Case 8: Jordu Flaisek Flashcards
(24 cards)
What is cellulitis? Common pathogens? S/Sx? Treatment? Complications?
- Spread of acute inflammation of dermis/subcutaneous tissue
- GAS, S. aureus, H. influenzae, P. aeruginosa
- Fever, chills, malaise, headache, tenderness, pain, erythema over affected area
- Oral/IV antibiotics (S. aureus-Cephalexin, S. pyogenes-Penicillin), high MRSA risk: Bactrim
- Sepsis, Post-strep glomerulonephritis, necrotizing fasciitis, meningitis
What is the role of Chuukese in Hawaii’s homeless population?
COFA (Compact of Free Association) allows Micronesians visa-free entry to US. Many migrate to escape Micronesia’s poor health & economic conditions, but they experience racism here. Unable to find jobs, so end up homeless. Majority of Micronesians are Chuukese
Tinea Pedis
Pathogens
S/Sx
Treatment
“Athlete’s foot”
- Dermatophyte (fungal) foot infection of feet that survives off keratin
- Trichopyton (rubrum, interdigitale), Microsporum, Epidermophyton (floccosum)
- White/green fungal growth btwn toes; fissuring/maceration; often seen with thickening/discoloration of toe nails, peeling/cracking/scale feet; itching/burning, foul odor
- Anti-fungal cream (Miconazole) or oral anti-fungals
Pharmacology of Cephalexin
- 1st generation cephalosporin with Beta-lactam microbial effects (like penicillin)
- Binds to PBP (transpeptidase)
- Inhibit final step in peptidoglycan synthesis on bacterial cell wall
- Cell wall weakened
- Bacterial cell lysis
- May also interfere with autolysin inhibitor to cause autolysis
Pharmacology of Trimethoprim-Sulfamethoxazole
“Bactrim” “TMP-SMX)
Poor GAS coverage
Contains trimethoprim & sulfamethoxazole
Sulfamethoxazole (sulfonamide, structural analog of PABA) competitively inhibits dihydropteroate synthase (humans have NO de novo folate synthesis)
-Decrease DHF synthesis
-Decrease purine and thymidine syn
Trimethoprim (structural analog of folic acid) inhibits DHF reductase (50k x more sensitive to bacteria than human)
-Decrease DHF to THF
-Decrease recycling of folic acid in bacteria
-Decrease thymidylate, purine nucleotide, amino acid synthesis
-Decrease nucleic acid/protein metabolism
Pharmacology Miconazole
Imidazole, antifungal
- Inhibits 14alpha demethylase of fungal cell
- No conversion of lanosterol to ergosterol
- Faulty membrane synthesis (destabilized)
- Leakage of cellular contents
- Cell lysis
Layers of skin
Epidermis (Stratum corneum, lucidum, granulosu, spinosum, basale)
Basement membrane (lamina lucida, densa)
Dermis
Subcutaneous tissue
Functions of skin
- Barrier to protect from environment, pathogens, injury
- Thermoregulation
- Neural sensation (pain, touch, temp)
- Immunologic function
- Endocrine organ (hormones, vitamin D, secretion of sweat/sebum)
Macule vs. Patch
Freckle
Circumscribed change in skin color that is flush with surrounding skin 1cm
Papule vs. Nodule vs. Tumor
Solid cystic elevations
Papule: 2cm
Plaque
Elevated lesion > 1 cm
Scale
Desiccated thin plates of cornified epidermal cells
Wheal
Circumscribed flat topped firm elevation of skin with well-demarcated and palpable margin
Vesicle vs. Bulla
Circumscribed elevated lesion with clear serous or hemorrhagic fluid < 1cm (vesicle) or >2cm (bulla)
Pustule
Vesicle containing purulent exudate
Staphylococcus aureus
ID
Virulence Factors
Gram +, Cocci, clusters, Catalase +, Coagulase +, B-hemolytic with golden hue
- Protein A: Attaches to Fc portion of IgG
- Coagulase: forms fibrin coat around organism
- Hemolysin/leukocydin: destroy RBC and WBC
- Hyaluronidase: breakdown CT
- Staphylokinase: lyse clots
- Lipase: breakdown fats
Trichuris Trichuria
Lifecycle
Whipworm Ingest embryonated eggs Eggs hatch into larval worms in small intestines Larvae migrate to cecum/large intestines Penetrate mucosa & develop into adults Females lay eggs after 3 months (3-10,000 eggs) Defecate on soil (feces containing eggs) Eggs mature (two cell stage, advanced cleavage) and become infectious over 3 weeks
Clinical presentation of Whipworm
Treatment
Mostly asymptomatic Heavy infections include: abdominal pain/distention Bloody diarrhea Acrid smelling stool Weakness Weight loss Anemia Treatment: Albendazole/mebendazole to inhibit microtubule synthesis, dysfunction of absorptive/secretory fx of nematode gut leads to death.
What are common health problems of homeless in Hawaii?
Approximately 5,000 in HI most of which are sheltered and on Oahu
- Exposure to communicable disease
- Malnutrition
- Respiratory infections
- STIs
- Trauma
- Substance Abuse
- Mental illness
- Chronic disease: HTN, diabetes, asthma
Waikiki Health Care-A-Van
2 vans that travel to 30 locations
Medical care, counseling, housing assistance, referrals, application help
Emergency food, hygiene, clothes
Next Step Shelter
Shelter, but also provides referrals, behavioral health, tobacco cessation, job training, housing placement assistance
HOME project
Hawaii Homeless Outreach Medical Education Project
-Student run clinic established in 2006
-Free, quality healthcare for homeless while increasing student/physician awareness
Medical (BP, sugar, eye/ear, labs,shots), Social/Dental referral
McGuire Fund
Est. 1988
Funds community projects, student research, and funds for patient (one time events)
Must have exhausted all attempts to find patient care funds elsewhere
Classic steps of wound healing
Blood clot
Regeneration of tissue via proliferation of residual cells & maturation of stem cells
If can’t be accomplished by regen
-Angiogenesis
-Form granulation tissue
Macrophages secrete cytokines (primarily TGF-b) which stimulates fibroblast migration/proliferation
Fibroblast deposition of ECM (CT)
Scar formation
Connective tissue remodeling (via MMPs that degrade ECM)
