Bacterial skin Flashcards
What are the clinical presentations of impetigo?
honey-crusted, non-bullous or bullous lesions superficial, contagious, usually on face or arms
What are the risks for impetigo?
poverty, crowded living conditions, poor hygiene, underlying scabies, GAS
What helps diagnose impetigo?
culture of pus or bullae fluid
How can you treat non-bullous impetigo?
topical – mupirocin, bacitracin, retapamulin, hydrogen peroxide cream
How can you treat bullous impetigo?
cephalexin, dicloxacillin, clindamycin and recommend IN mupirocin for everyone in the household to kill staph aureus
If the culture comes back as MRSA for impetigo, how do you treat it?
bactrim, doxycycline
If your impetigo case presents with systemic symptoms, how will you adjust your treatment?
oral cephalexin and or dicloxacillin
How does cellulitis present?
erythema or edema that is rare on the face
What are risks for cellulitis?
inflammation, pre-existing skin infection, previous edema, lymphatic obstruction, HIV
How does cellulitis occur?
bacterial entry with breaches in the skin barrier with staph aureus, gram + like strep
What diagnosis step is needed for cellulitis?
culture of blood, pus or bullae and mark the margins!
How do you treat cellulitis?
elevate affected area and treatment of underlying conditions
systemic toxicity means parenteral abx: nafcillin, cefazolin, clindamycin, cephalexin, doxycycline
followed by oral: cephalexin, dicloxacillin
treat everyone in home with mupirocin, and IV vanc if MRSA
What is necrotizing fasciitis?
thrombosis in blood vessels, destruction of soft tissues and fascia, a serious complication of cellulitis
What is erysipelas?
clear demarcation of erythema and edema often on face and lower legs. Often in young children in elderly, and can be considered cellulitis but in the dermis with strep pyogenes
How can you manage erysipelas?
oral penicillin, dicloxacillin, cephalexin, clindamycin, azithromycin
How do you treat severe erysipelas?
IV cefazolin or ceftriaxone; MRSA = vanc
How does folliculitis present?
clusters of small, raised pruritic erythematous lesions and pustules in areas of repeated shaving
What are common causes of folliculitis?
staph aureus, but from hot tubs = pseudomonas, malassezia, jellyfish!
How can you manage folliculitis?
anhydrous ethyl alcohol or topical abx (mupirocin or clindamycin) + BPO
if other organisms, systemic abx
What is pseudo folliculitis barbae?
papular and pustular inflammatory reaction, mostly on neck in beard area - massage area, stop shaving
What is erythrasma?
infection of intertriginous areas in well-demarcated, brown-red macular patches, often wrinkly with fine scales, potentially pruritic
How can you diagnose erythrasma?
wood’s lamp to view under fluorescence, KOH to rule out tinea, culture bacteria
How do you treat erythrasma?
topical abx - fusidic acid cream and clindamycin solution
OR
oral abx - erythromycin, penicillins, cephalosporins, clindamycin
What is a furuncle?
deep infection or small abscess in hair follicle; boil-like
indurated nodule with fluctuance
How do you decide whether to prescribe abx for furuncles?
whether there is associated extensive surrounding cellulitis or signs of systemic infection
How do you treat furuncles?
warm compress or I&D
oral abx: clindamycin or cephalexin, MRSA=doxycycline, clindamcyin
What is a carbuncle?
several head of inflamed follicles within 1 purulent mass. Ulcerated looking can present with fever, malaise, chills
What is the treatment of carbuncle?
require I&D, oral abx: clindamycin or cephalexin, MRSA=doxy
What’s the difference between a furuncle and carbuncle?
furuncle = 1 head, 1 follicle
carbuncle = multiple; ulcerated
What is a pilonidial cyst?
abnormal pocket in skin with hair and skin debris near tailbone from friction or pressure
soak, I&D, pack!
Where can MRSA present and how should you address it?
abscesses, furuncles, carbuncles, impetigo, cellulitis, wound
oral clindamycin, bactrim, doxy, or IV vanc, mupirocin for carriers
What is Hansen’s disease?
leprosy!
discolored patches of skin flat, numb, faded, nodules, considering painless, skin lesions
How do you manage Hansen’s disease?
rifampin, dapsone, clofazimine
How does subcutaneous tuberculosis present?
inflammatory papules with granuloma formation, chronic ulcers, plaques, warty area. This requires PCR, punch biopsy, check blood
What causes subcutaneous tuberculosis?
ritual circumcision, tattoo, piercing, venipuncture, intercourse, tooth extraction, spread through lymphactic/heme spread
What is meningococcemia?
maculopapular eruption frequently on trunk and lower extremeties that become a petechial rash, mucus membranes may show hemorrhage, can coalesce into purpuric and ecchymotic lesions
What should you do if a patient presents with meningococcemia?
admit to hospital for ceftriaxone, cefotaxime or ampicllin, a flox
resistant to vanc and aminoglycosides
