CM Bacterial Infections of the Skin
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| abscesses, furuncles and carbuncles are called | pyodermas
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| Most common cause of folliculitis | staph. also can have fungi, viral
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| Superficial kind of cellulitis | Erysipelas. (Vs. Ecthyma is a deeper type of impetigo that goes into the dermis; rare)
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| which bacteria causes almost all cellulitis | Group A strep
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| Pain out proportion is a good clue for | Necrotizing soft tissue infections (NSTI)
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| a superficial type of cellulitis caused almost exclusively by Group A strep. Characterized by sharp, raised borders | erysipelas
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| 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
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| a deep type of impetigo; is an ulcerative lesion with thick crust that is usually tender | Ecthyma
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| a type of NSTI caused by P. aeruginosa, in neutropenic patients | ecthyma
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| A type of bacterial intertrigo caused by C. minutissium | erythrasma
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| “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
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| 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
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| Impetigo over time | evolves from papule, vesicle, to erosion (with honey-colored crust).
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| 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
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| Why is the nose important in staph infections? | That's where you get transient colonization
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| 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.
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| Bacterial causes of intertrigo | groups A & B streptococci, non-diphtheroid species of Corynebacterium, P. aeruginosa
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| Bacterial intertrigo | Plaque borders appear defined, no satellite lesions, and odor
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| Tx of intertrigo | topical abx, role of topical steroids is controversial
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| Erythrasma causes | chronic bacterial infection (a type of intertrigo) caused specifically by C. minutissium. Type II DM increases risk. candida or bacterial causes
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| Locations where erythrasma occurs | most commonly seen in groin, webspaces of feet, less common in axillae. Appears bright red with Wood's lamp
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| Tx for Erythrasma | Topical and systemic abx
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| Most common cause of Neck-fold intertrigo in babies | Group A strep. Important to keep the skin folds dry.
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| Impetigo that extends down into the dermis | Ecthyma.
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| How to distinguish Ecthyma from impetigo | Ecythma is painful/tender (unlike impetigo)
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| Pyoderma etiology | almost always S. aureus
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| localized, walled-off collection of pus | abscess. Can develop at an sites
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| Deep-seated erythematous nodule | furuncle. Common in hair bearing regions
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| Carbuncle | large area of coalescing abscesses or furuncles
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| Pre-disposing factors to pyoderma | trauma, chronic carriage of S. aureus, DM, obesity, poor hygeine, minor immunologic deficits
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| Tx of Pyoderma | I & D. be sure to remove loculations or infection will recur. Adjunctive tx includes systemic abx and warm compresses
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| Prevention of pyoderma | routine use of antibacterial soaps for bathing, monthly betadine or hibiclens showers, control of any predisposing conditions (DM - glycemic control)
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| Abscesses vs. Furuncles | Abscesses are usually smaller. When larger, then furuncle
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| Populations at risk for MRSA | native americans, AA, homeless, populations in close quarters, competitive athletes. Clue to MRSA: looks really vesicular. SWAB and culture!
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| DOC for MRSA | Septra (don't need to double dose)
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| Once you unroof a vesicle caused by ______, the base is beefy red | MRSA
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| Most common soft tissue infections | Cellulitis, then erysipelas
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| ___ 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
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| extends into subcutaneous tissue;borders are often indistinct, etiologic agents: GAS; S. aureus, others in special settings, any cutaneous site | Cellulitis
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| 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
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| Predisposing factors to soft tissue infections | trauma, surgery, mucosal infection, underlying dermatoses, immunologic deficiency
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| 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
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| Penicillin-resistant synthetic penicillins | Methicillin, diclocicillon
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| Supportive tx for soft tissue infections | rest, elevation, warm compresses
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| Erythromycin does not cover | S. aureus.
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| Macrolides | Erythromycin, Clarithromycin, Azithromycin. Only C and A can be used to tx soft tissue infecitons b/c Erythromycin doesn't cover staff
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| 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
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| NSTI are often caused by | GAS (20%). Flesh eating bacteria. Commonly polymicrobial (80%).
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| NSTI usually induced by | trauma, then hematogenous spread from distal site
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| Common sites of infection with Necrotizing soft tissue infections | perineum, extremities, trunk
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| 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
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| Tx for infectious folliculitis | systemic abx
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| Keloidal folliculitis are found common in which population | African Americans. Abx tx often required, cyclic administration common
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| ______ is known as "hot tub" folliculitis | Pseudomonas. Very short incubation 1-5 days. Spontaneously clears 1-2 weeks
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| 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
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| 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
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| Vibrio presentation | start as macular area, develops into bullous lesions. Symmetric and bilateral
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| 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
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| blackness and eschar-covered ulcer suggests | Cutaneous anthrax
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