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Dermatology > Bacterial Pyoderma > Flashcards

Bacterial Pyoderma Flashcards

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Dermatology Board Prep flashcards
1
Q

In dogs and cats, bacterial follicultis and furunculosis are common and they develop

A

secondary to an underlying disease process

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2
Q

What are the skin barriers

A

1) Stratum corneum, hair, epidermal turnover
2) Langerhan’s cells, lymphocytes, immunoglobulins
3) Normal skin flora

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3
Q

bacterial pyoderma is a result of

A

altered barrier function and altered microenvironment +/- immunosuppression

pathogenic bacterial adhere to, colonize, infect abnormal skin

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4
Q

What is the most common cause of bacterial pyoderma in cats

A

Staph aureus

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5
Q

What is the most common bacterial pyoderma pathogen

A

Staphylococcus pseudintermedius- about 90%

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6
Q

What are the common Staph pathogens causing bacterial pyoderma

A

Staphylococcus pseudintermedius
Staph. aureus
Staph schleiferi
Staph epidermidis
Coagulase negative Staph?

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7
Q

What are common secondary bacterial invaders that colonize abnormal skin

A

Gram Negatives: E. coli, Proteus sp, Pseudomonas sp

Gram Positives: Corynebacterium sp, Streptococcus sp

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8
Q

Why does bacterial skin infection (pyoderma) present with a variety of lesions (ie papules, crusts, epidermal collarettes) and can appear in different places

A

1) Pyodermas are never primary
2) Pyodermas evolve

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9
Q

T/F: pyodermas are never primary

A

true

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10
Q

Another word for skin fold dermatitis

A

intertrigo - may not be true infection

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11
Q

What is another word for hot spots

A

Pyotraumatic dermatitis / Acute moist dermatitis

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12
Q

Superficial pyoderma is bacterial pyoderma in the

A

epidermis

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13
Q

Deep pyoderma is bacterial pyoderma in the

A

dermis/SQ

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14
Q

anatomical defect that creates the environment for bacterial proliferation
ex:
facial, lip, vulvar, tail, mammary and body folds

A

Intertrigo

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15
Q

What does intertrigo present like

A

erythema
moist exudate
alopecia
+/- pruritus, malodor

*In the fold (facial, lip, vulvar, tail, mammary, body)

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16
Q

What folds can intertrigo be in

A

Facial
Lip
Vulvar
tail
mammary
body

anatomical defect creates environment for bacterial proliferation

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17
Q

T/F: Pyotraumatic dermatitis (Hot spots) pop up over night

A

True- they truly do

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18
Q

How does Pyotraumatic dermatitis present

A

Alopecia, erythema, erosion, ulceration, exudative, prurutus
*well demarcated from normal skin - no satellite lesions
occur on caudodorsum and face

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19
Q

Where does Pyotraumatic dermatitis typically occur

A

caudodorsum
face

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20
Q

What typically causes hot spots

A

allergies, ectoparasites

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21
Q

How do you treat Pyotraumatic dermatitis

A

1) treat underlying cause- allergies, ectoparasites, otitis external?
2) Topical therapy: 2-4% chlorhexidine
3) Clip area wide

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22
Q

superficial pyoderma that occurs in puppies <1 year of age
infection beneath the stratum corneum in non-follicular areas (axilla and inguinal regions)

usually asymptomatic; usually no identifiable underlying cause

treat with topical therapy

A

Impetigo “puppy pyoderma”

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23
Q

Impetigo

A

“Puppy Pyoderma”
superficial pyoderma that occurs in puppies <1 year of age
infection beneath the stratum corneum in non-follicular areas (axilla and inguinal regions)

usually asymptomatic; usually no identifiable underlying cause

treat with topical therapy

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24
Q

infection that begins in the hair follicle and spreads peripherally under the stratum corneum

A

folliculitis (superficial pyoderma)

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25
Q

What distribution does follicultis typically have

A

truncal distribution

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26
Q

What are your differentials for for folliculitis *

A

bacterial pyoderma
dermatophytosis
demodicosis

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27
Q

What might you see with superficial pyoderma

A

Papules
Pustules
Crusts
Epidermal collarettes
Pruritus

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28
Q

Why might you see pruritus with superficial pyoderma

A

variable but no one knows why
-Hypersensitivity
-Irritant
-Underlying allergies
-Ectoparasites

29
Q

Most superficial pyodermas are in the

A

hair follicle (follicultis)

30
Q

What is the evolution of pyoderma

A

1) Papule as it is superficial and in hair follicle (folliculitis)
2) Pustule: papule becomes organized and forms a microabcess
3) Collarette: as the pustule ruptures and infection spreads (exudative +/- dried crusts)
4) Healing- center heals but continue to spreads peripherally (leading edge) which causes erythema, scaling, and alopecia
5) Resolution: as this heals, margins will resolve as well leading to asymmetric resolution “serpiginous”

31
Q

What are the 3 causes of folliculitis *

A

1) Bacteria
2) Demodex
3) Dermatophytes

32
Q

when the bacterial infection extends into the dermis/subcutaneous tissues

A

Deep Pyoderma

33
Q

What do you see with deep pyoderma

A

ulcers, hemorrhage, nodules, draining tracts

34
Q

How long do you treat deep pyodermas

A

longer than superficial pyodermas
-Two weeks past resolution
-Average 4-6 weeks

35
Q

How long to do treat superficial vs deep pyoderma

A

Superficial: one week beyond resolution

Deep: two weeks beyond resolution

36
Q

How do you diagnose pyoderma

A

Impression cytology of crusts
-Cocci (intracellular is gold standard)
-if there’s a lesion and it’s there it’s probably relevant

37
Q

What kind of bacteria is Staph

A

Gram + Cocci

38
Q

What is the gold standard when doing cytology for pyodermas

A

intracellular cocci- shows that there isnt just an overgrowth but theres and active infection

39
Q
A
39
Q

What rods might be causing the pyoderma when doing cytology

A

Ecoli
Pseudomonas
Corynebacterium

*Usually more chronic lesions

40
Q

When considering bacterial pyoderma, what should you do to rule out other primary differentials

A

-Skin scrapings
-Dermatophyte culture
-Culture
-Biopsy (rule out autoimmune): but treat infection first before biopsy

41
Q

Before taking a biopsy to rule out autoimmune, you should

A

treat any bacterial pyoderma first

42
Q

How do you take a cytology of papule

A

very hard to do (no sun roof)
but you can take the edge of the slide or use tape

43
Q

How do you take a cytology of a pustule

A

25g needle and get impression on the top
but reserve some pustules for biopsy

44
Q

How do you take a cytology of a collarette

A

do an impression smear on the exudative margin

45
Q

How do you take a cytology of a crust

A

scrape it off and then impression smear

46
Q

how do you do a cytology of a dry scale

A

acetate tape preps (margins)

47
Q

How do you treat pyoderma

A

1) Treat primary cause (restore skin barrier)
2) Topical therapy preferred (resistance) for superficial infections
3) Systemics if needed (deep, non-compliance, failure of topical monotherapy)
4) Duration
Superficial: one week past resolution (3 weeks)
Deep: two weeks past resolution (4-6 weeks)

48
Q

For pyoderma, when should you consider systemic treatment

A

deep
non-compliance
failure of topical monotherapy

49
Q

How should you treat superficial pyodermas topically

A

-1 to 2x daily wipes, ointments, sprays (some with steroids)
-2 to 3 x weekly shampoo

resistance theoretically minimized due to concentration of antimicrobial (ie chlorhexidine)

50
Q

How should you systemically treat pyodermas, if implied (deep, non-compliance, failure of monotherapy)

A

-Narrow spectrum
-Gram + Staph
-Adverse Effects
-Costs
-Adherence (frequency)

51
Q

What conferres antibiotic resistance in Staphylococcal spp

A

PBP2a

52
Q

What are risk factors of antimicrobial resistance

A

1) Frequent hospital visits (more exposure to resistant strains)
2) Healthcare family (more exposure to resistant strains
3) Previous antibiotic exposure (ie selection for resistant strains)

53
Q

All cultures should be performed with

A

cytology (antibiotic selection)

54
Q

T/F: culture is not super reliable for topical antimicrobials

A

true

55
Q

What should you do to treat pyoderma when the owner does not want to culture

A

empirical therapy- start with tier I

56
Q

for routine/empirical use in susceptible pyodermas
Low incidence of adverse effects, fairly well tolerated (expense/adverse effects)

A

Tier I: 1st generation cephalosporins:
-Cephalexin
-Clavamox
-Clindamycin

57
Q

What are examples of Tier II antibiotics that if you use them no one is going to complain too much. Maybe slightly higher adverse effect profile or expense. May be a little more broad sprectum

A

Doxycycline
Cefpodoxime?

58
Q

What are examples of Tier III antibiotics that have increased chance of adverse effects or accelerated initiation of resistance. Use restricted to culture susceptibility

A

Fluroquinolones
Cefovecin (Convenia)

59
Q

What are examples of Tier IV antimicrobials that have severe risk of adverse event. use only as a last resort

A

-Sulfas/TMS (horses exclusively)
-Chloramphenicol
-Aminoglycosides
-Rifampin

60
Q

You should not use the Tier IV antimicorbials like Sulfas/TMS, Chloramphenicol, aminoglycosides, and rifampin without

A

a culture

61
Q

Staph requires resistance really quickly to ______ because there is only 2 point mutations

A

Fluoroquinolones

62
Q

What drugs should you absolutely never use for bacterial pyoderma

A

Penicillin/amoxicillin
Imipenem
Vancomycin
Linezoid

63
Q

MRSP is resistant to

A

all penicillins/cephalosporins

64
Q

T/F: It is difficult to people to contract MRSP

A

True

65
Q

MRSP is _____________ to kill than MSSP but

A

MRSP is harder to kill than MSSP but not more severe than MSSP

66
Q

Do you have to separate other dogs when one has MRSP infection

A

No- other dog is likely already colonized but it isnt going to do anything unless immunosuppressed or skin barrier is compromised from another condition

67
Q
A

Dermatology (10 decks)

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