Simple Cellulitis Or a More Serious Infection? L

Total Page:16

File Type:pdf, Size:1020Kb

Simple Cellulitis Or a More Serious Infection? L PHOTO ROUNDS Susan Dufel, MD, and Margarita Martino, MD Simple cellulitis Associate Professor, Department Trauma and Emergency Medicine, University or a more serious infection? of Connecticut 54-year-old woman was admitted She related to her sisters that she had an to the emergency department with appointment with her gynecologist in the A a swollen right leg, fever, and next few days to have the lesion drained. altered mental status. Her family brought The patient had no fever, chest pain, her in after finding her confused and shortness of breath, nausea, or vomiting. lethargic. She was incontinent of stool and Her medical history included type 2 urine and complained of a rash with blis- diabetes mellitus, hypertension, and corti- ters on her right ®thigh.Dowden The patient Health had cal atrophyMedia with mild mental retardation. noted a pimple in her groin more than 5 She had been living independently in her days earlier; over the past few days she has own apartment, and was last seen by her beenCopyright complainingFor of personal increasing leg usepain. onlysisters 6 days before with no apparent FIGURE 1 Cellulitis in the leg FEATURE EDITOR Richard P.Usatine, MD University of Texas Health Sciences Center at San Antonio C ORRESPONDENCE Susan Dufel, MD, Department Trauma and Emergency Medicine, University of Connecticut, 80 Seymour Street, Hartford CT 06102. The patient’s right leg, showing the extent of her cellulitis. E-mail: [email protected] 396 VOL 55, NO 5 / MAY 2006 THE JOURNAL OF FAMILY PRACTICE For mass reproduction, content licensing and permissions contact Dowden Health Media. FIGURE 2 FIGURE 3 Radiograph of thigh and hip area Radiograph of knee Note the presence of the soft-tissue gas extending into Note the gas tracking down the patient’s leg, past areas FAST TRACK the patient’s pelvis. of obviously clinical celulitis. The patient’s right complaints. She had been wheelchair-bound right upper quadrant incision. Her geni- leg was swollen, for 6 months due to a fractured ankle from tourinary exam revealed a purulent had a brownish- which she has not been able to completely drainage in the groin near her vulva. red discoloration rehabilitate. Her right leg was markedly swollen, The medications she was taking includ- erythematous, and had a brownish-red from groin ed glyburide, raloxifene (Evista), and discoloration that extended from her to knee, and had furosemide (Lasix). Surgical history was groin circumferentially to her knee. The a “woody” feel significant only for a cholecystectomy. She skin had a “woody” feel when palpated when palpated did not smoke or drink alcohol. Upon pres- and large bullae were present (FIGURE 1). entation to the ED she appeared ill, with a The decision to obtain x-rays of her blood pressure of 124/50 mm Hg, pulse pelvis and femur was made to assess the 110, respiratory rate 18, and temperature extent of her infection (FIGURES 2 AND 3). of 102°F. Her fingerstick blood sugar was 573. She was able to answer simple ques- tions but was not oriented to time or place. T What is the differential Her skin was hot and dry. Chest exam diagnosis for this patient? revealed clear lungs with tachypnea and a 2/6 systolic murmur. Her abdomen was T What tests might help slightly obese, soft, and nontender with delineate the extent normal bowel sounds and a well-healed of her infection? www.jfponline.com VOL 55, NO 5 / MAY 2006 397 DS N OU T Diagnosis: Acute single organism. In immune-compromised R necrotizing fasciitis patients, Pseudomonas spp and gram- O T The patient was diagnosed with acute negative enteric organisms can be found. O H necrotizing fasciitis, a rare, often fatal, The organisms isolated most often in P soft-tissue bacterial infection. According to polymicrobial necrotizing soft-tissue infec- the Centers for Disease Control and tions are combinations of staphylococci Prevention, only 500 to 1500 cases of (especially Staphylococcus epidermis with necrotizing fasciitis are diagnosed each beta-hemolytic streptococcus), enterococ- year in the US.1 ci, Enterobacteriaceae spp (commonly Escherichia coli, Proteus mirabilis, Epidemiology Klebsiella pneumoniae, and Pseudomonas Peripheral vascular disease, diabetes, and a aeruginosa), streptococci, Bacterioides pre- compromised immune system are signifi- votella spp, anaerobic gram-positive cocci, cant risk factors for necrotizing fasciitis.2 and Clostridium spp.6 Diabetes is present in 18% to 60% of cases;1,3 in addition, 19% to 77% of Patient presentation patients use intravenous drugs.1,3,4 Other The clinical history and a meticulous significant predisposing factors include physical examination are essential in alcohol abuse (9%–31%),1,4 obesity,1,4 and establishing an early diagnosis of necro- malnutrition.3 Although risk factors are tizing infections.5 Necrotizing fasciitis can numerous, half of all cases of streptococcal be easily misdiagnosed as only cellulitis. necrotizing fasciitis occur in previously Most often, a patient with necrotizing healthy individuals. Pathogenic agents can fasciitis appears ill, with constitutional be introduced as a result of minor trauma, symptoms of fever, chills, hypotension, insect bites, or surgical incisions. dehydration, and rapid heart rate. You In this case the patient noted a “pim- can also see erythema with bullae forma- ple” in the groin area and complained of tion, serosanguineous fluids drainage, pain for 5 days. By the time she reached induration, and violaceous discoloration. FAST TRACK the hospital she had mental status changes, Pain and crepitation may be noted.3,5,7 Rapid progression fever, appeared toxic, and had signs of Rapid progression of edema and pain out early septic shock. We can identify in this of proportion to examination is seen in of edema and pain case the probable port of entry as the the early stages. The parts of the skin out of proportion lesion in the groin that was visualized on affected by the disease can become numb to exam is seen in physical exam to be draining pus. with progression of the infection; this is thought to be due to infarction of the the early stages; Pathophysiology cutaneous nerves located in necrotic sub- parts of the skin Necrotizing fasciitis involves the superficial cutaneous fascia and soft tissue.5 may become numb layer of skin, subcutaneous tissues, and fas- Causative factors in this patient with progression cia. The infection spreads rapidly along included diabetes and obesity. Diabetic these layers, causing edema and compres- neuropathy may have also delayed presen- sion of vasculature, which rapidly progress- tation and dulled her perception of pain. es to tissue necrosis and sepsis. Even with Diabetic microvascular disease may also new broad-spectrum antibiotics, mortality have contributed to a faster progression of can be as high as 75% in patients who tissue hypoxia. become septic and develop renal failure. Necrotizing fasciitis occurs when a mixed variety of organisms, both aerobic T Diagnostic methods: and anaerobic, invade the subcutaneous Lab tests, biopsy, x-rays tissue and fascia.5 Most necrotizing soft- Laboratory testing for necrotizing fasciitis tissue infections are polymicrobial, with is thought by most experts to be non- only a small percentage involving a specific. Another investigative team found 398 VOL 55, NO 5 / MAY 2006 THE JOURNAL OF FAMILY PRACTICE Simple cellulitis or a more serious infection? L that 76% of patients with necrotizing or another aminoglycoside for Entero- soft-tissue infections had low platelet bacteriaceae. Imipenem or meropenem count or PT and PTT with higher than can be used as the initial agent for high normal values; prolonged PT is associated beta-lactamase resistance, wide-spectrum with increase mortality.6 Hypocalcemia, efficacy, and inhibition of endotoxin hypoproteinemia, anemia, and acidosis release from aerobic bacilli. Tetanus pro- have also been noted. phylaxis with absorbed tetanus toxoid Diagnosis must be considered early and passive immune coverage with when necrotizing fasciitis is suspected. tetanus hyperimmune globulin is indicat- Although the gold standard for diagno- ed for a patient whose history of immu- sis is biopsy or wound exploration and nization is unclear or unavailable.6 surgical debridement,6 diagnosis can be made early when necrotizing fasciitis is Surgery suspected. Urgent surgical consultation is necessary. The role of soft-tissue radiographs in Early recognition and prompt aggressive the diagnosis of necrotizing fasciitis is debridement of all necrotic tissue is critical unclear. Plain films can provide informa- for survival—in fact, it is the only therapy tion such as soft-tissue thickening and demonstrated to improve the rate of sur- internal gas formation. Unfortunately, vival.7 Necrotic tissue serves as a culture plain radiographs typically show no spe- medium and creates an anaerobic environ- cific abnormality until the necrotizing ment, which hinders an adequate immune process is well advanced. response. Sufficient debridement consists of exposure to all margins of viable tissue. Antibiotics are important but are second- T Treatment of necrotizing ary to urgent removal of the toxic tissue. fasciitis Resuscitation Hyperbaric oxygen therapy Adequate fluid resuscitation and stabiliza- All necrotizing infections are associated tion of any patient suspected of having with ischemia, reduced tissue oxygen ten- FAST TRACK necrotizing fasciitis is the first line of ther- sion, and a decrease in host cellular Urgent surgical apy. Large-bore IV lines or a central
Recommended publications
  • Oral Lichen Planus: a Case Report and Review of Literature
    Journal of the American Osteopathic College of Dermatology Volume 10, Number 1 SPONSORS: ',/"!,0!4(/,/'9,!"/2!4/29s-%$)#)3 March 2008 34)%&%,,!"/2!4/2)%3s#/,,!'%.%8 www.aocd.org Journal of the American Osteopathic College of Dermatology 2007-2008 Officers President: Jay Gottlieb, DO President Elect: Donald Tillman, DO Journal of the First Vice President: Marc Epstein, DO Second Vice President: Leslie Kramer, DO Third Vice President: Bradley Glick, DO American Secretary-Treasurer: Jere Mammino, DO (2007-2010) Immediate Past President: Bill Way, DO Trustees: James Towry, DO (2006-2008) Osteopathic Mark Kuriata, DO (2007-2010) Karen Neubauer, DO (2006-2008) College of David Grice, DO (2007-2010) Dermatology Sponsors: Global Pathology Laboratory Stiefel Laboratories Editors +BZ4(PUUMJFC %0 '0$00 Medicis 4UBOMFZ&4LPQJU %0 '"0$% CollaGenex +BNFT2%FM3PTTP %0 '"0$% Editorial Review Board 3POBME.JMMFS %0 JAOCD &VHFOF$POUF %0 Founding Sponsor &WBOHFMPT1PVMPT .% A0$%t&*MMJOPJTt,JSLTWJMMF .0 4UFQIFO1VSDFMM %0 t'"9 %BSSFM3JHFM .% wwwBPDEPSg 3PCFSU4DIXBS[F %0 COPYRIGHT AND PERMISSION: written permission must "OESFX)BOMZ .% be obtained from the Journal of the American Osteopathic College of Dermatology for copying or reprinting text of .JDIBFM4DPUU %0 more than half page, tables or figurFT Permissions are $JOEZ)PGGNBO %0 normally granted contingent upon similar permission from $IBSMFT)VHIFT %0 the author(s), inclusion of acknowledgement of the original source, and a payment of per page, table or figure of #JMM8BZ %0 reproduced matFSJBMPermission fees
    [Show full text]
  • Communicable Disease Exclusion Guidelines for Schools and Child Care Settings
    Deschutes County Health Services COMMUNICABLE DISEASE EXCLUSION GUIDELINES FOR SCHOOLS AND CHILD CARE SETTINGS Symptoms requiring exclusion of a child from school or childcare setting until either diagnosed and cleared by a licensed health care provider or recovery. FEVER: ANY fever greater than 100.5 F., may return when temperature decreases without use of fever-reducing medicine. VOMITTING: > 2 in the preceding 24 hours, unless determined to be from non-communicable conditions. May return when resolved. DIARRHEA: 3 or more watery or loose stools in 24 hours. May return when resolved for 24 hours. STIFF NECK: or headache with accompanying fever. May return after resolution of symptoms or diagnosis made and clearance given. RASHES: ANY new onset of rash if accompanied by fever; may return after rash resolves or if clearance given by health care providers. SKIN LESIONS: Drainage that cannot be contained within a bandage. JAUNDICE: Yellowing of eyes or skin. May return after diagnosis from physician and clearance given. BEHAVIOR CHANGE: Such as new onset of irritability, lethargy or somnolence. COUGH /SOB: Persistent cough with or without fever, serious sustained coughing, shortness of breath, or difficulty breathing. SYMPTOMS or complaints that prevent the student from active participation in usual school activities, or student requiring more care than the school staff can safely provide. Inform local county health department, (LHD), of all diseases listed as reportable. The local county health department should be consulted regarding any written communication that may be developed to inform parents/guardians about disease outbreaks, risk to students, families, and staff and/or control measures specific to an outbreak.
    [Show full text]
  • Boils and Skin Infections Are Usually Caused by Bacteria
    Communicable Diseases Factsheet Boils and skin infections are usually caused by bacteria. Avoid sharing items and wash hands thoroughly, especially after touching skin Boils and skin infections infections. Last updated: March 2017 What are boils? A boil (sometimes known as a furuncle) is an infection of the skin, often around a hair follicle. It is usually caused by Staphylococcus aureus bacteria (commonly known as golden staph). Many healthy people carry these bacteria on their skin or in their nose, but do not have any symptoms. Boils occur when bacteria get through broken skin and cause tender, swollen, pimple-like sores, which are full of pus. Boils usually get better on their own, but severe or recurring cases may require medical treatment and support. Staph bacteria may also cause other skin infections, including impetigo. Impetigo, commonly known as school sores (as they affect school-age children), are small blisters or flat crusty sores on the skin. See the Impetigo factsheet at http://www.health.nsw.gov.au/Infectious/factsheets/Pages/impetigo.aspx for specific information on Impetigo. How are they diagnosed? Most skin infections are diagnosed on the basis of their appearance and the presence of any related symptoms (such as fever). Your doctor may take swabs or samples from boils, wounds, or other sites of infection to identify the bacteria responsible. Some infections may be caused by bacteria that are resistant to some antibiotics. See the MRSA in the community factsheet for detailed information on infections caused by antibiotic
    [Show full text]
  • Skin and Soft Tissue Infections Ohsuerin Bonura, MD, MCR Oregon Health & Science University Objectives
    Difficult Skin and Soft tissue Infections OHSUErin Bonura, MD, MCR Oregon Health & Science University Objectives • Compare and contrast the epidemiology and clinical presentation of common skin and soft tissue diseases • State the management for skin and soft tissue infections OHSU• Differentiate true infection from infectious disease mimics of the skin Casey Casey is a 2 year old boy who presents with this rash. What is the best treatment? A. Soap and Water B. Ibuprofen, it will self OHSUresolve C. Dicloxacillin D. Mupirocin OHSUImpetigo Impetigo Epidemiology and Treatment OHSU Ellen Ellen is a 54 year old morbidly obese woman with DM, HTN and venous stasis who presented with a painful left leg and fever. She has had 3 episodes in the last 6 months. What do you recommend? A. Cefazolin followed by oral amoxicillin prophylaxis B. Vancomycin – this is likely OHSUMRSA C. Amoxicillin – this is likely erysipelas D. Clindamycin to cover staph and strep cellulitis Impetigo OHSUErysipelas Erysipelas Risk: lymphedema, stasis, obesity, paresis, DM, ETOH OHSURecurrence rate: 30% in 3 yrs Treatment: Penicillin Impetigo Erysipelas OHSUCellulitis Cellulitis • DEEPER than erysipelas • Microbiology: – 6-48hrs post op: think GAS… too early for staph (days in the making)! – Periorbital – Staph, Strep pneumoniae, GAS OHSU– Post Varicella - GAS – Skin popping – Staph + almost anything! Framework for Skin and Soft Tissue Infections (SSTIs) NONPurulent Purulent Necrotizing/Cellulitis/Erysipelas Furuncle/Carbuncle/Abscess Severe Moderate Mild Severe Moderate Mild I&D I&D I&D I&D IV Rx Oral Rx C&S C&S C&S C&S Vanc + Pip-tazo OHSUEmpiric IV Empiric MRSA Oral MRSA TMP/SMX Doxy What Are Your “Go-To” Oral Options For Non-Purulent SSTI? Amoxicillin Doxycycline OHSUCephalexin Doxycycline Trimethoprim-Sulfamethoxazole OHSU Miller LG, et al.
    [Show full text]
  • Reportable Disease Surveillance in Virginia, 2013
    Reportable Disease Surveillance in Virginia, 2013 Marissa J. Levine, MD, MPH State Health Commissioner Report Production Team: Division of Surveillance and Investigation, Division of Disease Prevention, Division of Environmental Epidemiology, and Division of Immunization Virginia Department of Health Post Office Box 2448 Richmond, Virginia 23218 www.vdh.virginia.gov ACKNOWLEDGEMENT In addition to the employees of the work units listed below, the Office of Epidemiology would like to acknowledge the contributions of all those engaged in disease surveillance and control activities across the state throughout the year. We appreciate the commitment to public health of all epidemiology staff in local and district health departments and the Regional and Central Offices, as well as the conscientious work of nurses, environmental health specialists, infection preventionists, physicians, laboratory staff, and administrators. These persons report or manage disease surveillance data on an ongoing basis and diligently strive to control morbidity in Virginia. This report would not be possible without the efforts of all those who collect and follow up on morbidity reports. Divisions in the Virginia Department of Health Office of Epidemiology Disease Prevention Telephone: 804-864-7964 Environmental Epidemiology Telephone: 804-864-8182 Immunization Telephone: 804-864-8055 Surveillance and Investigation Telephone: 804-864-8141 TABLE OF CONTENTS INTRODUCTION Introduction ......................................................................................................................................1
    [Show full text]
  • Viability of Methicillin-Resistant Staphylococcus Aureus on Artificial Turf Under
    Viability of Methicillin-Resistant Staphylococcus aureus on Artificial Turf Under Outdoor and Laboratory Environmental Conditions A thesis presented to the faculty of the College of Health Sciences and Professions of Ohio University In partial fulfillment of the requirements for the degree Master of Science Ashley N. Hardbarger June 2012 © 2012 Ashley N. Hardbarger. All Rights Reserved. 2 This thesis titled Viability of Methicillin-Resistant Staphylococcus aureus on Artificial Turf Under Outdoor and Laboratory Environmental Conditions by ASHLEY N. HARDBARGER has been approved for the School of Applied Health Sciences and Wellness and the College of Health Sciences and Professions by Andrew Krause Assistant Professor of Applied Health Sciences and Wellness Randy Leite Dean, College of Health Sciences and Professions 3 ABSTRACT HARDBARGER, ASHLEY N., M.S., June 2012, Athletic Training Viability of Methicillin-Resistant Staphylococcus Aureus on Artificial Turf Under Outdoor and Laboratory Environmental Conditions Director of Thesis: Andrew Krause Methicillin-resistant Staphylococcus aureus has survived on artificial turf in a laboratory setting when provided a nutrient source. There is limited evidence on the viability of MRSA in outdoor environmental conditions. This study compared the survival of MRSA in a laboratory environment to an outdoor environment over seven days. Artificial turf was inoculated with MRSA strain USA300 and exposed to laboratory and outdoor environmental settings. Samples were collected daily. MRSA survival was determined by growth on CHROMagar plates. Results indicated a difference in the mean survival time of MRSA between a laboratory environment (7.00 ± 0.00 days) and an outdoor environment (4.67 ± 2.52). Conditions including surface temperature, ambient temperature, relative humidity, precipitation and solar radiation may have affected MRSA survival.
    [Show full text]
  • New Jersey Chapter American College of Physicians
    NEW JERSEY CHAPTER AMERICAN COLLEGE OF PHYSICIANS ASSOCIATES ABSTRACT COMPETITION 2015 SUBMISSIONS 2015 Resident/Fellow Abstracts 1 1. ID CATEGORY NAME ADDITIONAL PROGRAM ABSTRACT AUTHORS 2. 295 Clinical Abed, Kareem Viren Vankawala MD Atlanticare Intrapulmonary Arteriovenous Malformation causing Recurrent Cerebral Emboli Vignette FACC; Qi Sun MD Regional Medical Ischemic strokes are mainly due to cardioembolic occlusion of small vessels, as well as large vessel thromboemboli. We describe a Center case of intrapulmonary A-V shunt as the etiology of an acute ischemic event. A 63 year old male with a past history of (Dominik supraventricular tachycardia and recurrent deep vein thrombosis; who has been non-compliant on Rivaroxaban, presents with Zampino) pleuritic chest pain and was found to have a right lower lobe pulmonary embolus. The deep vein thrombosis and pulmonary embolus were not significant enough to warrant ultrasound-enhanced thrombolysis by Ekosonic EndoWave Infusion Catheter System, and the patient was subsequently restarted on Rivaroxaban and discharged. The patient presented five days later with left arm tightness and was found to have multiple areas of punctuate infarction of both cerebellar hemispheres, more confluent within the right frontal lobe. Of note he was compliant at this time with Rivaroxaban. The patient was started on unfractionated heparin drip and subsequently admitted. On admission, his vital signs showed a blood pressure of 138/93, heart rate 65 bpm, and respiratory rate 16. Cardiopulmonary examination revealed regular rate and rhythm, without murmurs, rubs or gallops and his lungs were clear to auscultation. Neurologic examination revealed intact cranial nerves, preserved strength in all extremities, mild dysmetria in the left upper extremity and an NIH score of 1.
    [Show full text]
  • What Is Fungal Acne, Exactly?
    If you’re dealing with angry red bumps on your skin, your first thought (understandably) probably jumps to acne. But what if you’ve tried absolutely everything—a salicylic acid face wash, benzoyl peroxide spot treatment, or other common OTC acne products—and they’re just not fading away? First, take a closer look at the spots. If you have inflamed, chicken skin-like bumps rather than your usual speckling of swollen pimples, you may actually be dealing with “fungal acne”—which technically isn’t like your normal acne at all. Fungal acne is common during the warmer, humid months, making now the prime time to develop those little bumps across your hairline, jawline, butt, chest, and back—pretty much anywhere on your body. “I’ve been seeing it a lot in the office lately,” says Doris Day, M.D., a board-certified dermatologist at Advanced Dermatology and Aesthetics in New York City. Here’s exactly how to differentiate fungal acne from your traditional breakout—and what you can do to get rid of it ASAP. What is fungal acne, exactly? First, a little acne 101: Your skin has tiny pores and, under normal circumstances, dead skin cells rise to the surface of the pore, where your body sheds them, according to the American Academy of Dermatology (AAD). But when your body starts to produce a lot of sebum (a.k.a. oil), those dead skin cells can stick together inside your pore and become clogged. Hello, pimple. Most commonly, bacteria that lives on your skin, called P. acnes, gets trapped inside the clogged pore and causes inflammation in what’s known as bacterial acne, the AAD says.
    [Show full text]
  • 62 Just a Pimple Elaine Ete Rasch
    ‘I THOUGHT IT WAS JUST A PIMPLE’ A study examining the parents of Pacific children’s understanding and management of skin infections in the home Elaine Ete-Rasch1 & Dr Katherine Nelson2 1. Public Health Nurse, Public Health Advisor Skin Health - Regional Public Health, Hutt Valley DHB & past student of Victoria University of Wellington 2. Senior Lecturer - Graduate School of Nursing, Midwifery & Health, Victoria University of Wellington Study Background Pacific children are more likely to be admitted to hospital for bacterial skin infections than non Pacific (Hunt, 2004; O’Sullivan et al., 2011). Increased to 2.9 and 4.5 times respectively, between 2000 ‐ 2007 (O’Sullivan et al., 2011) Skin infections; one of the leading causes for acute hospital admissions of Pacific children yrs 2000‐2006 (Craig et al, 2008) Skin infection complications for Pacific children: include death, paraplegia, dialysis (Hill et al., 2001; Miles et al., 2005) Limited information is known about the management and preventative measures of skin sores in the homes. Aims & Objectives To describe and explore Pacific parents’ knowledge and understanding of managing simple skin sores at home prior to secondary infections which required hospital admission. To identify knowledge and understanding of skin care by Pacific parents To describe first aid resources and treatments available and practiced in the homes To inform the development of appropriate resources or other health education materials Research design Descriptive qualitative methodology, informed by Pacific
    [Show full text]
  • What Is Impetigo?
    Quick Facts About… Impetigo What is impetigo? Impetigo (imp-uh-tie-go) is a common skin infection caused by Staphylococcus (staph) or Streptococcus (strep) bacteria. Impetigo commonly occurs when strep or staph bacteria enter the skin through cuts or insect bites. It can also develop in intact, healthy skin, particularly in children. Red, weeping sores form where the bacteria have entered the skin. How is impetigo spread? Impetigo is spread by direct contact with sores or mucus from the nose or throat of an infected person. The sores have large numbers of bacteria present, so impetigo is very contagious. Scratching or touching an infected area of the skin and then touching another part of the body can spread infection to that area. Impetigo can also spread from one person to another in the same manner. Hand-to-skin contact is the most common source for the spread of impetigo. Lesions will appear 1-3 days after the person is infected. Who is at risk for impetigo? Persons who have cuts, scratches, insect bites, or other breaks in the skin which come in contact with the bacteria that cause impetigo are at greatest risk. Crowded conditions and participation in skin-to-skin contact activities, such as sports, can increase the risk of infection. Persons who have chronic (long-term) skin conditions, such as eczema, are also more likely to get impetigo. Impetigo is most common among children 2-6 years of age. How do I know if I have impetigo? Symptoms start with red or pimple-like sores surrounded by red skin.
    [Show full text]
  • MRSA) Is a Bacterial Infection Caused by Staphylococcus Aureus “Staph” Bacteria That Are Resistant to Many Antibiotics
    Dear Parent/Guardian, Methicillin Resistant Staphylococcus Aureus (MRSA) is a bacterial infection caused by Staphylococcus Aureus “Staph” bacteria that are resistant to many antibiotics. Staph frequently causes skin infections and can enter wounds or other body sites. As a skin infection, MRSA can present as an abscess, infected pimple, impetigo, boil, or open wound. MRSA can be mistaken for a spider or insect bite. Symptoms can include: redness, swelling, warmth to touch, pus and tenderness at the site. MRSA is spread by skin-to-skin contact or by direct contact with the infected wound drainage. MRSA skin infections may also be spread by contact through shared equipment, personal articles/objects or contaminated surfaces. Please be assured that Norman Public Schools are using appropriate preventive measures to limit the spread of MRSA and ensure our schools remain safe learning environments for students. Possibly contaminated environmental surfaces are cleaned with CDC approved disinfectants. Parents or guardians of students with suspicious skin lesions will be asked to seek medical attention. Open wounds or sores are to be covered while the student is at school. You and your family can help prevent the spread of MRSA as well as colds and flu by following good health practices: • Encourage your student to wash his or her hands frequently for at least 15 seconds using soap and water, especially before eating, putting in or taking out contact lenses, and after using the restroom, blowing nose, coughing or sneezing, or whenever the hands look dirty. • Use alcohol hand gel when soap and water are not available. • Keep cuts and scrapes clean and covered with a bandage until healed.
    [Show full text]
  • Guidelines for Keeping Sick Kids Home Headache
    Runny Nose Runny Diarrhea Fever Chills Chills Sore Throat Sore Vomiting Headache Keeping Sick Kids Home Kids Sick Keeping Guidelines for Guidelines Protect your child by getting all recommended immunizations! Call for an appointment today! CLINTON BRANCH OFFICE GRATIOT BRANCH OFFICE MONTCALM BRANCH OFFICE 1307 E. Townsend Rd. 151 Commerce Dr. 615 N. State St. Suite 1 St. Johns, MI 48879 Ithaca, MI 48847 Stanton, MI 48888 (989) 224-2195 (989) 875-3681 (989) 831-5237 Select #5 Select #5 Select #5 For more information, visit: www.mmdhd.org, click on the “Health Services” tab and then “Communicable Disease.” Revised June 2019 A child’s illness is most contagious during the early stages • Signs of illness to watch for: skin rash, sore throat, flushed skin, vomiting, diarrhea, cough, headache, fever, runny nose, and fatigue. • Staying home and resting at the first sign of illness will help shorten the length of illness. • When your child begins to show signs of illness, contact your physician for instructions. • Cooperate with your school, day care center, and health department by keeping your child at home if they are ill. • Be sure to notify the school if your child is ill. • A sick child does not learn well at school and endangers the health of classmates. Scarlet Fever Droplets from nose, throat Begins with fever and sore throat. Variable. If not When signs of 2 - 5 days and mouth spread virus A bumpy, sunburn-like rash treated, can be illness are completely and bacteria by sneezing, appears and spreads to all parts contagious gone or on coughing, and speaking.
    [Show full text]