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39 Cards in this Set

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What is impetigo also known as?
School sores.
In what environment is impetigo best spread?
* warm, moist environments
* close physical contact
* poor hygiene
* Areas where the skin is broken by insect bites, superficial injury & excoriated eczema
What bug most commonly causes impetigo?
1. Staph aureus, and less commonly:
2. Strep pyogenes
What are the 3 ways in which impetigo presents?
1. Crusted or nonbullous: red base with golden yellow crusts & erosions, itchy but not painful: most common and subacute.
2. Bullous: (always s.aureus), mildly irritating blisters that erode rapidly leaving a brown crust
3. ulcerative lesions: always s.pyogenes.
What kidney condition might follow impetigo within 8 weeks, and which bug is this related to?
Glomerulonephritis (s. pyogenes)
What antibiotics can you give for methicillin resistant s. aureus?
Based on susceptibility testing, however, generally:
* clindamycin or
* trimethoprim + sulfamethoxazole
* vancomycin
Can ask the lab or an ID specialist before treating.
In recurrent cases of impetigo, what should you look out for & treat?
Nasal carriage of s.aureus.
If impetigo is mild, what can you treat it with?
Topical Muciprocin 2% ointment tds for ten days.
If impetigo is severe and widespread, what can you treat with?
Cephalexin (oral).
What does folliculitis look like?
Inflammatory papule centred on a follicule (a hair shaft can be seen in the centre, with a magnifying glass)
What are some common differential diagnoses for folliculitis?
* Miliaria rubra (heat rash)
* Insect bites
Note; none of these are centred primarily on the hair follicle.
What are some common causes of folliculitis?
1. Physical: e.g. shaving/waxing, occlusive clothing, grease
2. Patients who are colonised with s.aureus (nasal) may need prolonged decontamination regime using antiseptic washes, nasal muciprocin, oral a/b & washing clothes & linen in hot water to prevent occurences
3. Fungal causes
What is the deeper form of folliculitis known as?
Boils. They are usually tender and painful.
What is generally the causative organism in boils?
S. aureus, occasionally in concert with strep pyogenes.
How do you treat small boils?
Drainage. Usually you treat them the same as with folliculitis or impetigo.
What is the technical term for:
a. boils
b. boils that have coalesced & extend to deeper tissue
a. furuncles
b. carbuncles
How do you treat patients with larger abcesses?
* Drainage under local anaesthetic
* Lodoform gauze packing of the larger abcess cavities
* Daily cleansing & replacement of dressings
* When indicated, systemic treatment with anti-staph antibiotic for at least 10 days
What are the likely causes of:
a. acute paronychia
b. chronic paronychia
a. Acute: usually s. aureus
b. Chronic: usually chronic dermatitis, sometimes with with C. albicans superinfection
How do you normally treat acute bacterial paronychia?
The pustule can be easily drained by lifting the nail fold with a sterile needle. Topical treatment with muciprocin is usually effective.
What are the characteristics of cellulitis?
* pain
* redness
* edema
* Blistering with progression
* lymphadenopathy
What is cellulitis?
Bacterial infection of the dermis and subcutaenous tissues.
What is erysipelas?
More superficial, well-demarcated infection (than cellulitis) with lymphatic streaking.
What is the usual pattern of erysipelas?
1. usually affectrs face
2. butterfly pattern of erythema
3. Well defined with a sharp edge
4. May be accompanied by lymphadenopathy, high fever & malaise
What are some known underlying causes of cellulitis?
1. Tinea of the feet
2. Lymphoedema
3. Chronic dermatitis
4. Poor lower leg circulation
5. Wounds
6. Herpes infection
7. Dental caries
8. Chronic sinus infection
What are some differential diagnoses for cellulitis?
* Stasis dermatitis
* DVT
* Erythema nodosum (lower legs)
* Contact dermatitis
Where do children often get cellulitis?
Periorbital.
How do you treat cellulitis?
Often oral antibiotics, however the following categories may need IV:
* obese pts
* diabetic pts
* lymphoedema
* post-animal bite
* post-surgical
* burns
* immunosuppressed pts
What is a simple cause of recurrent cellulitis that you should always look for?
Tinea of the feet.
What agent often is the cause of acute balanitis (often in uncircumcised males) and vulvovaginitis in children?
Strep pyogenes. May occur in conjunction with perianal lesions or in isolation.
What may cause a persistent perianal eruption in children?
Streptococcal perianal dermatitis. the rash is tender, itchy & may be accompanied by painful fissuring.
What are some agents which often cause otitis externa?
1. Staph aureus
2. Pseudomonas aeruginosa
3. Fungi e.g. c. albicans
How do you treat otitis externa?
* Swabs to determine if bacterial infection is playing a role + antibiotics if so
* Corticosteroid ear drops
What factors play a part in developing otitis externa?
1. Environmental: heat, humidity, swimming
2. Trauma (stop pt picking ear canal with cotton buds, hairpins etc)
3. Genetic/constitutional: shape of external auditory canal, type & amount of wax etc
What are some symptoms of otitis externa?
* Inflammation fo the outer ear canal epithelium
* Pain
* Itch
* Deafness
* Discharge
What is verruca vulgaris another name for?
Common wart.
What is molluscum contagiousum?
Common contagious DNA poxvirus infection. The virus is spread in water.
What are the 2 peaks in onset of molluscum contagiousum?
Children: 3-9 years
Young adults: 16-24
In the immunocompromised host, why might you biopsy what looks like molluscum contagiosum?
To determine whether it is in fact cryptococcosis or histoplasmosis.
What is a chemical therapy that might help in molluscum contagiosum (if you can't wait a couple of years for it to resolve by itself)?
Imiquimod.