Flashcards in Bacterial Skin Deck (65)
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1
What are the localized infections?
Folliculitis
Cellulitis
Erysipelas
Abscess
Impetigo
2
What are potentially lethal infections?
Necrotizing fasciitis
Clostridial myonecrosis (gas gangrene)
3
What is the treatment for impetigo?
may resolve on it own or progress to cellultitis or glomerulonephritis
4
What is the systemic abx for impetigo?
Dicloxacillin 250-500 mg po q4-6h x 5-10d
5
What is the topical meds for impetigo?
Mupirocin (Bactroban) – apply tid x 5-10d
6
What pt education do you need for give for impetigo?
hand washing, don't share towels, bed linens, wash lesions 2-3x a day or warm soaks
7
What are the general features of cellutitis and erysipelas?
varying degrees of skin or soft-tissue erythema, warmth, edema, and pain
associated fever and leukocytosis
history of trauma, abrasion, or skin ulceration (not reported by every patient)
8
How is celluitis on PE?
ill-defined border that merge smoothly with adjacent skin; usually pinkish to redish
9
What is erysipelas on PE?
elevated and sharply demarcated border with a fiery-red appearance
10
How do you dx celluitis and erysipelas?
clinically
11
What is the management of cellutitis and erysipelas?
local care - immoblize, elevate to reduce swelling
2 weeks of abx
-penicillin and dicloxacillin for most pt
12
What is the admission criteria for cellulitis?
Animal bite on patient’s face or hand
Area of skin involvement >50% of limb or torso, or >10% of body surface
Coexisting morbidity
(diabetes, heart failure, renal failure, generalized edema)
Edge of cellulitis advancing at rate >5cm/2 in, per hour
History of saphenous venectomy, pelvic surgery, pelvic irradiation, or neoplastic pelvic lymph nodes
(with lower extremity cellulitis)
Immunosuppression
Intolerance of oral or IM antibiotic therapy
Lack of response after 72 hours of oral therapy
Noncompliance with medication and follow-up visits
Purpuric or petechial rash, numbness at skin surface, or impaired tendon or nerve function
shock or disseminated intravascular coagulation
Signs and symptoms suggestive of bacteremia
Total WBC
13
What do you give for erysipleas most common?
pencillin V 500 mg po q6h
14
What do you give most common for cellulitis?
dicloxacillin 500 mg po q6h
15
What is inflammation of hair follicle that occurs as a result of various infections, or it can seconday to follicular trauma or occlusion?
Infectious folliculitis
16
What does infectious folliculitis looks like?
follicular based pustules, multiple small papules and pustules on an erythematous base that are pierced by a ccentral hair
17
What do deeper infectious folliculitis look like?
erythematous, often fluctuant, nodules
18
What orangism cause infectious folliculitis?
staphylococcus aureus
19
What is the topical treatment of infectious follicultis?
topical bactroban, dicloxacillin or cephalosporin first choice
20
What is chronic pustular staph infection of the beard?
pseudofolliculitis barbae
21
Who is pseudofollicuilits barbae more common in?
african americans
22
What is the treatment for pseudofollicultitis barbae?
skin cleanse, bacitracin, bactroban, erythro, diclox
23
What do you do for formed abscess?
I and D, give abx to immunocompromised (in real world give to all)
24
Streptococcal/Staph skin infection confined to epidermis
impetigo
25
infection of the skin and subcutaneous tissue. Flat lesions and edges are indistinct. Cause GAS
cellulitis
26
a type of cellulitis that is bright red, raised, with sharp borders.
erysipelas
27
What causes skin abscess?
s. aureus
28
What causes impetigo?
s. aureus, GAS
29
What are features of impetigo?
honey crusted lesions, kids get it, exposed areas, contagious
30
What are predisposing factors to impetigo?
poor hygiene, anemia, malnutrition, warm climates
31
What causes most cellulitis?
GAS and staph
32
How does cellulitis present?
boarders blend, redness, tender, deeper injury
33
Who can cellulitis be life threatening in?
immunocomp, DM, PV
34
What causes periorbital cellulitis in kids?
HIB
35
What does erysipelas require?
prompt tx
36
How does erysipelas spread?
superficial lymphatics
37
How does erysipelas appear?
confluent rash, sharply demarcated
abrupt with - fever chills pain
38
What is the tx for erysipelas?
pen or erythromycin, rest, elevation, warm compress
39
What does GAS cellulitis look like?
follow unnoticed injury, diffuse inflammation, spread on tissue planes
40
What does s. aureus cellulitis look like?
wound or pentrating trauma, local abscess becomes surrounded with cellulitis
41
What causes erysipelas?
GAS
42
What do you get when symptoms of toxicity or temp >102?
blood cultures
43
What do you give for penicillin resistant pt with cellulitis?
cephalexin 500 mg po qh6
clindamycin 450mg po qh6
cefazolin 1mg iv q8h
44
Where do you get hot tub folliculitis?
axillae, butt, trunk
45
How do you treat hot tub folliculitis?
self limiting
46
What does hot tube folliculitis look like?
follicular vesicular/pustular lesions
47
cluster of boils
carbuncle
48
What causes skin abscesses?
autoinoculation, immunosuppression, etoh, malnutrition
49
How do you tx skin abscess?
Dicloxacillin 250-500mg po q4-6h x 7-10d, erythromycin, cephalexin 500-1000 mg po qid 7-10d
50
Gangrenous cellulitis of the genitals
fournier's gangrene
51
What causes ecthyma gangrenosum?
pseudomonas
52
What causes toxic shock syndrome?
s. aureus, GAS
53
a clopolymicrobial infection, commonly caused by a mixture of anaerobic and aerobic bacteria
stridium species, enterobacteriaceae (E. coli, Enterobacter, Klebsiella, and Proteus species), and “flesh-eating” streptococci
necrotizing fasciitis
54
Where does necrotizing fasciitis start?
site on nonpenetrating trauma (a bruise)
55
Who are more prone to necrotizing fasciitis?
DM, PV, ETOH, IV drug use, immunosuppression
56
What does the infected area look like in necrotizing fasciitis?
swollen, erythematous, painful, warm, tender
rapidly advancing boarders
discoloration
57
How do you treat necrotizing fasciitis?
surgical debridement emergent
metronidazole+clindamycin+ceftriaxone
vancomycin+ piperacillin tazobactam/imipenem/meropenem/clinda
Ampicilin sulbactam + clinda + cipro
antibiotics for a minimum of 3 wks
58
What causes myonecrosis (gas gangrene)?
clostridium perfringens
59
What does myonecrosis look like?
gas, local edema, pain, fever
60
What is the incubation period for myonecrosis?
hr to days
61
What is the discharge like for myonecrosis?
serosanguinous, dirty, foul smelling
62
How do you treat myonecrosis?
IV vanco + zosyn/meropenem/clinda
surgical debridement of infected muscles
63
A Necrotizing Soft Tissue Infection caused by Pseudomonas in immunocompromised patients
ecthyma gangrenosum
64
How do you treat ecthyma gangrenosum?
antipseudomonal penicillin (piperacillin) should be used in conjunction with an aminoglycoside (gentamicin)
fluoroquinolones, third-generation cephalosporins, or aztreonam also effective
65
