DOCSLIB.ORG

Identify Signs and Symptoms That May Indicate a SSTI List

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Identify Signs and Symptoms That May Indicate a SSTI List SKIN AND SOFT TISSUE INFECTIONS (SSTIs) Learning Objectives: ● Identify signs and symptoms that may indicate a SSTI ● List common causative organisms and risk factors for SSTIs ● Distinguish between antibacterial treatments for SSTIs in the organisms they cover ● Describe supportive therapies that may be indicated in treatment of SSTIs Patient Case: Chief Complaint: “I have a boil on my butt, and I cannot sit down for class.” HPI: Jimmie Chipwood is a 19-year-old college student who presents to the ED with a new-onset “boil” on his right buttock. He noticed some pain and irritation in the right buttock area over the past week, but thought it was due to having slid into second base during a baseball game. The pain gradually increased over the next few days, and he went to the student health center, where they cleaned the wound and gave him a prescription for clindamycin 300 mg QID for 7 days. They recommended he try to keep the area covered until the antibiotic began to work. Today, Jimmie returned to the student health center for further evaluation and was referred to the ED for further care for his continued SSTI. At the ED, Jimmie says the area on his buttock is worse, and he cannot sit down for class. He reports only partial adherence to the clindamycin regimen, because he often forgets to take it and says it makes him nauseous. PMH: Right gluteal skin and soft tissue infection, diagnosed approximately 1 week ago (Rx for clindamycin was given, but the patient reports nonadherence); 2010--appendectomy; 2012--repair of left ACL Meds: Prescription ● Clindamycin 300 mg PO QID × 7 days (prescribed at student health center visit 1 week ago; patient did not complete full course). Allergies ● Penicillin (hives as a child). Immunizations ● Up-to-date per student health center records SH: Denies any alcohol or illicit drug use. This patient has a SSTI. Think about what you already know about SSTIs and how these case details relate. What are your initial thoughts for treating this patient? Background ● SSTIs are infections involving any or all layers of the skin (epidermis, dermis, subcutaneous fat), fascia, and muscle, and they can remain local or spread far from the initial site of infection, leading to more severe complications ● Primary bacterial infections: usually involve areas of previously health skin and are caused by a single pathogen ● Secondary bacterial infections: occur in areas of previously damaged skin and are frequently polymicrobic ● Complicated SSTI: involve deeper skin structures (eg. fascia, muscle layers), require significant surgical intervention, or occur in patients with compromised immune function (eg. DM, HIV infection) Pathophysiology: ● Human skin is host to an abundance of diverse bacteria and fungi (main SSTI causes are staph and strep), but several factors act together to confer protection against skin infections (eg. continuous epidermal renewal, sebaceous secretions) ● Conditions that may predispose a patient to the development of SSTIs: ○ High concentrations of bacteria (more than 105 microorganisms) ○ Excessive moisture of the skin ○ Inadequate blood supply ○ Availability of bacterial nutrients ○ Damage to the corneal layer allowing for bacterial penetrations (the best defense against SSTIs is intact skin!) ○ Uncontrolled diabetes (diabetic ulcers) Types of SSTI ● Folliculitis, furuncles, and carbuncles: foliculitis is inflammation of the hair follicle and is caused by physical injury, chemical irritation, or infection; furuncles and carbuncles occur when a follicular infection extends to involve deeper areas of the skin (furuncle is a walled-off mass aka boil; carbuncle is a coalescence of furuncles, forming a single inflamed area) ● Erysipelas: distinct form of cellulitis involving the more superficial layers of the skin and cutaneous lymphatics ● Impetigo: superficial skin infection that is seen most commonly in children; categorized as bullous or nonbullous ● Lymphangitis: inflammation involving the subcutaneous lymphatic channels; characterized by red, linear streaks extending from the initial infection site toward the regional lymph nodes ● Cellulitis: acute infectious process that initially affects the epidermis and dermis and may spread subsequently within the superficial fascia ● Necrotizing soft-tissue infections: consist of a group of extremely severe infections, associated with high morbidity and mortality, requiring early and aggressive surgical debridement and appropriate antibiotics and intensive supportive care ● Diabetic foot infections: abscesses, cellulitis, or ulcers on the feet arising secondary to diabetes ● Pressure sores: ulcers caused by prolonged pressure against an area of skin; decubitus ulcer and bed sore are two types of pressure sores ● Animal and human bite wounds: associated with significant risk of infection without prompt attention to appropriate management Signs and Symptoms: ● Vary widely depending on the category of SSTI ● Think pain, redness, warmth of an area of skin (lesions), which may or may not feature purulent or non-purulent abscesses ● Systemic signs of infection may or may not be present (eg fever, chills, malaise) Gen: WDWN Caucasian male in no acute distress, but with noticeable pain when he walks and tries to sit VS: BP 129/74, P 96, RR 16, T 37.5°C; Wt 77.5 kg, Ht 6′0″ Skin: Right gluteal area: red, erythematous, warm, and tender to touch; localized fluid collection that appears fluctuant, consistent with a carbuncle and surrounding erythema HEENT: PERRLA; EOMI, oropharynx clear Neck/Lymph Nodes: Supple, no lymphadenopathy Lungs/Thorax: CTA, no rales or wheezing CV: RRR, no MRG Abd: Soft, NT/ND; (+) BS Genit/Rect: Large 2 cm × 4 cm red swollen area over the right buttock, with a localized fluid collection and surrounding erythema Extremities: Upper extremities: WNL; Lower extremities: could not be adequately assessed due to patient’s inability to sit; 2+ pulses bilaterally Neuro: A & O × 3 What signs and symptoms of the patient reinforce the diagnosis? What other information would you like to have to help you formulate a treatment plan? Diagnosis and determination of organisms: ● Diagnosis often made on the basis of characteristic lesion(s) ● For certain types of SSTI, cultures should be collected if possible (eg. impetigo; cellulitis; DBI; pressure sores (from biopsy or fluid obtained by needle aspiration); animal bites showing signs of infection; otherwise complicated SSTIs), but diagnosis is still frequently made on clinical grounds rather than by culture ● Blood cultures may be useful (eg cellulitis, where bacteremia may be present in up to 30% of cases) ● When there is a high risk of polymicrobic infection (eg. cellulitis, DBI, animal bites), wounds should be cultured for aerobic and anaerobic organisms Labs NA 138 mEq/L Hgb 15.5 g/dL WBC 11.3 x 103/mm3 K 3.2 mEq/L Hct 44% Neutros 89% Cl 98 mEq/L Plt 279 x 103/mm3 Lymphs 10% CO2 23 mEq/L Monos 1% BUN 33 mg/dL SCr 0.9 mg/dL Glu 95 mg/dL Ca 9.4 mg/dL Urine Drug Screen (-) Alcohol, (-) marijuana, (-) cocaine and other substances How might labs influence your treatment plan? Is there concern that this patient may have a systemic infection? How can you tell? Treatment ● Considerations ○ Determine presence of signs of systemic illness ○ Supportive care ■ For mild infections, minimal; may include painkillers for pain and/or antipyretics for mild fever ■ For more serious infections involving extensive surgical debridement, more intensive care may be warranted; may include IV fluids ● Antimicrobial agents ○ Empiric antibiotic use for mild, uncomplicated SSTIs is appropriate (many SSTI diagnoses and treatments take place in the outpatient setting) ○ In an inpatient setting, empiric antibiotic use once cultures have been sent (if cultures are appropriate) ○ Narrow (or potentially broaden) therapy once results of cultures are known ○ Typical duration of therapy is 5 to 10 days, but is individualized per patient ● Incision and drainage (I&D) ○ Often employed for mild purulent infections, sometimes even without systemic antibiotic therapy when no signs of a systemic infection ○ Plays a role in more complicated or sever SSTIs as well, accompanied by antibiotic therapy ● Monitoring ○ WBC - for resolution of infection if initially elevated ○ Clinical stability ○ Fever and other signs of systemic infection ○ Resolution of symptoms (eg. pain, redness, swelling) of the site of infection Likely Organisms General treatment recommendations and dosing ● See DiPiro Chapter 110 Recommended Oral Drugs for Outpatient Treatment of Mild-Moderate SSTIs aMay be used in patients with penicillin allergy. bRecommended if CA-MRSA is suspected. cFluoroquinolone alone may be suitable for mild infections, while addition of drugs with antianaerobic activity may be recommended for more severe infections. Treatment algorithm from the IDSA Guidelines Figure 1. Purulent skin and soft tissue infections (SSTIs). Mild infection: for purulent SSTI, incision and drainage is indicated. Moderate infection: patients with purulent infection with systemic signs of infection. Severe infection: patients who have failed incision and drainage plus oral antibiotics or those with systemic signs of infection such as temperature >38°C, tachycardia (heart rate >90 beats per minute), tachypnea (respiratory rate >24 breaths per minute) or abnormal white blood cell count (<12 000 or <400 cells/μL), or immunocompromised patients. Nonpurulent SSTIs. Mild infection: typical cellulitis/erysipelas with no focus of purulence. Moderate infection: typical
Load more

Recommended publications
  • 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]
  • 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]
  • 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.
    [Show full text]
  • Cellulitis (You Say, Sell-You-Ly-Tis)
    Cellulitis (you say, sell-you-ly-tis) Any area of skin can become infected with cellulitis if the skin is broken, for example from a sore, insect bite, boil, rash, cut, burn or graze. Cellulitis can also infect the flesh under the skin if it is damaged or bruised or if there is poor circulation. Signs your child has cellulitis: The skin will look red, and feel warm and painful to touch. There may be pus or fluid leaking from the skin. The skin may start swelling. The red area keeps growing. Gently mark the edge of the infected red area How is with a pen to see if the red area grows bigger. cellulitis spread? Red lines may appear in the skin spreading out from the centre of the infection. Bad bacteria (germs) gets into broken skin such as a cut or insect bite. What to do Wash your hands before and Cellulitis is a serious infection that needs to after touching the infected area. be treated with antibiotics. Keep your child’s nails short and Go to the doctor if the infected area is clean. painful or bigger than a 10 cent piece. Don’t let your child share Go to the doctor immediately if cellulitis is bath water, towels, sheets and near an eye as this can be very serious. clothes. Make sure your child takes the antibiotics Make sure your child rests every day until they are finished, even if and eats plenty of fruit and the infection seems to have cleared up. The vegetables and drinks plenty of antibiotics need to keep killing the infection water.
    [Show full text]
  • 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.
    [Show full text]
  • Factsheet Boils and Impetigo
    FACTSHEET BOILS AND IMPETIGO WHAT IS A BOIL? HOW CAN YOU STOP THE SPREAD OF BOILS A boil is an infection of the skin, usually caused by AND IMPETIGO? Staphylococcus bacteria. Boils are tender, swollen sores, Wash your hands which are full of pus. The tenderness usually goes away, Hand washing is the most important way to prevent the once the boil bursts and the pus and fluid drain. spread of boils and impetigo. Wash all parts of your hands (including between the fingers and under fingernails) WHAT IS IMPETIGO? vigorously with soap and running water for 10-15 seconds. Impetigo is an infection of the skin caused by either Rinse well and dry your hands (with a paper towel if you Staphylococcus or Streptococcus bacteria. The symptoms can). Wash your hands: of impetigo are either small blisters or flat, honey-coloured crusty sores, on the skin. Impetigo is sometimes called • before and after touching or dressing an infected area ‘school sores’. or wound; • after going to the toilet; HOW ARE BOILS AND IMPETIGO TREATED? • after blowing your nose; If you have the symptoms of boils or impetigo: • before handling or eating food; • see your doctor for advice on the treatment of both; • before handling newborn babies; • if sores are small or few, local antiseptic cream and hot • after touching or handling unwashed clothing or linen; compresses may help; • after handling animals or animal waste. • your doctor may prescribe you antibiotic tablets or Cover boils and impetigo ointment. It is important to take the full course of antibiotics. If you don’t, the sores may come back.
    [Show full text]
  • Final Report of the Lyme Disease Review Panel of the Infectious Diseases Society of America (IDSA)
    Final Report of the Lyme Disease Review Panel of the Infectious Diseases Society of America (IDSA) INTRODUCTION AND PURPOSE In November 2006, the Connecticut Attorney General (CAG), Richard Blumenthal, initiated an antitrust investigation to determine whether the Infectious Diseases Society of America (IDSA) violated antitrust laws in the promulgation of the IDSA’s 2006 Lyme disease guidelines, entitled “The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Clinical Practice Guidelines by the Infectious Diseases Society of America” (the 2006 Lyme Guidelines). IDSA maintained that it had developed the 2006 Lyme disease guidelines based on a proper review of the medical/scientifi c studies and evidence by a panel of experts in the prevention, diagnosis, and treatment of Lyme disease. In April 2008, the CAG and the IDSA reached an agreement to end the investigation. Under the Agreement and its attached Action Plan, the 2006 Lyme Guidelines remain in effect, and the Society agreed to convene a Review Panel whose task would be to determine whether or not the 2006 Lyme Guidelines were based on sound medical/scientifi c evidence and whether or not these guidelines required change or revision. The Review Panel was not charged with updating or rewriting the 2006 Lyme Guidelines. Any recommendation for update or revision to the 2006 Lyme Guidelines would be conducted by a separate IDSA group. This document is the Final Report of the Review Panel. REVIEW PANEL MEMBERS Carol J. Baker, MD, Review Panel Chair Baylor College of Medicine Houston, TX William A. Charini, MD Lawrence General Hospital, Lawrence, MA Paul H.
    [Show full text]
  • 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
    [Show full text]
  • Laboratory Diagnosis of Gonococcal Infections * ALICE REYN, M.D.'
    Bull. Org. mond. Sante 1 1965, 32, 449-469 Bull. Wld Hlth Org. Laboratory Diagnosis of Gonococcal Infections * ALICE REYN, M.D.' CONTENTS Page Pagp INTRODUCTION . ............... 449 DRUG SENsiTIVITY DETERMINAnON .... 462 COLLECTION AND HANDLING OF SPECIMENS MEDIA AND REAGENTS General remarks .... ........... 450 Preparation of broth . 462 Method of transportation . ........ 451 Chocolate ascitic-fluid-agar . ....... 463 HYL medium ..... ......... 464 BACTERIOLOGICAL EXAMINATION Fermentation media .... ...... 464 . Microscopy and Gram-staining technique . 452 1. Danish fermentation medium .... 464 2. HAP medium ...... 465 Culture and isolation . ....... 453 Stuart's medium with solid agar ..... 465 Control strains . ......... 456 .... .. 466 Fermentation tests .... ......... 457 Oxidase reagent ........ .... Diagnostic criteria .... ......... 458 Polymyxin B .......... 466 . Reporting of results ... ......... 458 Nystatin ..... ............ 466 Reagents to be used in the Gram-staining technique 466 SEROLOGICAL EXAMINATION ANNEX. Reviewers ...... 467 General remarks .... ........... 459 Gonococcus complement-fixation reaction . 460 REFERENCES .................. 467 INTRODUCTION The genus Neisseria comprises Gram-negative, organisms have been described more thoroughly than aerobic or facultatively anaerobic cocci, usually but the other members of the group, such as N. catar- not invariably arranged in pairs. The size is about rhalis, N. flavescens, N. sicca and N. flava (sub- 0.8,u by 0.6,u. They often grow poorly on ordinary species I-III). The classification of the Neisseria is media and they are frequently pathogenic. Few far from being complete and a taxonomic study of carbohydrates are fermented, indole is not produced this group is needed. and nitrates are not reduced. With a few exceptions, are N. gonorrhoeae (gonococcus) is the etiological catalase and oxidase abundantly produced; some agent of " gonorrhoea ", whereas N.
    [Show 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
    [Show full text]
  • Building Blocks of Clinical Practice Helping Athletic Trainers Build a Strong Foundation
    Building Blocks of Clinical Practice Helping Athletic Trainers Build a Strong Foundation Issue #2: Bacterial Infections of the Skin Folliculitis Carbuncles Definition: Definition: • Inflammation of a hair follicle • A complication of folliculitis, a carbuncle is several • Can progress down hair follicle or into multiple furuncles that have merged.merged follicles and result in a furuncle or carbuncle • Carbuncles are readily transmitted by skin-to-skin contact. Often, the direct cause of a carbuncle cannot Causes: be determined.determined • Bacterial or viral infection, chemical irritation • Secondary to skin injury, which introduces bacteria to Causes: the area • Most carbuncles are caused by the bacteria • Shaving hairy areas may facilitate infection staphylococcus aureus. The infection is contagious and • Occlusion of hair-bearing areas may facilitate growth may spread to other areas of the body or other people.people of microbes • Friction Symptoms: • Hyperhidrosis • A carbuncle is a swollen lump or mass under the skin which may be the size of a pea or as larlargege as a golf ball.ball Symptoms: • The carbuncle may be red and irritated and might hurt • Areas are usually non-tender or slightly tender when you touch it.it • Area may itch • Pain gets worse as it fills with pus and dead tissue.tissue • Erythematous perifollicular papules or pustules may • Other signs and symptoms include itching at the site of develop infection, skin inflammation around the wound, general • Grouped lesions ill feeling, fever, or fatigue. Pain improves
    [Show full text]
  • Perianal Streptococcal Infection Kumara V
    CASE REPORT Perianal Streptococcal Infection Kumara V. Nibhanipudi, MD A 3-year-old boy is brought to the ED for evaluation of perianal desquamation. Case The mother of a 3-year-old boy presented her son to the ED for evaluation after she noticed peeling of the skin in his perianal region. She stated that the peeling had started 1 day prior to presentation. Two days earlier, the mother had brought the same patient to the ED for evaluation of a fever, sore throat, and a slight rash over his face. The boy’s vital signs at the initial presentation were: temperature, 101.8°F; heart rate, 102 beats/minute; and respira- tory rate, 28 breaths/minute. Oxygen satu- ration was 98% on room air. During this first visit, the mother denied the child having had any fever, chills, headache, sore throat, facial rash, joint pain, or pain on defecation. He had no significant medical history and no known drug allergies. After examination, a throat culture was taken, and the patient was giv- en acetaminophen and discharged home with a diagnosis of viral syndrome. At the second presentation, physical examination revealed a well-developed child in no distress. The examination was negative except for a 4 x 2 cm area of des- quamation present over the perianal region (Figure). The area of desquamation was dry, mild- Figure. Photograph of the patient’s perianal region showing the area of desquamation. ly erythematous without discharge, and Dr Nibhanipudi is a professor of clinical emergency medicine at New York Medical College - Metropolitan Hospital Center, New York.
    [Show full text]