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Senior - Derm 3 > 11 - Bacterial Infections Of Skin > Flashcards

11 - Bacterial Infections Of Skin Flashcards

1
Q

List of bacterial infections of skin

A 
Impetigo
Erysipelas
Cellulitis
Slistering distal dactylitis
Folliculitis
Sycosis barbae
Furnicle
Pseudomonas folliculitis and cellulitis
Trichomycosiasis axilaris 
Erythasma 
Pitted keratolysis
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2
Q

What accounts for the maj of skin and soft tissue infections?

A

Staphylococcus aureus and group A beta-hemolytic streptococci

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3
Q

S. Aureus causes?

A

Invades the skin and causes

  • impetigo
  • folliculitis
  • cellulitis
  • furuncles
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4
Q

Elaborations of S. Aureus causes?

A

Leasions of bullous impetigo and SSSS

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5
Q

What does group A beta hemolytic strep cause?

A

Impetigo
Erysipelas
Cellulitis
Lymphangitis

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6
Q

Beta hemolytic strep causes?

A

Non bullous impetigo

Aka impetigo contagiosum

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7
Q

Progression of beta hemolytic strep - non bullous impetigo?

A

Starts as stratum corneum pustule or vesicle -> ruptures to expose a red moist base

Progresses to adherent “honey crusted” weeping lesions

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8
Q

Pt population for beta hemolytic strep - non bullous impetigo?

A

Kids 2-5
Warm moist climate
Poor hygeine

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9
Q

Beta hemolytic strep - non bullous impetigo often comes with?

A

Staph

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10
Q

Non derm symptom of beta hemolytic strep - non bullous impetigo?

A

regional LAD

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11
Q

Tx for beta hemolytic strep - non bullous impetigo?

A

Cool or warm soaks (remove crust)

Control infection (bactroban)

Systemic abx prn
- doxy

Dressing to prevent spread

Isolate pt

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12
Q

Beta hemolytic strep - eryspelas is aka?

A

St. Anthony’s fire

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13
Q

What is erysipelas?

A

Superficial cellulitis of lymphatics

  • erythema
  • edema
  • pain

Seen on: (2/2 vascular insufficiency)

  • face
  • ears
  • legs
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14
Q

Presentation of Erysipelas?

A

Lymphatic cellulitis

Prodrome

Slightly raised plaque w sharp demarcation

Red, warm, tender

ILL w malase, fever, nodes

WBC elevated

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15
Q

Tx for erysipelas?

A

Systemic abx
- oral
- IV
Cephelexin, diclox etc

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16
Q

cellulitis?

A

infection that extends into sub Q

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17
Q

Etiology of cellulitis?

A

GABHS (MC)
Staph
H. Flu (kids <2)
Pseudomonas (DM)

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18
Q

Where does cellulitis present?

A

Usually areas compromised by stasis/lymphedema

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19
Q

cellulitis presentation?

A
  • erythema, edema, TTP (diffuse)
  • no sharply defined border
  • red streaks w swollen nodes
  • vesicles or bullae
  • dusky red skin
  • constitutional ssx
  • H WBC
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20
Q

cellulitis tx?

A

Cool compress
Elevation

Outpatient
- dicloxacillin, cephalexin
Inpatient
- IV Nafcillin
- IV vancomycin

Pesudomonas (DM)
- aminoglycosides

H. Flu
- cephalosporins

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21
Q

blistering distal dactylitis is?

A

Superficial infx of anterior fat pad of fingertips

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22
Q

blistering distal dactylitis is MC seen in?

A

Kids 2-16

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23
Q

Progression of blistering distal dactylitis ?

A

Faint erythema, Vesicles to oval 1-3cm bullae and exfoliation

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24
Q

Tx for blistering distal dactylitis?

A

I/D

Oral (anti-strep) abx x 10 days

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25
Carriers of strep like to keep it?
Nasal Axilla Groin Perianal area
26
MC secondary invader?
Staph aureus
27
Constitutional symptoms w Staph?
Nope
28
Staph toxin?
Epidermolytic toxin as in SSS or bullous impetigo
29
Staph aureus - bullous impetigo
Caused by toxin release in epidermis -> cleaving | - staph only (usually)
30
Bullous lesions are?
Less exudative crusting - 1 or more vesicles enlarged rapidly to form bullae - turn from clear to cloudy
31
Describe bullous impetigo?
Bullous lesion where the center collapses and leaves a TUBE-LIKE RIM HONEY CRUST at center - removal leaves bright red, moist base, that oozes She said “youre taking the inter-tube down the staph river”
32
Tx for bullous impetigo?
Strict hand washing Warm/coal soaks (remove crusts) Muciprocin ointment Systemic abx PRN
33
What is SSSS?
Staph scalded skin syndrome | - more diffuse form of bullous impetigo
34
What is folliculitis?
Inflammation of hair follicle Typically caused by infection, chemical irritation, or physical injury Think makeup, motor oil, steroid therapy
35
MC form of infectious folliculitis?
Staph folliculitis | - comes from the nose
36
Folliculitis workup?
Culture | - scrape and put on cotton swab
37
Tx for folliculitis?
Removal of occlusion/irritants etc Good skin hygiene Benzyol peroxide Systemic abx
38
Long term scalp folliculitis?
Treat for folliculitis decalvans
39
What is sycosis barbae?
Inflammation of entire follicle - staph impetigo of beard - spread by razor
40
Tx for syscosis barbae?
Same as staph impetigo - bactroban - oral abx prn
41
Severe sycosis barbae?
Eval for dermatophyte infx | - remove hair for culture
42
Furncle vs carbuncle?
Furuncle - boil/abscess - walled off collection of pus - painful - firm - fluctuant mass Carbuncle - multi furncles Furry uncles get together and get in a car...
43
Where do furuncles and carbuncles present?
Friction prone or traumatized areas - thighs - buttocks - groin - axillar - waist
44
Tx for furuncle/carbuncle?
Primary: I/D - moist heat to localize/spontaneously rupture (can also ease I/D) Systemic abx prn - not usually necessary
45
MRSA?
Consider w recurrent furnculosis - mupirocin - chlorhexidine/bleach baths
46
Abx for MRSA?
Septra | Clindamycin
47
Ecthyma?
Jungle sores | - like impetigo but worse
48
Ecthyma lesion?
``` Localized Thick Crusted Exudative Tumor-like lesion ``` Ulcers w crust Heals w scar Common on legs
49
Ecthyma tx?
``` Warm/coal soaks (remove crust) Good hygiene Dry dressing Mupirocin Dicloxacillin Cephalexin ```
50
This gram neg organism is not part of the normal flora?
Pseudomonas aeruginosa Seen in sugar aids pts
51
Pseudomonas aeruginosa causes?
Green pigment - pyoverdin - seen on wood light - light green Fruity, grape like odor
52
Pseudomonas folliculitis is aka?
Hot tub folliculitis
53
Presentation of pseudomonas folliculitis?
Hx of hot tub 8hrs-5 days ago Often seen on bathing suit lines Multiple pruritic, round, urticarial plaques w/ central papule or pustule Malaise w low grade fever
54
So i got drunk and got in a hot tub, what now?
Showering will not help so, just pray i suppose Fortunately its usually a self-limiting disease (7-10 days)
55
Tx for pseudomonas folliculitis?
``` Antihistamine - hydrozyzine (atarax) PRN Vinegar soaks (acetic acid) Domeboro’s Burrows ``` Ciprofloxacin if severe
56
Pt population for pseudomonas cellulitis?
Debilitated sugar aids pt
57
pseudomonas cellulitis is?
``` 2/2 infasion of tinea of toe webs or groin Bed sores Stasis ulcers Burns Grafted areas Under foreskin Or following injury ```
58
pseudomonas cellulitis is encouraged by?
Occlusion and or suppression of normal flora w broad spectrum abx Seen in swampy environment
59
pseudomonas cellulitis can also be found?
Around ear | - due to external otitis
60
pseudomonas cellulitis tx?
DM - blood sugar - watch for sepsis Acetic acid Domeboro (aluminum acetate) Systemic abx - oral cipro - IV aminoglycosides Severe inf - clindafloxacin IV
61
Pseudomonas toe web infection?
Between 4th and 5th toe Caused by moisture Thick white macerated skin Green fluoresence (woods light)
62
Pseudomonas toe web infection commonly mixed w?
Candida Or other bacteria
63
Pseudomonas toe web infection txt?
Keep clean and dry - sandals Acetic acid soaks Drysol (aluminum chloride)
64
What is trichomycosis axillaris?
Corynebacterium infection of the hair of the axilla
65
Describe trichomycosis axillaris?
Whitish or colored hair Associated w heavy sweating Malodorous (very)
66
Tichomycosis axillaris txt?
``` Shave area Topical erythromycin Topical naftifine (naftin) Control hyperhidrosis - antiperspirants - drysol ```
67
What is naftifine (naftin) normally used for?
It is for superficial fungal (tinea) | Also has antibacterial properties
68
MC site for erythrasma - C. Minutissimum?
4th interdigital space
69
Other sites for erythrasma - C. Minutissimum?
Bilateral inguinal Axillae Inframammary fold
70
Describe erythrasma - C. Minutissimum?
Macular Brown-red Scaly Noninflammatory Itches Burnes Looks like T. cruris
71
Hwo to differentiate T. Cruris from C. Minutissimum?
KOH | Woods lamp
72
What does C. Minutissimum look like under a woods lamp?
Coral red fluorescence | - due to porphyrins produced by organism
73
Tx for erythrasma?
Keep clean and dry Systemic (pick one) - erythromycin - clarithromycin Topical (pick one) - erythromycin - clindamycin - miconazole - clotrimazole
74
Your pt presents with multiple 1-3mm pits to wt bearing areas of the feet
Pitted keratolysis
75
What causes pitted keratolysis
caused by micrococcus sedentarius which produces an enzyme that digests keratin
76
Symptoms of pitted keratolysis
1-3 mm pits to wt bearing areas Hyper hydrosis Malodor Sliminess of skin
77
Pitted keratolysis is associated with?
The tropics | Occlusive footwear
78
Pitted keratolysis tx?
Clean daily Promote dryness Change socks Rotate footwear Drysol (20% aluminum chloride) Topical ( pick one) - erythromycin - Clindamycin - mupirocin Oral (alternate treatment) - erythromycin
79
What do you get from a pampered cow?
Spoiled milk

Senior - Derm 3 (7 decks)

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