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35 Cards in this Set
- Front
- Back
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Impetigo
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Infection of the epidermis
Staph aureus, strep pyogenes Vesicles --> pustules w/ honey colored crust Usually on faces of kids Treat with dioxacillin, cephalexin (pen if known to be strep) |
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Erysipelas
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Infection of epidermis and dermis
Mostly caused by group A strep Sharply demarcated raised epithelium Pea d'orange Systemic symptoms, very painful Treat with pen |
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Cellulitis
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Infection involving epidermis, dermis, subcutaneous tissue
Spreading painful erythema w/ indistinct borders May be patchy May form necrotic bullae Risk for systemic spread via lymphatics, blood |
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Fasciitis
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Infection of the fascia
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Myositis
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Infection of the muscle
Pyomyositis is almost always Staph aureus Can be strep as a complication of nec fac With gas production think Clostridia |
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Staph aureus skin infections
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Abscess formation -folliculitis, furuncles, pustules
Locally necrotizing infections Toxins - scalded skin, TSS Spreading infections - cellulitis |
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Strep infections of the skin
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Most commonly s. pyogenes
Can cause glomerulonephritis Other beta hemoytic strep also cause skin infections (but not glomerulonephritis) Group B - primarily in immunocompromised host |
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Ulcerated and nodular skin lesions
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Anthrax
Syphilis Fungal Mycobacterial |
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Cellulitis predisposing factors
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Trauma
Obesity Edema, lymphedema Chronic venous insufficiency Fissured toe-webs, athletes foot Impaired lymphatic drainage Other skin lesion |
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Microbio of cellulitis
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Strep pyogenes is most common
associated with lymphangitis Staph aureus after a penetrating trauma |
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Dog/cat bite + cellulitis
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Pasturella multocida
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Freshwater injury + cellulitis
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Aeromonous hydrophilia
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Salt water/raw oysters + cellulits
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Vibrio vulnificus
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Lymphangitis
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Infection spreading via lymphatics
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Periorbital cellulitis may indicate
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Sinus disease
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Diagnosis of cellulitis
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Clinical appearance
Blood cultures - + in 5% Aspiration of inflammed skin really better to use a bullae Punch biopsy with culture (20-30%) |
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Recurrent cellulitis
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Associate with chronic lymphatic/venous obstruction
Usually strep pyogenes Represents colonization Chronic suppression with Pen VK can be helpful |
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Paronychia
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Painful infection of nail bed or margin
S. aureus commonly Treatment: Moist heat, drainage prn, oral antibiotic for systemic symptoms or large lesions |
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Folliculits
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Pustular hair follicle infection
No systemic toxicity Staph aureus Treat with topical muprocin or polymixin B-neomycin-bacitracin |
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Recurrent furunclosis is associate with?
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Nasal staph carriage
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Treatment of furuncle
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Moist heat
Drainage of large lesions Oral antibiotic for systemic symptoms, large lesions, lesions on face |
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Sporotrichosis
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Painless pustule that ulcerates
Secondary lesions along lymphatics Gardeners and farmers |
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Infection with mycobacterium marinum
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Contact with aquariums and freshwater
Small papule that ulcerates Lymphangitic spread |
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Cutaneous anthrax
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Painless papule
Associated edema, regional lymphadenopathy Papule w/erythema --> vesicle/bullae --> black from hemorrhage--> ulcerate to form eschar Often, several pearl-like satellite vesicles develop Necrotic area--but not painful |
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Loxocelism
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Painful
Spider bites Necrotic lesions without much surrounding edema |
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Secondary infections complicate these skin lesions
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Eczema
Lacerations Decubitus ulcers (bowel flora) Human bites Animal bites Surgical wounds Burns |
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Infection associated with puncture through sneaker
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Pseudomonas aeruginosa
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Skin infection with foul smelling gas in tissues
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Clostridia
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Secondary bacterial infections associated with lacerations and punctures are caused by
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Staph and strep usually
Can be caused by environmental contaminants Enterobacteraciae Pseudomonas Aeromonas Vibrio vulnificus |
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Secondary infection of human bite
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Staph, strep, Eikenella corrondens, oral anerobes (Fusobacteria, Prevotella)
Often on the hand, so can be complicated by tenosynovitis, arthritis, osteomyelitis Treat with ampicillin/sulfbactam (amoxicillin/clavulanate), cefotetan |
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How to triage cellulitis of hands or face?
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Admit them
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Secondary infections of animal bites
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Often polymicrobial
S. aureus, beta hemolytic strep Pasturella Capnocytophaga --can cause sepsis in immunocompromised host Treat with amoxicilin/clavulanate or ampicillin/sulfbactam |
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Secondary infections of decubitus ulcers
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Sacral
--polymicrobial bowel flora need deep cultures can invade bone Heel Stap and strep |
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Necrotizing faciitis
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Rapid progression
Necrosis of subcutaneous tissues and overlying skin Systemic toxicity Causes by group A strep or polymicrobial aerobic/anerobic May need MRI/exploratory surgery to differentiate from cellulitis |
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Clues that this skin infection is from an anaerobe
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Gas production (crepitus or seen on imaging)
Foul odor Tissue necrosis Rapid spread through tissue planes Gram stain showing mixed organisms |
