Ulcerative Or Necrotic Lesions

Front 1

Foot puncture with tennis shoes.
Diagnosis?

Back 1

Burn or Wound Infections -
Ps. aeruginosa - foul green-pigmented discharge and necrosis; distant ecthyma gangrenosum indicated sepsis.

Front 2

Etiology of burns?

Back 2

Burns: S. aureus > Ps. aeruginosa, Proteus > GAS > other streptococci, Enterococci, Candida, Aspergillus

Front 3

Etiology of surgical wounds?

Back 3

S. aureus

Front 4

Etiology of prosthetic heart valves, artificial joints, plastic devices?

Back 4

Staph. epidermidis

Front 5

Etiology of Catheters in place >48hr?

Back 5

Gram - rods

Front 6

Therapy of burns or wound infections:
S. pyogenes and S. aureus?
Ps. Aeruginosa?

Back 6

S. pyogenes and S. aureus - Oral dicloxacillin
Ps. aeruginosa - Imipenem cilastatin

Front 7

A 3 year old child presents with purulent lesions and/or honey-crusted scabs around the nose and mouth.

Back 7

Impetigo

Front 8

Manifestations of Impetigo?

Back 8

Vesicles rupture > purulent erosions with honey-colored thick crusts

Front 9

Etiology of Impetigo?
Pathology?
Therapy?

Back 9

M protein type 49 with AGN
Infection usually limited to skin
Therapy - topical antibiotics

Front 10

While on a medical mission, several subjects are seen with pyoderma and ulcers of the face and arms. Some individuals show a severe pharyngitis. Skin scrapings show Gram-positive rods.

Back 10

Cutaneous Diphtheria

Front 11

Etiology of Cutaneous Diptheria?

Back 11

Corynebacterium diphtheriae

Front 12

Epidemiology of Cutaneous Diptheria?

Back 12

Transmitted by pharyngeal droplets, fomites or active skin infection (ulcers or normal appearing skin). Poor hygiene and warm climates increase infection rate.

Front 13

An adult who has handled raw rabbit flesh or a person bitten by a tick who presents with fever, skin ulceration and regional lymphadenopathy. Serolgy shows B. abortus titer.

Back 13

Tularemia

Front 14

Diagnosis of Tularemia?
Therapy?

Back 14

Cross reaction with B. abortus
Therapy: Gentamicin or Tobramycin

Front 15

Responses to bite ranges from mild local urticarial (hive like) reactions to full thickness skin necrosis. Nonpainful bite but can progress to painful. Site of bite is white with red halo; vesiculates and becomes necrotic, leaving a gaping ulcer. Location: hands, arms, lower extremities

Back 15

Loxoscelism (Brown spider bite)

Front 16

Epidemiology of Loxoscelism?

Back 16

Loxosceles reclusa, SOUTHEAST and MIDWEST

Front 17

The primary lesion usually develops at the site of a minor scratch or abrasion; hemorrhagic necrotic ulcer covered by a black crust or eschar (malignant pustule); Dissemination

Back 17

Cutaneous Anthrax

Front 18

Etiology of Anthrax?
Epidemiology?

Back 18

Etiology: Bacillus anthracis
Epidemiology: Spores are commonly found on animal skins, hides, or bone meal. Inoculation anthrax is commonly limited to skin.

Front 19

Pathology of cutaneous anthrax?
Therapy?

Back 19

3 factors of pathology: 1) Edema factor 2) Protective antigen (induces protective antibodies) 3) Lethal factor
Therapy: Ciprofloxacin

Front 20

Red macules enlarge becoming slightly elevated papules, then hemorrhagic and necrotic centrally with purple to black coloration. Older lesions are ulcers with a hemorrhagic crust or eschar. Concurrent Gram-negative sepsis.

Back 20

Ecthyma Gangrenosum

Front 21

Epidemiology of Ecthyma Gangrenosum?
Therapy?

Back 21

At risk: immunocompromised
Therapy: Imipenem and Meropenem (Pseudomonas)

Front 22

A primary or herald lesion, occurs at bite site 1-2 weeks. Black eschar forms and inflammation is intense in the deeper layer of the dermis, where necrosis occurs. A generalized vesicular/papular rash occurs evenly distributed over the body except for the palms, soles, and mucous membranes.

Back 22

Rickettsialpox

Front 23

Etiology of Rickettsialpox?
Therapy?
Contraindicated?

Back 23

Rickettsia akari (obligate intracellular bacterium)
Therapy: Doxycycline
Contraindicated: Sulfonamides

Front 24

Epidemiology of Rickettsialpox?

Back 24

A benign urban disease that occurs when the mouse popularion increases to an unusually high level disease. Involves mainly adults, transmitted to man by a MITE

Front 25

Papule, which ulcerates, becomes granulomatous. Location: knees, elbows, extremities at site of inoculation

Back 25

Swimming pool granuloma (atypical mycobacterial infections)

Front 26

Etiology of swimming pool granuloma?
Diagnosis?

Back 26

Mycobacterium marinum, M. kansasii, M. intracellulare
Diagnosis: Acid fast stain, culture at 37 degree and 32 degree C; skin test with PPD

Front 27

Epidemiology of Swimming pool granuloma?

Back 27

M. marium most common in the US; fresh or salt water, contaminated swimming pools, or from cleaning a home aquarium

Front 28

Later, multiple painless, red to violet ulcerated nodules develop along lymphatic channels that drain the initial lesion.

Back 28

Sporotrichosis (Rose growers disease)

Front 29

Etiology of Sporotrichosis?
Pathology?

Back 29

Sporothrix schenckii
Lesions appear 7 days to 6 months after puncture wound inoculaton. Microscopy shows cigar shaped yeast

Front 30

Epidemiology of Sporotrichosis?
Therapy?

Back 30

Transmitted by puncture wounds that inoculate dust. ie: rose thorn punctures. AT RISK: gardeners, farmers, florist
Therapy: Oral itraconazole

Front 31

A variety of lesions including cellulitis, pustules, abscesses and ulcerated nodules.

Back 31

Primary cutaneous nocardiosis

Front 32

Papules or nodules on the foot or hand slowly progress to indurated skin and soft tissue swelling with multiple sinus tracts draining sulfur granule filled pus

Back 32

Mycetoma (Nocardiosis)

Front 33

Etiology of Nocardiosis?

Back 33

Nocardia

Front 34

Epidemiology of Nocardiosis?

Back 34

Spores introduced from soil into skin by trauma

Front 35

Diagnosis of Nocardiosis?

Back 35

Weakly GRAM POSITIVE and weakly ACID-FAST POSITIVE, beaded, branching filaments, AEROBIC culture

Front 36

Subcutaneous indurated tissue containing multiple, small, communicating abscesses surrounded by granulation tissue from sinus tracts that communicate to the skin and drain a purulent discharge containing yellow sulfur granules.

Back 36

Actinomycosis

Front 37

other manifestations of actinomycosis?

Back 37

ongoing infections of the jaw, pelvis, lung or GI tract are the source of the skin lesion

Front 38

Etiology of Actinomycosis?
Diagnosis?

Back 38

Actinomyces israelii
Dx: Branched and unbranched wavy filaments or as the distinctive sulfur granules. These consist of a central mass of tangled bacterial filaments, pus cells, and debris.

Front 39

Pustular, papular, nodular, or ulcerated lesions, sometimes resembling acne, molluscum contagiosum, or basal cell carcinoma. Most patients with this disease have meningitis and/or pulmonary disease

Back 39

Cryptococcosis

Front 40

Etiology of Cryptococcosis?
Epidemiology?

Back 40

Cryptococcus neoformans
Worldwide distribution, associated with pigeon droppings. Infection results from inhalation of soil contaminated with the encapulated yeast.

Front 41

Pathology of Cryptococcosis?
Diagnosis>

Back 41

Patholgy: Involved tissues contain cystic masses of yeast that appear gelatinous because of accumulated cryptococcal capsular polysaccharide.
Diagnosis: Culture

Front 42

Cutaneous and Mucocutaneous Leishmaniasis: types?

Back 42

Old World Cutaneous (oriental sore, Delhi or Aleppo boil)
NW C (tropical sore, uta, chiclero ulcer, bay sore, forest yaws)
New World Mucocutaneous (espundia)

Front 43

Cutaneous Leishmaniasis manifestations?

Back 43

Furuncle like nodule which ulcerates; red raised area around the ulcer enlarges for 2-3 months, heals leaving scar

Front 44

Mucocutaneous Leishmaniasis manifestations?

Back 44

Produces similar lesions as the cutaneous version, but can metastasize to nasopharyngeal tissues, up to several years later and cause gross mutilations of the nose and palate.

Front 45

Epidemiology of Cutaneous Leishmaniasis?

Back 45

Endemic to the Mediterranean and Middle East, Asia, Africa, Central and South America (extending north to Mexico and SC Texas)

Front 46

Epidemiology of Mucocutaneous Leishmaniasis?

Back 46

Disease is limited to the new world. THe SANDFLY vector is infected by biting humans or animals. Outbreaks of cutaneous leishmaniasis have occurred among US military personnel operating the Middle East.

Front 47

Diagnosis of Leishmaniasis?

Back 47

Leishmanin Skin Test

Front 48

Papule which ulcerates, giving rise to large ulcer with round paillomatous or vegatative surface. Elevated, papillomatous, crusted lesion resembling a rasberry and may enlarge to several centimeters, forming an ulcerative mass. Location: Site of inoculation (an area of abrasion or gnat bite), generally below knees

Back 48

YAWS (Frambesia)

Front 49

Etiology of YAWS?

Back 49

Treponema pallidum pertenue

Front 50

Epidemiology of Yaws?

Back 50

Humid equatorial countries. Transmission-scany clothing, poor hygiene, and skin trauma

Front 51

Deep destructive ulceraton (infectious necrotizing panniculitis) at the site of inoculation, usually the arms and legs.

Back 51

Buruli Ulcers (Mycoburuli ulcers)

Front 52

Etiology of Buruli Ulcers

Back 52

Mycobacterium ulcerans...only grows below 37 degrees

Front 53

Epidemiology of Buruli Ulcers?

Back 53

An ulcer of the skin and underlying tissue is the sole symptom due to the temperature requirements of the organism. Common along the Nile River, also found in W. Africa, SE Asia, Australia, and Mexico. Strongly linked to the aquatic ecosystem, transmitted by water and possibly insects

Front 54

Pathology of Buruli ulcers?

Back 54

Polyketide mycolactone.