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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
Q

Carriers of strep like to keep it?

A

Nasal
Axilla
Groin
Perianal area

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26
Q

MC secondary invader?

A

Staph aureus

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27
Q

Constitutional symptoms w Staph?

A

Nope

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28
Q

Staph toxin?

A

Epidermolytic toxin as in SSS or bullous impetigo

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29
Q

Staph aureus - bullous impetigo

A

Caused by toxin release in epidermis -> cleaving

- staph only (usually)

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30
Q

Bullous lesions are?

A

Less exudative crusting

  • 1 or more vesicles enlarged rapidly to form bullae
  • turn from clear to cloudy
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31
Q

Describe bullous impetigo?

A

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”

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32
Q

Tx for bullous impetigo?

A

Strict hand washing
Warm/coal soaks (remove crusts)
Muciprocin ointment
Systemic abx PRN

33
Q

What is SSSS?

A

Staph scalded skin syndrome

- more diffuse form of bullous impetigo

34
Q

What is folliculitis?

A

Inflammation of hair follicle
Typically caused by infection, chemical irritation, or physical injury

Think makeup, motor oil, steroid therapy

35
Q

MC form of infectious folliculitis?

A

Staph folliculitis

- comes from the nose

36
Q

Folliculitis workup?

A

Culture

- scrape and put on cotton swab

37
Q

Tx for folliculitis?

A

Removal of occlusion/irritants etc
Good skin hygiene
Benzyol peroxide
Systemic abx

38
Q

Long term scalp folliculitis?

A

Treat for folliculitis decalvans

39
Q

What is sycosis barbae?

A

Inflammation of entire follicle

  • staph impetigo of beard
  • spread by razor
40
Q

Tx for syscosis barbae?

A

Same as staph impetigo

  • bactroban
  • oral abx prn
41
Q

Severe sycosis barbae?

A

Eval for dermatophyte infx

- remove hair for culture

42
Q

Furncle vs carbuncle?

A

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
Q

Where do furuncles and carbuncles present?

A

Friction prone or traumatized areas

  • thighs
  • buttocks
  • groin
  • axillar
  • waist
44
Q

Tx for furuncle/carbuncle?

A

Primary: I/D
- moist heat to localize/spontaneously rupture (can also ease I/D)

Systemic abx prn
- not usually necessary

45
Q

MRSA?

A

Consider w recurrent furnculosis

  • mupirocin
  • chlorhexidine/bleach baths
46
Q

Abx for MRSA?

A

Septra

Clindamycin

47
Q

Ecthyma?

A

Jungle sores

- like impetigo but worse

48
Q

Ecthyma lesion?

A 
Localized
Thick
Crusted
Exudative
Tumor-like lesion

Ulcers w crust
Heals w scar

Common on legs

49
Q

Ecthyma tx?

A 
Warm/coal soaks (remove crust)
Good hygiene
Dry dressing
Mupirocin
Dicloxacillin
Cephalexin
50
Q

This gram neg organism is not part of the normal flora?

A

Pseudomonas aeruginosa

Seen in sugar aids pts

51
Q

Pseudomonas aeruginosa causes?

A

Green pigment

  • pyoverdin - seen on wood light
  • light green

Fruity, grape like odor

52
Q

Pseudomonas folliculitis is aka?

A

Hot tub folliculitis

53
Q

Presentation of pseudomonas folliculitis?

A

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
Q

So i got drunk and got in a hot tub, what now?

A

Showering will not help so, just pray i suppose

Fortunately its usually a self-limiting disease (7-10 days)

55
Q

Tx for pseudomonas folliculitis?

A 
Antihistamine
- hydrozyzine (atarax) PRN
Vinegar soaks (acetic acid)
Domeboro’s 
Burrows

Ciprofloxacin if severe

56
Q

Pt population for pseudomonas cellulitis?

A

Debilitated sugar aids pt

57
Q

pseudomonas cellulitis is?

A 
2/2 infasion of tinea of toe webs or groin
Bed sores
Stasis ulcers
Burns
Grafted areas
Under foreskin
Or following injury
58
Q

pseudomonas cellulitis is encouraged by?

A

Occlusion and or suppression of normal flora w broad spectrum abx

Seen in swampy environment

59
Q

pseudomonas cellulitis can also be found?

A

Around ear

- due to external otitis

60
Q

pseudomonas cellulitis tx?

A

DM - blood sugar
- watch for sepsis

Acetic acid
Domeboro (aluminum acetate)

Systemic abx

  • oral cipro
  • IV aminoglycosides

Severe inf
- clindafloxacin IV

61
Q

Pseudomonas toe web infection?

A

Between 4th and 5th toe

Caused by moisture

Thick white macerated skin

Green fluoresence (woods light)

62
Q

Pseudomonas toe web infection commonly mixed w?

A

Candida

Or other bacteria

63
Q

Pseudomonas toe web infection txt?

A

Keep clean and dry
- sandals

Acetic acid soaks

Drysol (aluminum chloride)

64
Q

What is trichomycosis axillaris?

A

Corynebacterium infection of the hair of the axilla

65
Q

Describe trichomycosis axillaris?

A

Whitish or colored hair
Associated w heavy sweating
Malodorous (very)

66
Q

Tichomycosis axillaris txt?

A 
Shave area
Topical erythromycin
Topical naftifine (naftin) 
Control hyperhidrosis
- antiperspirants
- drysol
67
Q

What is naftifine (naftin) normally used for?

A

It is for superficial fungal (tinea)

Also has antibacterial properties

68
Q

MC site for erythrasma - C. Minutissimum?

A

4th interdigital space

69
Q

Other sites for erythrasma - C. Minutissimum?

A

Bilateral inguinal
Axillae
Inframammary fold

70
Q

Describe erythrasma - C. Minutissimum?

A

Macular
Brown-red
Scaly
Noninflammatory

Itches
Burnes

Looks like T. cruris

71
Q

Hwo to differentiate T. Cruris from C. Minutissimum?

A

KOH

Woods lamp

72
Q

What does C. Minutissimum look like under a woods lamp?

A

Coral red fluorescence

- due to porphyrins produced by organism

73
Q

Tx for erythrasma?

A

Keep clean and dry

Systemic (pick one)

  • erythromycin
  • clarithromycin

Topical (pick one)

  • erythromycin
  • clindamycin
  • miconazole
  • clotrimazole
74
Q

Your pt presents with multiple 1-3mm pits to wt bearing areas of the feet

A

Pitted keratolysis

75
Q

What causes pitted keratolysis

A

caused by micrococcus sedentarius which produces an enzyme that digests keratin

76
Q

Symptoms of pitted keratolysis

A

1-3 mm pits to wt bearing areas
Hyper hydrosis
Malodor
Sliminess of skin

77
Q

Pitted keratolysis is associated with?

A

The tropics

Occlusive footwear

78
Q

Pitted keratolysis tx?

A

Clean daily
Promote dryness
Change socks
Rotate footwear

Drysol (20% aluminum chloride)

Topical ( pick one)

  • erythromycin
  • Clindamycin
  • mupirocin

Oral (alternate treatment)
- erythromycin

79
Q

What do you get from a pampered cow?

A

Spoiled milk

Senior - Derm 3 (7 decks)

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