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Derm Bact Infections
CM Bacterial Infections of the Skin
| Question | Answer |
|---|---|
| abscesses, furuncles and carbuncles are called | pyodermas |
| Most common cause of folliculitis | staph. also can have fungi, viral |
| Superficial kind of cellulitis | Erysipelas. (Vs. Ecthyma is a deeper type of impetigo that goes into the dermis; rare) |
| which bacteria causes almost all cellulitis | Group A strep |
| Pain out proportion is a good clue for | Necrotizing soft tissue infections (NSTI) |
| a superficial type of cellulitis caused almost exclusively by Group A strep. Characterized by sharp, raised borders | erysipelas |
| Occupational infection. single lesion (plaque) with sharp borders usually on hand; caused by Erysipeolthrix rhusiopathiae and seen in those who handle poultry, fish, animal carcasses | Erysipeloid |
| a deep type of impetigo; is an ulcerative lesion with thick crust that is usually tender | Ecthyma |
| a type of NSTI caused by P. aeruginosa, in neutropenic patients | ecthyma |
| A type of bacterial intertrigo caused by C. minutissium | erythrasma |
| “scabbing eruption”, very common in children but adults often infected, classification:primary vs secondarynon-bullous vs bullous | Impetigo. etiologic agents: group A ß-hemolytic Streptococcus pyogenes (GAS) or S. aureus. impetigo that extends into dermis = ecthyma |
| Predisposing factors to impetigo | trauma (often minor, bugbites), underlying dermatoses (atopic dermatitis and herpes infections are common), poor hygeine, previous abx tx, warm temps and humidity |
| Impetigo over time | evolves from papule, vesicle, to erosion (with honey-colored crust). |
| Tx for Impetigo | few lesions: topical ok; Bactroban (mupirocin) which also covers MRSA. TID application 7-10 days. Altabax only treats MSSA. Young kids: systemic - cephalosporins, dicloxacillin |
| Why is the nose important in staph infections? | That's where you get transient colonization |
| Intertrigo note | does not give you a clue to etiology, just tells you that it happens when skin opposes skin. No satellite lesions (satellite seen with candida). Smells bad. |
| Bacterial causes of intertrigo | groups A & B streptococci, non-diphtheroid species of Corynebacterium, P. aeruginosa |
| Bacterial intertrigo | Plaque borders appear defined, no satellite lesions, and odor |
| Tx of intertrigo | topical abx, role of topical steroids is controversial |
| Erythrasma causes | chronic bacterial infection (a type of intertrigo) caused specifically by C. minutissium. Type II DM increases risk. candida or bacterial causes |
| Locations where erythrasma occurs | most commonly seen in groin, webspaces of feet, less common in axillae. Appears bright red with Wood's lamp |
| Tx for Erythrasma | Topical and systemic abx |
| Most common cause of Neck-fold intertrigo in babies | Group A strep. Important to keep the skin folds dry. |
| Impetigo that extends down into the dermis | Ecthyma. |
| How to distinguish Ecthyma from impetigo | Ecythma is painful/tender (unlike impetigo) |
| Pyoderma etiology | almost always S. aureus |
| localized, walled-off collection of pus | abscess. Can develop at an sites |
| Deep-seated erythematous nodule | furuncle. Common in hair bearing regions |
| Carbuncle | large area of coalescing abscesses or furuncles |
| Pre-disposing factors to pyoderma | trauma, chronic carriage of S. aureus, DM, obesity, poor hygeine, minor immunologic deficits |
| Tx of Pyoderma | I & D. be sure to remove loculations or infection will recur. Adjunctive tx includes systemic abx and warm compresses |
| Prevention of pyoderma | routine use of antibacterial soaps for bathing, monthly betadine or hibiclens showers, control of any predisposing conditions (DM - glycemic control) |
| Abscesses vs. Furuncles | Abscesses are usually smaller. When larger, then furuncle |
| Populations at risk for MRSA | native americans, AA, homeless, populations in close quarters, competitive athletes. Clue to MRSA: looks really vesicular. SWAB and culture! |
| DOC for MRSA | Septra (don't need to double dose) |
| Once you unroof a vesicle caused by ______, the base is beefy red | MRSA |
| Most common soft tissue infections | Cellulitis, then erysipelas |
| ___ is exquisitely tender. Presentation: acute, diffuse inflammation of skin, warmth | Cellulitis and Erysipelas. Generally indurated around the lesion. Good way to tell the difference between hypersensitivity rxns |
| extends into subcutaneous tissue;borders are often indistinct, etiologic agents: GAS; S. aureus, others in special settings, any cutaneous site | Cellulitis |
| superficial cellulitis, raised borders with clear demarcation from uninvolved skin etiologic agents: GAS; very rarely S. aureus. lower extremities and face are most commonly affected | Erysipelas |
| Predisposing factors to soft tissue infections | trauma, surgery, mucosal infection, underlying dermatoses, immunologic deficiency |
| Tx for soft tissue infections | systemic therapy needed. Coverage for both GABS and S. aureus: PRSPs (diclocicillin)or cephalosporins, use macrolides (but not erythromycin) in penicillin allergic pts |
| Penicillin-resistant synthetic penicillins | Methicillin, diclocicillon |
| Supportive tx for soft tissue infections | rest, elevation, warm compresses |
| Erythromycin does not cover | S. aureus. |
| Macrolides | Erythromycin, Clarithromycin, Azithromycin. Only C and A can be used to tx soft tissue infecitons b/c Erythromycin doesn't cover staff |
| What else can penicillin allergic patients take aside from macrolides or PRSPs? | FQ's: levoquin, avalox. Augmentin. Save these drugs for patients with higher white counts |
| NSTI are often caused by | GAS (20%). Flesh eating bacteria. Commonly polymicrobial (80%). |
| NSTI usually induced by | trauma, then hematogenous spread from distal site |
| Common sites of infection with Necrotizing soft tissue infections | perineum, extremities, trunk |
| Causes of infectious folliculitis | can be caused by a variety of infectious agents (not just bacteria). Bacterial: S. aureus, gran neg (acne), Pseudomonas spp (immunocompromised). Special types: pseudofolliculitis barbae (barber's itch), keloida folliculitis, "hot tub" folliculitis |
| Tx for infectious folliculitis | systemic abx |
| Keloidal folliculitis are found common in which population | African Americans. Abx tx often required, cyclic administration common |
| ______ is known as "hot tub" folliculitis | Pseudomonas. Very short incubation 1-5 days. Spontaneously clears 1-2 weeks |
| infection of subcutaneous lymphatic channels; usually results from trauma. etiology: most commonly Group A streptococci; less commonly S. aureus | Acute lymphangitis. Lesion: erythematous linear streaks extending from wound/site of break. Tx: abx coverage for strep and staph |
| gram negative bacteria found in marine animals that inhabit warm bodies of water | Vibrio, two specifies cause skin infections. Vulnificus, parahemolyticus. Can get it from eating seafood, skin dz can develop secondary to enteric infection, walking in contaminated water. Risk factors: immunocompromised,liver dz, high serum iron levels |
| Vibrio presentation | start as macular area, develops into bullous lesions. Symmetric and bilateral |
| Suspect ___________ in patients with frequent aquatic exposure: boats, piers, fish & fishing equipment, aquarium owners | Mycobacterium marinum. Usually starts as a single nodule that ulcerates or crusts; joined by satellite lesions. Lesions usually resolve spontaneously, excisions may hasten resolution. Anti-TB drugs not helpful |
| blackness and eschar-covered ulcer suggests | Cutaneous anthrax |
Created by:
ltm12