CHAPTER 14: BACTERIAL INFECTIONS Flashcards
painful, erythematous nodule with a pale center located on the finger- tips.
Seen in bacterial endocarditis
mnemonic: Ouchey Fingers
OSLER NODES
nontender, angular hemorrhagic lesion of the soles and palms
seen in subacute bacterial endocariditis
janeway lesions
type of impetigo that occurs characteristically in newborns, although it may occur at any age.
common sites are the FACE and HANDS
majority are caused by phage types 71 or 55 coagulase-positive S. aureus or a related group 2 phage type.
maybe and early manifestation of HIV infection
Bullous impetigo
bullos impetigo begins between the _____ and ____ days of life with the appearance of bullae, which may appear on any part of the body.
he fourth and tenth days of life
acute glomerulonephritis is associated with ______ infection
Group A B-hemolytic streptocccal skin infection ( impetigo)
treatment of Group A B-hemolytic streptocccal skin infection ( impetigo)
application of mupirocin oint- ment to the anterior nares twice daily or
by a 10-day course of rifampin, 600 mg/day, combined with dicloxacillin (for MSSA) or TMP-SMX (for MRSA).
is a superficial folliculitis with thin-walled pustules at the follicle orifices. Susceptible locations are the extremities and scalp, although it is also seen on the face, especially periorally.
S. aureus- MCC
Bockhart impetigo
also known as “barber’s itch”
s a perifollicular, chronic, pustular staphylococcal
infection of the bearded region characterized by inflammatory papules and pustules, and a tendency to recurrence
Sycosis vulgaris or Sycosis barbae
is an acute, round, tender, circumscribed, perifollicular staphylococcal abscess that generally ends in central suppuration
furuncle, or boil,
merely two or more confluent furuncles, with separate heads.
carbuncle
The proximate cause of furunculosis is either contagion or autoinoculation from a carrier focus, usually in ______.
nose or groin
Treatment for acutely inflamed furuncle
incision should be strictly avoided, and warm compresses and oral antibiotics are administered.
A penicillinase-resistant penicil- lin or first-generation cephalosporin should be given orally in a dose of 1–2 g/day, according to the severity of the case.
Methicillin-resistant and even vancomycin-resistant strains of furunculosis occur and, if suspected, are treated with
trimethoprim- sulfamethoxazole double strength twice daily, clindamycin 300 to 450 mg three times daily, or doxycycline or minocycline 100 mg two times daily.
Mupi- rocin ointment applied to the anterior nares daily for 5 days and bleach baths may help prevent recurrence.
when should incision with drainage is indicated in furunculosis?
When the furuncle has become localized and shows definite fluctuation.
The cavity should be packed with iodoform or petrolatum gauze.
in furunculosis , Indications for antibiotics in addition to drainage are
Indications for antibiotics in addition to drainage are high fever, lesion larger than 5 cm or located in a critical location or difficult-to-drain area, multiple furuncles, or signs and symptoms persisting after drainage.
is an inflammatory reaction involving the folds of the skin surrounding the fingernail.
It is characterized by acute or chronic purulent, tender, and painful sw
Paronychia
The primary predisposing factor of pyogenic paronychia is
sepa- ration of the eponychium from the nail plate.
Treatment of pyogenic paronychia
- protect and effort to keep fingernails dry
- Acutely inflamed pyogenic abscesses should be incised and drained.
- penicillin / cephalosporin
- TMP-SMX for MRSA
- for C. albican infetion: miconazole + topical cortisocteroid cream
Staphylococcus aureus abscess formation within the deep, large, striated muscles usually presents with fever and muscle pain. It is typically hematogenous in origin.
Pyomyositis
most frequent muscle site of Pyomyositis in tropic is ___; in HIV infected px is ____
pyomyosistis in tropics: Thigh
HIV infected px: deltoid
is a febrile, rapidly evolving, desquamative infectious disease in which the skin exfoliates in sheets.
Skin does NOT separate at the dermoepidermal junc- tion, as in toxic (drug-induced) epidermal necrolysis (TEN), but WITHIN the granular layer.
Staphylococcal scalded skin syndrome (SSSS)
mcc causative agent of SSSS
Group 2 S. aureus, usually phage types 71 or 55,
Treatment of choice od SSSS
penicillinase-resistant penicillin such as dicloxacillin com- bined with fluid therapy and general supportive measure
is an acute, febrile, multisystem illness, with one of its major diagnostic criteria being a wide- spread macular erythematous eruption. It is usually caused by toxin-producing strains of S. aureus, most of which were ini- tially isolated from the cervical mucosa in menstruating young women.
Toxic shock syndrome (TSS)
what is the streptococcal strain causing TSS?
The streptococci are usually of M-types 1 and 3, with 80% of the isolates producing pyrogenic exotoxin A.
what is the biologic marker of TSS, that is an indicator of severe bacterial infection?
procalcitonin
treatment of TSS
systemic antibiotics: Vancomycin + nafcillin ,
fluid tx to trea shock and drainage of S. aureus infected site.
is an ulcerative staphylococcal or streptococcal pyo- derma, almost always of the shins or dorsal feet.
The disease begins with a vesicle or vesicopustule, which enlarges and in a few days becomes thickly crusted. When the crust is removed, there is a superficial, saucer-shaped ulcer with a raw base and elevated edges
Ecthyma
Treatment of ecthyma
- cleansing with soap and water + application of mupirocin, retapamulin, or bacitracin ointment, twice daily.
- Oral dicloxacillin or a first-generation cephalosporin
Cephalocaudal cutaneous eruption: begins on the neck, then spreads to the trunk and finally the extremities
WHITE strawberry tongue appearance: tongue has a white coating through which reddened, hypertrophied papillae project.
pastia line: There is accentuation over the skinfolds, and a linear petechial eruption
+ GAS,
+ inc ASO titer after strep pharyngeal infection
Scarlet fever
Also once known as St. Anthony’s fire and ignis sacer,
A streptococcal infection of the skin involving the superficial dermal lymphatics.
It is characterized by local redness, heat, swelling, and a highly characteristic raised, indurated border, preceeded prodromal symptoms of malaise for several hours, chills, high fever, headache, vomiting, and joint pains and inc PMN leukocytosis of 20,000 cells/ mm3 or more.
Erysipelas
Erysipelas is caused by ___ organism
β-hemolytic group A streptococcal
treatment of erysipelas
- Systemic penicillin
- ice bags and cold compresse
- IV antibiotics
is a suppurative inflammation involving the subcu- taneous tissue.
Mild local erythema and tenderness, malaise, and chilly sensations or a sudden chill and fever may be present at the onset. The erythema rapidly becomes intense and spreads. The area becomes infiltrated and pits on pressure.
Cellulitis
tx of cellulitis
Initial empiric therapy with dicloxacillin or cephalexin for 5 days will usually suffice.
tx of Necrotizing fasciitis
Early surgical debridement is an essential component of suc- cessful therapy.
ppro- priate IV antibiotics, and supportive care.
The most definitive confirmatory test of Necrotizing fasciitis
MRI
characterized by tense superficial blisters occurring on a tender erythematous base over the volar fat pad of the phalanx of a finger or thumb or occasion- ally a toe.
caused by Group A β-hemolytic streptococci or S. aureus
Blistering distal dactylitis
appears as a spreading, patchy ery- thema that migrates peripherally and often forms polycyclic configurations.
It is usually part of the early phase of the rheumatic fever, coexisting with carditis but usually preceding the arthritis.
Erythema marginatum
JONES Criteria: ( Major signs)
- erythema marginatum
- subcu- taneous nodules
- carditis
- polyarthritis
- (sydenham) chorea
is the major cause of bacterial sepsis and meningitis in neonates. It may cause orbital cellulitis or facial erysipelas in these patients.
Streptococcus agalactiae
Cellulitis of the hands may be caused by the fish pathogen.
Treatment : penicillin
Streptococcus iniae infections
an acute infectious disease characterized by a rapidly necrosing, painless eschar with associated edema and suppurative regional adenitis
Anthrax
an acute infectious disease characterized by a rapidly necrosing, painless eschar with associated edema and suppurative regional adenitis
Anthrax
an acute infectious disease characterized by a rapidly necrosing, painless eschar with associated edema and suppurative regional adenitis
Anthrax
what is woolsorter’s disease?
woolsorter’s disease is an inhalational form of Anthrax.
what is woolsorter’s disease?
woolsorter’s disease is an inhalational form of Anthrax.
a large, square- ended, rod-shaped gram-positive organism that occurs singly or in pairs in smears from the blood or in material from the local lesion, or in long chains on artificial media, where it tends to form spores.
Bacillus anthracis
hree virulence factors of Bacillus anthracis
- a polyglutamate acid capsule inhibiting phagocytosis; 2. an edema toxin, composed of edema factor and a transport protein termed protective antigen;
- and lethal toxin, composed of lethal factor plus protective antigen.
tx of Anthrax
- Ciprofloxacin (500 mg) or doxycycline (100 mg), twice daily for 60 days, are curative in the cutaneous form when there are no systemic symptoms, lesions are not on the head or neck and are without significant edema, and the patient is not a child younger than 2 years.
- Agressive IV Ciprofloxacin or doxycycline for severe cases.
- vaccine is available
is a gram-positive bacillus with rounded ends that may be isolated from soil, water, animals, and asymptomatic individuals.
produce meningitis or encephalitis with monocytosis.
Risk factors include alcoholism, advanced age, pregnancy, and immunosuppression.
Listeria monocytogenes
tx of Listeriosis
Ampicillin + gentamicin is the antibiotic of choice, and TMP-SMX is an effective alternate.
disease causing ulceration that is punched out and has hard, rolled, elevated edges with a pale- blue tinge (Fig. 14-24). Often, the lesion is covered with a leathery, grayish membrane.
Corynebacterium diphtheriae infection