I used to be https://saskpic.ipac-canada.org/ so strong...” STAYING POWER photos/custom/UTI%20Guidelines%20 2) 60% - Are you kidding?! 19April2013.pdf In some institutional settings, like long-term care, E. coli resistance to ciprofloxacin can be as high as ~60%. No wonder antimicrobial SOGC 2010: stewardship messaging suggests “Reserve to Preserve” for when we really Recurrent UTI C IPROFLOXAC I N need it! http://www.jogc.com/article/S1701- 2163(16)34717-X/pdf 3) Urine cultures are not required - for most Skip the Urine Req.
Differential Diagnosis of the Scalp Hair Folliculitis

Acta Clin Croat 2011; 50:395-402 Review DIFFERENTIAL DIAGNOSIS OF THE SCALP HAIR FOLLICULITIS Liborija Lugović-Mihić1, Freja Barišić2, Vedrana Bulat1, Marija Buljan1, Mirna Šitum1, Lada Bradić1 and Josip Mihić3 1University Department of Dermatovenereology, 2University Department of Ophthalmology, Sestre milosrdnice University Hospital Center, Zagreb; 3Department of Neurosurgery, Dr Josip Benčević General Hospital, Slavonski Brod, Croatia SUMMARY – Scalp hair folliculitis is a relatively common condition in dermatological practice and a major diagnostic and therapeutic challenge due to the lack of exact guidelines. Generally, inflammatory diseases of the pilosebaceous follicle of the scalp most often manifest as folliculitis. There are numerous infective agents that may cause folliculitis, including bacteria, viruses and fungi, as well as many noninfective causes. Several noninfectious diseases may present as scalp hair folli- culitis, such as folliculitis decalvans capillitii, perifolliculitis capitis abscendens et suffodiens, erosive pustular dermatitis, lichen planopilaris, eosinophilic pustular folliculitis, etc. The classification of folliculitis is both confusing and controversial. There are many different forms of folliculitis and se- veral classifications. According to the considerable variability of histologic findings, there are three groups of folliculitis: infectious folliculitis, noninfectious folliculitis and perifolliculitis. The diagno- sis of folliculitis occasionally requires histologic confirmation and cannot be based
Bacterial Skin Infections

What is Impetigo? • When treated appropriately, impetigo heals over a • Avoid touching the infected areas and prevent others • Impetigo is a superficial bacterial infection of the few days without leaving scars, although there may from touching them too. skin. be temporary redness and darker pigmentation that • Wash hands after touching affected area. • The most common bacteria causing impetigo is may take weeks or months to resolve. • Wash hands before and after applying creams or Staphylococcus aureus, or “Staph aureus”. Less ointments to the affected area. commonly, it can be caused by another bacteria, How is impetigo diagnosed? • Do not share towels or personal items until the Streptococcus. • Impetigo is diagnosed by the typical appearance and infected area is completely healed. Bacterial Skin • Impetigo is common in young children but can symptoms. • Do not let your child return to school or childcare also affect people of other ages, especially those • A skin swab from the affected area may be taken to facilities until the lesions are dried and healed. Infections with skin that is damaged by cuts, insect bites, or identify the bacteria. eczema. • If the infection recurs, a swab from your child’s nose What is erysipelas/cellulitis? • The bacteria can spread by skin-to-skin contact or by to test for the presence of “Staph aureus” may be • Erysipelas and cellulitis are bacterial infections touching contaminated surfaces such as towels and indicated. affecting deeper layers of skin. clothes. • The most common bacteria causing erysipelas or How is impetigo treated? cellulitis is Streptococcus, but other bacteria may be Treatment depends on the severity and extent of the involved, including Staphylococcus aureus.