DOCSLIB.ORG

Twenty Skin Infections That an I T I T Sh Ld K Internist Should Know

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Twenty Skin Infections That an I T I T Sh Ld K Internist Should Know Twenty Skin Infections that an ItIntern itShldKist Should Know Ana Paula Velez, MD, FACP Assistant Professor University of South Florida ObjectivesObjectives •• 1. Identify the most and challenging skin infections commonly encounter in the outpatient and inpatient practice •• 2.2.RRecogniz e som e com pli cati on s associated with skin infections •• 333. Formulate medical or surgical treatment plan for these infections Case 1 Impetigo Impetigo •• Group A Streptococcus and S. Aureus •• Blisters or ulcers •• “Candy like crust” Group A Streptococcus •• “Varnish like ” bullousaureus, S . aureus •• Culture under the crust •• Acute Glomerulonephritis •• Not Acute rheumaticever f fever Case 2Case 2 Case 2 ERYSIPELAS A. group A strept >> group C or G or B B. 70-80% lower extremity C. 5-20% on face D. lymphedema E. recurrence rate 30% in 3 years F. peau D’orange, we ll d emarca te d e leva ted border, dermal involvement Erysipelas Erysipelas •• Bright red, edematous •• Advancing, raised, sharply demarcated border border •• Systemic toxicity: fever, leukocytosis •• Group A streptococci if nonpurulent •• SSS. aureusifif ifpuru llent l CELLULITES 1) SQ tissue 2) SA, GAS 3) Indistinct border not elevated Cellulitis (continued) 4. GAS/Clostridia surgical wound infx 6-48 hr incubation 5. SA SWI> 48 hr incubation 6. tinea pedis portal of entry 7. recurrent cellulites grp B or G – esp ? GU malig. 8.saphihihaneous vein harvest site – recurrent celluli ti s 9. rec. Rx pen augmentin, keflex, clinda, levo BiteBite Bite)vsvs e4Furunculitis s a (C( Case 4) ) e4 s a (C CMRSA CMRSA •• Sharing personal items •• Skin cuts, abrasions (sports, military recruits) recruits) •• Skin to skin contacts(MSM , sports participants, correctional facilities) •• Crowding(correctional facilities , day care) NECROTIZING FASCIITIS 1. TIType I a) anaerobes (Bacteroides, peptostrepto) b) anaerobic streptococci c) GNR (E.coli, Enterobacter, Kleb) NECROTIZING FASCIITIS 2. Type II a) grp A strept b) occ Staph a c) risks – trauma, diabetes , PVD, cirrhosis, steroids d) toxic shock -like syndrome – hypothermia, shock MS, MSOF, CPK, localized erethema 30% mortalityyy youn g health y adults after minor trauma 3. Anesthesia of area involved NecrotizingNecrotizingFascitis Necrotizing Fascitis •• Macule Bullae •• Pain Numb •• Red BlueBlue--greygrey Edema•• EdemaCrepitance Edema Crepitance Therapy Therapy •• Surgical emergency Betalactam•• /beta Betalactam /beta--lactamase inhibitor plus clindamycin with an agent with activity against MR SA •• Intravenous Immunoglobulin Intravenous Immunoglobulin •• Binds toxin presenting TT--cell receptor activation activation •• Most experience in streptococcal shock sy d osyn edro syme d o e CLOSTRIDIAL CELLULITIS a) CfiCtiC. perfringes, C. septicum b) traumatic wounds c) ibiincubation – severaldl days d) crepitus e) muscle normal (Clostridial gangrene muscle involved) f) pcn/lid//clinda/blactam///BI/carbapenom g) (gas also produced by E.coli, Kleb, Aeromonas) Vibri o vul nifi cus Saltwater exposure within the past 7 days. In US,,y mainly states bordering Gulf of Mexico. April through October. Highest fatality rate in liver disease. Occupation risk Dock worker, oyster schucker, commercial fisherman Tx with cefotaxime, doxycycline or quinolone. SPONTANEOUS, NONTRAUMATIC GAS GANGRENE C. SEPTICUM a) colon cancer 88% b) diverticulitis c) bowel infarction d) neutropenic enterocolitis AGC <500 e) volvulus f) mortality 67-100% (most in 24 hrs) Neutropppenic Enterocolitis (Typhlitis) (Typhlitis) •• RLQ rebound tenderness •• CT abdomen thicken ileocecum •• Ileus or diarrhea •• Neutropenia day 21 5-- 21 •• Pathogens: Clostridia septicum, GNR’s rarelCly Candid a and mold s •• Rx: Flagyl, Zosyn, Meropenem, Clindamycin Fournier Gangrene Case 8Case 8 Case 8 PdPseudomonas aerug inosa Hot tub folliculitis Appears 1-3 days after exposure Predisposition Length of time in water Increased number of bathers HhlitiHypochlorination Resolves spontaneously Not contagious. FOLLICULITIS A. SA (beard – sycosis barbae) B. PSA whirlpool/hot tub/swimming pool C. Candida D. Malassezia furfur E. Eosinophilic pustular folliculitis Tina Tina What are the toppp 3 dermatophytesdermatophytes?? •• Trichophyton rubrum •• Microsporumcanis canis •• Epidermophyton floculosum ERYTHRASMA 1. CbiiiiiCorynebacterium minitissimum 2. Coral pink flourescence – woods lamp 3. Eythro x 7 days topical clinda 4. Groin R/O tinea cruris NODULAR LYMPHANGITIS 1. Sporo tri ch osi s ( sp hagnum moss)(itraconazol e) 2. Nocardia brasiliensis 3. MbMycobacter ium mar inum, c hlifihelonei, fortuitum 4. Francesella tularensis 5. Leishmania braziliensis Mycobacterium marinum—”Fish TkTank GlGranuloma Acquisition Before 1962--hypochlorinated swimming pools. After 1962--cleaning aquariums. Also crab bites, sea-urchin spines Single ulcerated lesion Sporotrichoid pattern lymphatic spread. Diagnosis delayed Tx for 3-12 months. CCylarithromycin, doxyyycycline,,p septra or rifampin +ethambutol Mycob btiaterium f ftitortuitum Atypical, rapidly growing AFB. Associated with pedicures or foot baths. Causes lower extremity furunculosis. Most heal spontaneously but some scar. Could tx with ciprofloxacin, clarithromycin or doxyyycycline. RGM Outbreaks •• Nailll salon wh hllfbhCirlpool footbath in CA •• M fortuitum furunculosis 61 patients•• 61 patients 61 patients •• Mean disease duration 170 days (41(41--336)336) 48•• Rx48median AbxRx 48 Rx Abx 4medianmo 4 median mo(1(1mo-- 4666 mo)) most ••toSensitvity cipro Sensitvitycipro mostand minocyclineto •• Earlier Rx = shorter duration of disease •• 1 pateint had lymphatic dissemination •• CID 2004;38:382004;38:38--4444 RGM Outbreaks •• Nail salon whirlpool footbath in CA fortuitum•• MMM fortuitumfurunculosis •• 110 patients •• # of boils median 37 range) 2 (1 --37 range) 37 range) •• Shaving legs with a razor before pedicure was a rikfisk factor for ifinfect ion •• NEJM 2002;346:1366-2002;346:1366-7171 RGM Outbreaks •• Facelifts (Rhytidectomies(Facelifts Rhytidectomies)) in NJ •• Outpatient surgical center •• 4 patients with M chelonaeinfection •• Contaminated methylene blue used as a tissue marking agent •• MMWR 2004 ;53 :192 --44 RGM Outbreaks •• Lipotourists from U S to DR 2003--44 •• 8 healthy Hispanic females underwent abdominoplasties •• Sx developp(ed median 7 weeks (11--1818 wks)) •• Presented with painful, red, draining SQ abdominal nodulesnodules •• 2of8correctlydiagnosedatpresentation2 of 8 correctly diagnosed at presentation •• 7 I and D’s7 D’s •• 6 Combo Abx macrolide and IV abxcefoxitin, cefoxitin, imipenem,imipenem, amikacinamikacin, and/or linezolid •• All but 1 cured after median 9 mo(2- (2-1212 mo)mo) •• CID 2008;46:11812008;46:1181--88 Atypical HSV Presentations •• Linear Erosive Herpes Simplex Virus Infection in Immunocompromised Patients. It can be seen in the mouth or genitals genitals •• The “Knife-“Knife-CutCut Sign” •• Intertriginousfissures fissures •• Clinical Infectious Diseases 2008;47:1440–2008;47:1440– 14411441 1441 What is the Rx of acyclovir resistant herpes simplex or herpppes zoster? •• Foscarnet IV (NEJM 1991;325:5511991;325:551--5)5) •• Cidofovir IV (JID 1994;170:5701994;170:570--2)2) •• Cidofovir (NEJM 1993;329:9681993;329:968--9,9, JID 1997;176:8921997;176:892--8)8) •• Imiquimod (Am J Med 2006;119:e9-2006;119:e9-11,11, Arch Derm 2001;137:10152001;137:1015--17)17) •• Trifluridine (JAIDSHR 1996;12:147-1996;12:147-152)152) •• Interferon alfa and Trifluridine (Arch Derm 1995;131:241995;131:24--55 Case 16Case 16 Case 16 Hutchinson’ sssign sign 1)Jonathan Hutchinson (1828-1913) 2) HZ of tip of nose likely to also involve the eye 3)Nasal branch of the nasociliary nerve Case 18Case 18 Case 18 Case 19Case 19 Case 19 Case 20Case 20 Case 20 infectiousNon-- Noninfectiousconditionsskin infectiousskin skinconditions conditions Most common bacterial causes of erythema nodosum •Streptococcus infections •TB • Yersinia • Mycoplasma • LGV •Salmonella • ClbCampylobacter What is the most common fungal cause of erythema nodosumnodosum • Coccidiodomycosis • Histoplasmosis • Blastomycosis What is the most common druggg cause of erythema nodosum •• Oral contraceptives Sulfa•• Sulfa •• Halides (gold, iodines)iodines) Do not forget… References References •• Dennis L. Stevens,1,3 Alan L. Bisno,5 Henry F. Practice Guidelines for the Diagnosis and Management of Skin and SoftSoft--TissueTissue Infections. Clinical InfInfecectioustious Diseases ; 2005 ; 41 : 1373 - 1406 1406 Siberry•• GKTekle SiberryGK, GK TekleT, Carroll K , et al . Failure of clindamycin treatment of methicillinresistant--resistant resistant Staphylococcus aureus expressing inducible clindamycin resistance in vitro. ClinInfect Dis. 2003 Nov 1;37(9):12571;37(9):1257--6060 •• Richard L Oehler,Oehler, Ana P Velez, Michelle Mizrachi,Mizrachi, et al. Bite-Bite-relatedrelated and septic syndromes caused by cats and dogs. Lancet Infect Dis 2009; 9: 439–43947 –47 •• Winthrop KL, AlbridgeK, South D, et al. The clinical managementmanagement and outcome of nail salon-salon- acquired Mycobacterium fortuitumskin infection. Clin Infect Dis. 2004 Jan 1;38(1):38-1;38(1):38-44.44. •• Winthrop KL, Abrams M, YakrusM, et al. An outbreak of mycobacterial furunculosis associated with footbaths at a nail salon. N Engl J Med. 2002 May 2;346(18):13662;346(18):1366--71.71. •• Mycobacterium chelonae Infections Associated with Face Lifts --- New Jersey, 20022003.—— 2003. MMWR 2004;53:192-2004;53:192-44 •• E. Yoko Furuya,1,a Armando Paez,5,a Arjun SrinivasanSrinivasan,, et al. Outbreak of Mycobacterium abscessus Wound Infections among ““LipotouristsLipotourists”” from the United States Who Underwent Abdominoplasty in the Dominican Republic. CID 2008;46:1181--88 •• Jeffrey I. Cohen. Herpes Zoster. N Engl J Med 2013; 369:255369:255--263263 .
Load more

Recommended publications
  • Smelly Foot Rash
    CLINICAL Smelly foot rash Paulo Morais Ligia Peralta Keywords: skin diseases, infectious Case study A previously healthy Caucasian girl, 6 years of age, presented with pruritic rash on both heels of 6 months duration. The lesions appeared as multiple depressions 1–2 mm in diameter that progressively increased in size. There was no history of trauma or insect bite. She reported local pain when walking, worse with moisture and wearing sneakers. On examination, multiple small crater- like depressions were present, some Figure 1. Heel of patient coalescing into a larger lesion on both heels (Figure 1). There was an unpleasant ‘cheesy’ protective/occluded footwear for prolonged odour and a moist appearance. Wood lamp periods.1–4 examination and potassium hydroxide testing for fungal hyphae were negative. Answer 2 Question 1 Pitted keratolysis is frequently seen during What is the diagnosis? summer and rainy seasons, particularly in tropical regions, although it occurs Question 2 worldwide.1,3,4 It is caused by Kytococcus What causes this condition? sedentarius, Dermatophilus congolensis, or species of Corynebacterium, Actinomyces or Question 3 Streptomyces.1–4 Under favourable conditions How would you confirm the diagnosis? (ie. hyperhidrosis, prolonged occlusion and increased skin surface pH), these bacteria Question 4 proliferate and produce proteinases that destroy What are the differential diagnoses? the stratum corneum, creating pits. Sulphur containing compounds produced by the bacteria Question 5 cause the characteristic malodor. What is your management strategy? Answer 3 Answer 1 Pitted keratolysis is usually a clinical Based on the typical clinical picture and the negative diagnosis with typical hyperhidrosis, malodor ancillary tests, the diagnosis of pitted keratolysis (PK) (bromhidrosis) and occasionally, tenderness, is likely.
    [Show full text]
  • Chapter 3 Bacterial and Viral Infections
    GBB03 10/4/06 12:20 PM Page 19 Chapter 3 Bacterial and viral infections A mighty creature is the germ gain entry into the skin via minor abrasions, or fis- Though smaller than the pachyderm sures between the toes associated with tinea pedis, His customary dwelling place and leg ulcers provide a portal of entry in many Is deep within the human race cases. A frequent predisposing factor is oedema of His childish pride he often pleases the legs, and cellulitis is a common condition in By giving people strange diseases elderly people, who often suffer from leg oedema Do you, my poppet, feel infirm? of cardiac, venous or lymphatic origin. You probably contain a germ The affected area becomes red, hot and swollen (Ogden Nash, The Germ) (Fig. 3.1), and blister formation and areas of skin necrosis may occur. The patient is pyrexial and feels unwell. Rigors may occur and, in elderly Bacterial infections people, a toxic confusional state. In presumed streptococcal cellulitis, penicillin is Streptococcal infection the treatment of choice, initially given as ben- zylpenicillin intravenously. If the leg is affected, Cellulitis bed rest is an important aspect of treatment. Where Cellulitis is a bacterial infection of subcutaneous there is extensive tissue necrosis, surgical debride- tissues that, in immunologically normal individu- ment may be necessary. als, is usually caused by Streptococcus pyogenes. A particularly severe, deep form of cellulitis, in- ‘Erysipelas’ is a term applied to superficial volving fascia and muscles, is known as ‘necrotiz- streptococcal cellulitis that has a well-demarcated ing fasciitis’. This disorder achieved notoriety a few edge.
    [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]
  • Bacterial Skin Infections
    BACTERIAL SKIN INFECTIONS SPEAKER: DR LUIZ ALBERTO BOMJARDIM PÔRTO DERMATOLOGIST BRAZIL MRSA INFECTIONS • Concept: Methicillin- resistant Staphylococcus aureus • Epidemiology: Gradual increase of resistance. • Nosocomial MRSA risk factors: Hospitalization, ICU, invasive procedures, previous antibiotic therapy, health professionals, diabetes mellitus, EV drugs, immunosuppression and chronic diseases. MRSA INFECTIONS • Community MARSA risk factors: Children, EV drugs, indigenous, homosexual men, military, prisoners and athletes. • Microorganisms more virulent by genetic characteristics. MRSA INFECTIONS • Clinic caracteristics: -Abscess, cellulitis, folliculitis, impetigo, infected wounds, external otitis, paronychia and colonization of the skin in cases of atopic dermatitis. - Increased morbidity. • Propedeutics: Culture blood, tissue or secretion. MRSA INFECTIONS • Treatment: - Pathology-specific treatment. - Prefer non-beta-lactam antibiotics, such as: clindamycin, sulfamethoxazole- trimethoprim and tetracyclines. - On suspicion of MARSA infection, start empirical antibiotics and stagger specific antibiotics by culture with antibiograma. MRSA INFECTIONS • Treatment: - Decolonization: systemic antibiotic therapy, topical 2% mupirocin, personal hygiene with antiseptic or antimicrobial solutions (iodine-povidine, chlorhexidine or triclosan). MRSA INFECTIONS • Prevention: - Avoid skin-to-skin contact and share personal belongings / clothing. - Hand washing. - Use of alcohol gels. - Cover wounds. - Isolation contact of MARSA carriers. - Early
    [Show full text]
  • Bacterial Infections and Infectious Dermatologic Emergencies.Pdf
    Learning Objectives Common Bacterial Infections recognition treatment complications Infectious Dermatologic Emergencies Necrotizing Fasciitis Toxic Shock Syndromes Normal Skin Flora Major function is to prevent skin infections Provides ecological competition for pathogens Hydrolyzes the lipids in sebum into free fatty acids which are toxic to many bacteria- linoleic and linolenic acid are more inhibitory of Staph Aureus Antimicrobial Peptides from lamellar bodies, Cathelicidins, and Defensins function to control overgrowth of pathogens Normal Skin Flora Aerobic Cocci Staphylococcus epidermidis Most common coccus on human skin All body sites, especially intertriginous areas Staphylococcus aureus More common in Atopic Dermatitis, Diabetes Mellitus, Hemodialysis, IVDU, Liver Disease, and HIV resident or contaminant? anterior nares- 20-35% perineum- 20% axillae and toe webs- 5-10% Normal Skin Flora Aerobic Coryneform Bacteria Corynebacterium minutissimum- intertriginous sites Erythrasma Anaerobic Coryneform Bacteria Propionibacterium acnes- sebaceous glands, hair follicles Acne vulgaris Gram Negative Bacteria Acinetobacter species- axillae, perineum, antecubital fossae - Requires moisture and maceration which increases pH and CO2 levels Yeast Pityrosporum ovale/Malassezia furfur- sebaceous sites Tinea Versicolor Introduction Strep and Staph cause the majority of skin infections in immunocompetent patients Immunodeficiency and underlying systemic disease result in severe infections which tend to be refractory to
    [Show full text]
  • Red-Brown Patches in the Groin
    DERMATOPATHOLOGY DIAGNOSIS Red-Brown Patches in the Groin Dong Chen, MD, PhD; Tammie C. Ferringer, MD Eligible for 1 MOC SA Credit From the ABD This Dermatopathology Diagnosis article in our print edition is eligible for 1 self-assessment credit for Maintenance of Certification from the American Board of Dermatology (ABD). After completing this activity, diplomates can visit the ABD website (http://www.abderm.org) to self-report the credits under the activity title “Cutis Dermatopathology Diagnosis.” You may report the credit after each activity is completed or after accumu- lating multiple credits. A 66-year-old man presented with reddish arciform patchescopy in the inguinal area. THE BEST DIAGNOSIS IS: a. candidiasis b. noterythrasma c. pitted keratolysis d. tinea cruris Doe. tinea versicolor H&E, original magnification ×600. PLEASE TURN TO PAGE 419 FOR THE DIAGNOSIS CUTIS Dr. Chen is from the Department of Pathology and Anatomical Sciences, University of Missouri, Columbia. Dr. Ferringer is from the Departments of Dermatology and Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania. The authors report no conflict of interest. Correspondence: Dong Chen, MD, PhD, Department of Pathology and Anatomical Sciences, University of Missouri, One Hospital Dr, MA204, DC018.00, Columbia, MO 65212 ([email protected]). 416 I CUTIS® WWW.MDEDGE.COM/CUTIS Copyright Cutis 2018. No part of this publication may be reproduced, stored, or transmitted without the prior written permission of the Publisher. DERMATOPATHOLOGY DIAGNOSIS DISCUSSION THE DIAGNOSIS: Erythrasma rythrasma usually involves intertriginous areas surface (Figure 1) compared to dermatophyte hyphae that (eg, axillae, groin, inframammary area). Patients tend to be parallel to the surface.2 E present with well-demarcated, minimally scaly, red- Pitted keratolysis is a superficial bacterial infection brown patches.
    [Show full text]
  • Pseudomonas Skin Infection Clinical Features, Epidemiology, and Management
    Am J Clin Dermatol 2011; 12 (3): 157-169 THERAPY IN PRACTICE 1175-0561/11/0003-0157/$49.95/0 ª 2011 Adis Data Information BV. All rights reserved. Pseudomonas Skin Infection Clinical Features, Epidemiology, and Management Douglas C. Wu,1 Wilson W. Chan,2 Andrei I. Metelitsa,1 Loretta Fiorillo1 and Andrew N. Lin1 1 Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada 2 Department of Laboratory Medicine, Medical Microbiology, University of Alberta, Edmonton, Alberta, Canada Contents Abstract........................................................................................................... 158 1. Introduction . 158 1.1 Microbiology . 158 1.2 Pathogenesis . 158 1.3 Epidemiology: The Rise of Pseudomonas aeruginosa ............................................................. 158 2. Cutaneous Manifestations of P. aeruginosa Infection. 159 2.1 Primary P. aeruginosa Infections of the Skin . 159 2.1.1 Green Nail Syndrome. 159 2.1.2 Interdigital Infections . 159 2.1.3 Folliculitis . 159 2.1.4 Infections of the Ear . 160 2.2 P. aeruginosa Bacteremia . 160 2.2.1 Subcutaneous Nodules as a Sign of P. aeruginosa Bacteremia . 161 2.2.2 Ecthyma Gangrenosum . 161 2.2.3 Severe Skin and Soft Tissue Infection (SSTI): Gangrenous Cellulitis and Necrotizing Fasciitis. 161 2.2.4 Burn Wounds . 162 2.2.5 AIDS................................................................................................. 162 2.3 Other Cutaneous Manifestations . 162 3. Antimicrobial Therapy: General Principles . 163 3.1 The Development of Antibacterial Resistance . 163 3.2 Anti-Pseudomonal Agents . 163 3.3 Monotherapy versus Combination Therapy . 164 4. Antimicrobial Therapy: Specific Syndromes . 164 4.1 Primary P. aeruginosa Infections of the Skin . 164 4.1.1 Green Nail Syndrome. 164 4.1.2 Interdigital Infections . 165 4.1.3 Folliculitis .
    [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]
  • Download Erythasma
    ERYTHASMA What is it? Erythasma is a common skin condition that affects the following areas – the groin, under the arms and between the toes What does it look like? Erythrasma appears as well-defined scaly red, pink or brown patches. The most commonly affected areas are the groin, armpits, between the toes and in other skin folds. It can sometimes become generalized and affect larger areas on the body. The patches can sometimes be itchy or have an odor. What causes it? Erythrasma is an infection of the skin caused by an overgrowth of a bacterium called Corynebacterium minutissimum. It can affect healthy adults, but it more frequently affects older people with obesity, excessive sweating (hyperhidrosis [link]), diabetes mellitus or people who live in tropical climates. Infection is facilitated under conditions of moisture and occlusion. How is it diagnosed? Erythrasma is diagnosed based on the history and physical appearance of the lesions. A special lamp called a Wood’s lamp can be used to help confirm the diagnosis, as erythrasma glows bright pink under the lamp. How is it treated? Erythrasma can be treated with either topical (applied directly to the skin) or oral therapies. For patients with localised disease, a topical antibiotic such as clindamycin or erythromycin can be used. On the hand, it can be difficult to treat extensive areas with creams and so oral antibiotics (clindamycin or erythromycin) may be preferred. It is important to note that recurrence is common. What can be done to prevent it? In order to avoid recurrences, it is important to keep the skin as dry as possible and optimise pre-disposing conditions such as keeping diabetes well-controlled.
    [Show full text]
  • Erythrasma Capitis and Diffuse Hair Loss with Patches and Eczema-A Rare but Underdiagnozed Entity? Rauno J
    Annals of Case Reports Harvima RJ and Harvima IT Ann Case Report 6: 666. Case Report DOI: 10.29011/2574-7754.100666 Erythrasma Capitis and Diffuse Hair Loss with Patches and Eczema-a Rare but Underdiagnozed Entity? Rauno J. Harvima1*, Ilkka T. Harvima2 1Department of Dermatology, University of Eastern Finland, Kuopio University Hospital and Helsinki University Central Hospital, Finland 2Department of Dermatology, University of Eastern Finland and Kuopio University Hospital, Finland *Corresponding author: Rauno J. Harvima, Department of Dermatology, Kuopio University Hospital, Puijonlaaksontie 2, FIN- 70210 Kuopio, Finland Citation: Harvima RJ, Harvima IT. (2021) Erythrasma Capitis and Diffuse Hair Loss with Patches and Eczema-a Rare but Underdiagnozed Entity. Ann Case Report 6: 666. DOI: 10.29011/2574-7754.100666 Received Date: 11 May, 2021; Accepted Date: 14 May, 2021; Published Date: 17 May, 2021 Introduction Corynebacterium minutissimum is considered to belong to the normal flora of skin [1]. However, it can cause a skin disease erythrasma, especially in axillar area. Certain corynebacterium species are associated with skin infections [2,3], and pitted keratolysis. There are only a few reports published for animals regarding the association of corynebacterium and alopecia in one Beagle dog [4], and in two horses [5,6]. However, there are no reports in the literature or in Textbooks of Dermatology on the association of corynebacterium with scalp hair loss in humans. Due to only a few Figure 1a: Patient 1, a healthy 16-year-old woman suffering from patients seen in clinical practice, this association is likely rare, and scalp dermatitis and diffuse hair loss for 2 months, back of head.
    [Show full text]
  • Bacterial Skin Infections
    MYTHS AND FACTS: BACTERIAL SKIN INFECTIONS A better understanding of these often-serious infections that are rising in incidence and becoming more resistant to antibiotics is the first step to improved treatment. Ronale Tucker Rhodes, MS 38 BIO SUPPLY TRENDS QUARTERLY | Summer 2016 DURING THE PAST several years, disturbing headlines about can result in methicillin-resistant Staphylococcus aureas flesh-eating bacteria have raised fear among the public, but few (MRSA), which can be a life-threatening infection because think they’ll actually be the next victim. That was certainly true certain antibiotics in the penicillin family cannot treat it. 8 of Cindy Martinez, who, in May 2015, somehow contracted one Streptococcal infection also can cause many types of infections, strain of the dangerous bacteria known to cause necrotizing but it more regularly causes impetigo, which results in a rash fasciitis. A former Marine and mother of two small children, several days after infection with small blisters that burst and Cindy survived but only after her feet and right hand were leave crusty, golden patches on the skin — occurring most amputated to halt the bacteria’s effects. 1 Necrotizing fasciitis is commonly on the face. 5 Both Staphylococcus and Streptococcus rare. According to the Centers for Disease Control and also commonly cause cellulitis, which can occur anywhere on Prevention (CDC), which tracks specific infections in the U.S. the body; however, the most common location is the lower leg. 9 through a special system called Active Bacterial Core surveillance Cellulitis is a painful infection of the deeper layers of the skin (ABCs), there are about 650 to 850 cases of necrotizing fasciitis that appears as an area of redness, warmth and swelling that caused, predominantly, by group A Streptococcal bacteria each gradually spreads.
    [Show full text]
  • Dermatology in the ER
    DRUG ERUPTIONS and OTHER DISORDERS Lloyd J. Cleaver D.O. , F.A.O.C.D, F.A.A.D. Professor of Dermatology ATSU-Kirksville College of Osteopathic Medicine INTERNAL MEDICINE BOARD REVIEW COURSE I Disclosures No Relevant Financial Relationships DRUG ERUPTIONS Drug Reactions 3 things you need to know 1. Type of drug reaction 2. Statistics What drugs are most likely to cause that type of reaction? 3. Timing How long after the drug was started did the reaction begin? Clinical Pearls Drug eruptions are extremely common Tend to be generalized/symmetric Maculopapular/morbilliform are most common Best Intervention: Stop the Drug! Do not dose reduce Completely remove the exposure How to spot the culprit? Drug started within days to a week prior to rash Can be difficult and take time Tip: can generally exclude all drugs started after onset of rash Drug eruptions can continue for 1-2 weeks after stopping culprit drug LITT’s drug eruption database Drug Eruptions Skin is one of the most common targets for drug reactions Antibiotics and anticonvulsants are most common 1-5% of patients 2% of all drug eruptions are “serious” TEN, DRESS More common in adult females and boys < 3 y/o Not all drugs cause eruptions at same rate: Aminopenicillins: 1.2-8% of exposures TMP-SMX: 2.8-3.7% NSAIDs: 1 in 200 Lamotrigine: 10% Drug Eruptions Three basic rules 1. Stop any unnecessary medications 2. Ask about non-prescription medications Eye drops, suppositories, implants, injections, patches, vitamin and health supplements, friend’s medications
    [Show full text]