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Dermatology - Clinical Medicine IV > Bacterial Skin > Flashcards

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

Mupirocin

Bactroban