Dermatology - Bacterial Skin Infections Flashcards
(139 cards)
1
Q
Pustules
Furuncls
Erosions with honey colored crusts
A. Gram (+) cocci
B. Gram (-) cocci
A
A. Gram (+) cocci
2
Q
Indicators of Staphylococcus aureus infection
A
Bullae
Widespread erythema
Desquamation (scaling and crusting)
Vegetating pyodeermas
3
Q
Confluence of pustules
A
Pyodermas
4
Q
Indicated by a purulent purpura
Caused by S. Aureus or immunocompromised ptx infected with S. Epidermidis
A
endocarditis
5
Q
Painful, erythematous nodule with pale center located ion the fingertips
A
Osler node
6
Q
3 signs of endocaditis
A
Purulent purpura
Osler node
Janeway lesion
7
Q
Nontender, angular hemorrhagic lesion of the palms and soles
A
Janeway lesion
8
Q
Janeway lesion is likely to be due to
A
Septic embolic
9
Q
Normal habitation of S. Aureus
A
Anterior nares (20-40%)
Hands
Perineum
10
Q
Spread of S. Aureus in the hospital is frequently traced to
A
Hands of a healthcare worker
11
Q
Is essential in limiting nosocomial complication of S. Aureus
A
Proper handwashing
12
Q
PF to MRSA
A
Age (older thna 65)
Exposure to others with MRSA
Prior antibiotic therapy
Recent hospitalization or chronic illness
13
Q
Tx MRSA
A
IV vancomycin
Linezolid
14
Q
Ptx with no RF for MRSA
Tx of S. Aureus infection
A
Clindamycin
Trimethoprim - sulfamethoxazole (alone or w/ rifampin)
Minocycline
Oral linezolid
15
Q
Mamaso
A
Impetigo
16
Q
Tagalog word for Impetigo
A
Mamaso
17
Q
T/F
Impetigo
Common contagious superficial skin infection
A
T
18
Q
Impetigo
Does it scar?
A
No
19
Q
RF for impetigo
A
Any spontaneous or induced lesions may become secondarily infected
20
Q
Causative agents
A
Staphylococci -
Streptococci
Combination of both
21
Q
What is the specie isolated from majority of lesions in both bullous and nonbullous impetigo
A. Staphylococci
B. Streptococci
A
A. Staphylococci
22
Q
Now known as the primary pathogen to both bullous and nonbullous impetigo
A
S. Aureus
23
Q
Produces an epidermolytic toxin that lyses the desmosomes which chemically split the epidermis
A
S. Aureus
24
Q
S. Aureus
What causes the blister formation
A
Epidemolytic toxin
25
Start as oozing erosion, or transient thin-roofed vesicle which inc. in size rapidly that develop honey colored crust
Thought to be primarily streptococcal dse (now staphylococcal)
Non-bullous impetigo
26
Age demographic common to have bullous impetigo
Infants
27
Staphyloccocal disease
Lesions are vesicles (fluid filled <5 mm) and bullae (>5mm) on bland, non-inflamed skin
Dried, collapsed roofs of vesicles cover very superficial erosions
Bullous impetigo
28
Consitutional sx
| Bullous impetigo
Initially absent
Later, weakness, fever, subnormal tempetrature
Diarrhea with green stools
29
Bullous impetigo complication
Bacteremia
Pneumonia
Meningitis
Develop rapidly with fatal termination
30
Tx and management impetigo
Lesions sprinkled with penicillin -dangerous because hypersensitivity rxn may develop
Moist, weeping lesions - cream
Dry - ointment
Keep injured area clean
1. Gentle washing
2. Antibacterial soap
3. Soaks or compresses (PNSS)
Gentle debridement with fingers or gauze after soak
Topical antibiotic - Mupirocin, Gentamicin
widespread and resistant - cloxacillin
31
Tx widespread and resistant cases impetigo
Cloxacillin
32
Impetigo of Bockhart
Superficial pustular folliculitis
33
Superficial pustular folliculitis
Impetigo of Bockhart
34
Superficial folliculitis with thin-walled pustules at the follicle orifices
Superficial pustular folliculitis
35
Favorite locations of Superficial pustular folliculitis
Extremities
Scalp
Face (periorally)
36
Fragile, yellow-white, domes pustules develops in crops and heal in a few days
Superficial pustular folliculitis
37
Most frequent cause of Superficial pustular folliculitis
S. Aureus
38
Superficial pustular folliculitis secondarily arises in
Scratches, insect bites, other skin injuries
39
Sycosis barbae
Sycosis vulgaris
40
Formerly known as barber’s itch
Sycosis barbae
41
A perifollicular, chronic, pustular staphylococcal infection of the bearded region
Sycosis vulgaris
42
Inflammatory papules and pustules and tendency to recurrence
Begins with erythema and burning or itching usually on the upper lip near the nose
In a 1-2 days, one or more pinhead-sozed pustules pierced by hairs develop
Sycosis vulgaris
43
There pustules rupture after shaving and leave a crop of erythematous spot, which is later the site of fresh crop of pustules, in this manner the infection persists and gradually spreads
Sycosis vulgaris
44
With severe cases of sycosis barbae, what other disease is usually present
Marginal blepharitis with conjunctivitis
45
Inflammation of eyelids in which they become red, irritated, and itchy, and dandruff-like scales form on the eyelashes
Blepharitis
46
Diffrential diagnosis for sycosis vulgaris
Tinea barbae
Acne vulgaris
Pseudofolliculitis barbae
Hepetic sycosis
47
Common location for sycosis
| Not usually affected by tinea barbae
Sycosis barbae
48
Usual area affected by tinea barbae
Submaxillary region, or on the chin (beard area)
49
Spores and hyphae are found in the hairs
Tinea barbae
50
Manifests topid papules at the sites of ingrowing beard hairs in black men
Pseudofolliculitis barbae
51
Differential diagnosis for sycosis barbae caused by herpes simplex type 1
Herpetic sycosis
52
Herpetic sycosis caused by
HSV-1
53
Vesicles that lasts for a few days in the beard area
Herpetic sycosis
54
Tx sycosis vulgaris
Oral and topical antibiotics
Corticosteroids
Antifungal agents
55
Diagnosis sycosis barbae
Request gram stain
56
Inflammation of hair follicles
| Caused by bacterial infection, chemical irritation, physical injury
Folliculitis
57
Does folliculitis heal without scarring?
Depends on its depth of infection
58
Painless or tender pustule that heals without scarring
Folliculitis
59
Painless or tender pustule that heals without scarring
| Dirty yellow or gray erythema
Folliculitis
60
Pustule is confined to the ostium of the hair follicle
Folliculitis
61
Involves the sweat ducts
| Folliculitis
Milliaria
62
Folliculitis
| Involves the sebaceous glands wherin secretions come off the hair follicles
Millia
63
The pustule is not associated with hair follicle
Milliaria pustulosa
64
Folliculitis infection with Staphylococcus in the face
Folliculitis barbae
65
Folliculitis in the scalp of legs
Follicular impetigo
66
It causes red sores that can break open, ooze fluid, and develop a yellow-brown crust. These sores can occur anywhere on the body.
Impetigo
67
Impetigo affects this age group very often
Impetigo
68
Folliculitis in the trunk caused by pseudomonas aeroginosa
Hot tub folliculitis
69
Hot tub folliculits is caused by
Pseudomans aeroginosa
70
Back folliculitis
reaches young children and usually follows the miliaria, with inflammatory nodules or superficial pustules that eventually drain pus.
Periporitis suppurativa
71
in this case the infectious process leads to atrophy of the hair, leaving bald patches that extend due to peripheral progression of the disease.
Folliculitis decalvans
72
Gram + cocci in clusters
Staphylococcus
73
Gram + cocci in pairs/chains
Streptococcus
74
Folliculitis considerd to be a sexually transmitted disase
Miniepidemics of folliculitis nd
| Furunculosis of genital and gluteal areas
75
Tx of folliculitis
Heal with drainage (deep lesions of folliculitis) and topical tx
Removal of exciting agents 3 times a day with antibacterial soaps
Topical antibiotics
Systemic antibiotics
76
Topical antibiotics used for folliculitis
Mupirocin (Bactroban)
Retapamulin - non responsive to mupirocin
Fusidic acid
77
Folliculitis
If drainage fail/ soft tissue infections
Tx
Systemic antibiotic
78
Systemic antibiotic for Folliculitis
1st generation cephalosporin ( IV cephazolin, cephalothin; Oral: Cephalexin, cephradine, cefadroxil)
Penicillinase resistant penicillin
(Cloxacillin, dicloxacillin)
79
Aqueous solution of aluminium triacetate. It jas astringent and antibacterial properties.
Burrow’s solution
80
When folliculitis is acute and wet tx
Soak with burrow’s solution diluted 1:20
81
Chronic folliculitis esp. for buttocks
Anhydrous formulation of aluminium chloride (can be used once a night)
82
Pigsa
Furuncle
83
Acute, deep-seated, erythematous, hot, very tender inflammatory nodule
Furuncle
84
Evolves from staphylococcal folliculitis
| Deeper lesion
Furuncle
85
Boil
Furuncle
86
Acute, round, tender, circumscribed, perifollicular staphycoccal abscess that generally ends in central suppuration
Furuncle, boil
87
2 or more confluent furuncles, with separate heads
Carbuncle
88
PR for furuncle
Chronic staphyloccocal carrier states in nares or perineum
Intergrity of the skin surface - irritation, pressure, friction, hyperhidrosis, dermatitis, dermatophytosis (tinea), shaving
Systemic disorders- alcholism, manutrition, blood dyscrasias, disorder neutrophil function, iatrogenic or other immunosuppression, AIDS, diabetes
Obesity
Bactericidal defects
Scabies, pediculosis, abrasions
89
hard nodule -> fluctuant abscess with central necrotic plug -> rupture -> ulceration -> scarring
Furuncle
90
Bright red, indurated round plaque
Isolated single lesions or few multiple lesions (Scattered discrete)
Occurs only where there are hair follicles and in areas subject to friction and sweating
Furuncles
91
Areas commonly affected by furuncles
```
Nose
Neck
Face
Axilla
Buttocks
```
92
Lab examination for a suspected furuncle
Incision and drainage of abscess (gram stain, culture, antibiotic sensitivity)
Blood culture - fever, constitutional symptoms
93
Tx of simple furunculosis
Local application of heat (15-20 mins)
| Incision and drainage (if antibiotics failed)
94
Tx furunculosis with surrounding cellulitis or fever
Systemic antibiotics for 1-2 weeks
Penicillinase- resistant penicillin (cloxacillin, dicloxacillin) or
1st generation cephalosporin orally dose of 1-2 g/day according to severity of case
95
Type of furunculosis difficult to tx
Recurrent furunculosis
96
May be related to persistent staphylococcus in the nares, perineum, and body folds
Type of furunculosis
Recurrent furunculosis
97
Tx for Recurrent furunculosis
Frequent bathing, germicidal soap
Antibacterial ointments
(Bactroban - anterior nares daily or 5 days, bleach baths prevent recurrence)
Oral antibiotic until all lesions have resolved, and as a OD prophylactic dose for many months
98
Bakokang / piso piso
Ecthyma
99
Uncerative impetigo
Ecthyma
100
Ulcerative staphylococcal or streptococcal pyoderma, (usually) of the shins and dorsal feet
Ecthyma
101
Lesion of neglect
Ecthyma
102
Ecthyma develops in
Minor trauma
Insect bites
Excoriations
103
Etiology ecthyma
Group A beta-hemolytic streptococci (GAHBS)
Staphylococci
Both
104
Disease begins with a vesicle, or vesicopustule which enlarges in a few days becomes thickly crusted.
When crust is removed, there is a suprficial saucer-shaped ulcer with a raw base and elevated edges
Ecthyma
105
PF for ecthyma
Uncleanliness
Malnutrition
Trauma
106
```
Round, oval 0.5 to 0.3 cm
Indurated ulcer
Dirty yellowish-gray crust
Pruritus and tenderness
Located on the lower extremities
Last for weeks
```
Ecthyma
107
Tx ecthyma
Cleansing with soap, water, followed by application of mupirocin, retapamulin, bacitracin ointment twice a day
```
Systemic tx is usually indicated
Cloxacillin
Dicloxacillin
Erythromycin ( for sensitive S. Aureus)
Clindamycin (MRSA)
```
108
Ecthyma MRSA tx
Clindamycin
109
Ecthyma same supportive management as
Impetigo
Gentle washing, antibacterial soap
Soaks or compresses
Gentle debridement with fingers or gauze after soak
Moist lesions - use cream
Dry lesions - ointment
110
Acute spreading infection of the dermis and subcutaneous tissue
Cellulitis
111
Cellulitis
| Caused most frequently by
S. Pyogenes or S. Aureus
112
Most common portal of entry of cellulitis
Tinea pedis
113
Cellulitis accompanying sx and signs
Mild local erythema and tenderness, malaise, chilly sensations,sudden chill and fever may be present at onset
114
```
Erythematous, hot edematous
Very tender
Vary in size nad shape
Borders are usually sharply defined, irregular, slightly elevated
Associated with lymphangitis
```
Cellulitis
115
Can form on the plaques and primary lesions of cellulitis
Vesicles, bullae, erosions, abscesses, hemorrhage, necrosis
116
Kolebra
Erisypelas
117
Also known as St. Anthony;s fire and ignis sacer
Erysipelas
118
Acute, superficial inflammatory form of cellulitis
Involves superficial dermal lymphatics (streaking prominent)
Painful
Margins more clearly demarcated than normal skin
More superficial
Erysipelas
119
What makes erysipelas differ from other types of cellulitis
Involves superficial dermal lymphatics (streaking prominent)
Margins more clearly demarcated than normal skin
More superficial
120
Cause of erysipelas
Acute beta hemolytic group A streptococcal infection
| Group B in newborn, abdominal or perineal erysipelas in postpartum women
121
Characterized by local redness, heat, swelling, highly characteristic raised indurated border
Erysipelas
122
Erysipelas often preceded by prodromal sx of
Malaise for several hours
| Severe constitutional rxn with chills, high fever, headache, vomiting, joint pains
123
Early stages Erysipelas, affected skin is
Scarlet
Hot to touch
Branny and swollen
124
Distinctive feature of the inflammation is the advancing edge of the patch
This is raised and sharply demarcated, feels like a wall to the palpating finger
Often painful
Erysipelas
125
Sites of predilection
| Erysipelas
Lower legs -edema and bullous lesions, spreads centrally
Face - cheek, near the nose, in front of the lobe of the ear and spreads upward toward the scalp, hairline (usually) acts as a barrier against further extension
Ears
Umbilical stump
Areas of pre-existin lymphedema
126
PR
| Erysipelas
```
Operative wounds
fissures - nares, auditory meatus, under the lobes of the ears, anus, penus, between an under toes (little toe usually)
Abrasions or scratches
Venous insufficiency
Obesity
Lymphedema
Chronic leg ulcers
```
127
Tx Erysipelas
Systemic penicillin - rapidly effective (24-48 hours)
Vigorous tx with antibiotics - continued 10 days
Locally, ice bags, cold compresses may be used
Leg involvement - likely require hospitalization with IV antibiotics
128
H. Influenza cellulitis mainly in (age)
Young children <3 years old
129
Most common sites of H. Influenza cellulitis
Most common : cheek, periorbital area, head and neck
130
Ecthyma gangrenosum caused by
P. Aeuroginosa
131
Most common site of Ecthyma gangrenosum
Extremity
132
Ecthyma that rapidly becomes necrotic, leads to ulcer
Ecthyma gangrenosum
133
Rapidly progressive
| Extensive necrosis of subq tissue and overlying skin
Infectious gangrene
134
Etiology infectious gangrene
Group A beta-hemolytic Streptococcus pyogenes
| S. Aureus
135
Etiology of infectious gangrene
| Adults with underlying disease
```
Clostridium septicum
P. Aeruginosa
E. Coli
Acinetobacter
Pasteurella multocida
H. Influenza
enterobacter
Proteus mirabilis
```
136
Etiology of infectious gangrene
| Children
H. Influenza
Group A streptococci
S. Aureus
137
Transmission infectious gangrene
Break in the skin (puncture, abrasion, laceration, surgical site)
Underlying dermatosis (tinea pedis, stasis dermatitis/ ulcer)
Nasal fissures
138
RF infectious gangrene
```
Diabetes mellitus
Hematologic malignancies
IV drug use
Immunocompromise
Chronic lymphedema
```
139
Tx infectious gangrene
Oral antibiotics
| Wound care - debridement
