Common pediatric skin infections Flashcards
Description of Impetigo?
discrete purulent lesions, usually multiple coleascing lesions on face (perioral and perinasal) and extremities. initially are small vesicles r pustules that rupture and become honey colored crusts with moist erythematous base. regional lymphadenopathy present.
two typs:bullous or nonbullous.
bullous will rupture and then lacquer like crust forms.
nonbullous begin as papules and and evolve into vessibles w/erythema. pusutules break down, form crusts. usually self limiting in 2 weeks.
high incidence 2-5 years old.
cause of impetigo?
gram positive group A streptococci, staphylococcus aureus (usually bullous), strept pyrogenes or mix
what is ecythma?
deep ulcers associated with impetigo
Treatment of localized impetigo?
mupirocin topically (bactroban or centany)
alt: retapamulin (altabax)
less effective: bacitracin and neomycin and NOT recommended
Tx of impetigo w/numerous lesions or not responding to topical?
Need: stability against beta lactamase and against gram positive S aureus and streptococcus
options: dicloxacillin, cephalosporin (first or second generation)
MRSA impetigo tx?
TMP- SMX or clindamycin
alt: doxycycline and minocycline but not in children
How long after antibiotic tx before can go back to school?
24 hours
Tx mild acne?
benzoyl peroxide or topical retinoid.
alt: BP + antibiotics or all three
mild acne definition?
fewer than 20 comedones or
moderate acne definitions?
total lesion count 30-125, 20 -100 comedones or 15-50 inflamm lesions
severe acne definition?
more than 5 nodules or total inflamm lesion count > 50 or total lesion count > 125
SE of accutane?
idiopathic intracranial hypertesion, hypertrigluceridemia, elevated hepatic enzymes, cheilitis , altered mood
oral antibiotics used for acne?
doxycycline, minocycline, clindamycin, erythromycin, azithromycin
topical antibiotics used for acne?
clindamycin, erythromycin, tetracycline
tx moderate acne?
topical combo: BP, retinoid, antibiotic in various arrangements
alter: oral antibiotic with topical combo
tx severe acne?
combination therapy = oral antibiotics + topical retonioid + BP +- oral isoretinoin
Rabies risk in what type of bites?
bat, raccoon, skunk,
tx of bat, racoon, or skunk bite?
amoxicillin with clavulante, 875 mg/125 mg BID or 500 mg/125 mg TID
alter: doxycycline 100 mg BID
rabies immunoglobulin and vaccine
tx cat bite?
amoxicillin with clavulante, 875 mg/125 mg BID or 500 mg/125 mg TID
alter: cefurozime, 0.5 g BID, doxycycline 100 mg BID
culture and tx empirically –>
switch to penicillin if P multicoda present
tx dog bite?
amoxicillin with clavulante, 875 mg/125 mg BID
altern: clindamycin 300 mg QID + flouroquinolone
or
clindamycin with TMP-SMX
tx only if high risk
tx human bite?
amoxicillin with clavulante, 875 mg/125 mg BID for 5 days
if later after bite or signs of infection - parental therapy with ampicillin with sulbactam, cefixutub
PCN alergy: clindamycin wit cpirofloxacin or TMP SMX
tx rat bite?
amoxicillin with clavulante, 875 mg/125 mg BID
alt: doxycycline, rabies not indicated!
pig or swine bite tx?
amoxicillin with clavulante, 875 mg/125 mg BID
alter: parenteral third-generation cephalosporin
tx nonhuman primate?
acyclovir
What type f burns can be treated in outpatient setting?
10% BSA or less, second-degree or lower, ad not involving foot or hand
What bacteria can colonize burns and cause infections?
staphylococcus aurea or CNS, enterococci or pseudominea aureg, E coli, klebsiella pneumoniae
mafenide acetate or silver sulfadiazine are used for what?
infection prevention
first and second degree burns defined as?
erythema, hyperemia, and pain
first degree- skin blanches easily
second degree - blisters and raw moist surface
third - pain may be minimal and white nd leathery
rubella description?
mild viral illness involving skin, lymphadenopathy (suboccipital, postauricular, anterior and posterior cervical nodes) and joints at times. droplet based.
incubation 14-19 days and onset rash on 15 day. appearance of exanthem rash.discrete macules on face. spreads to neck, trunk, and extremities. macules coalesce on trunk. rash lasts 1-3 days. desquamation occurs.
adults can have fever, sore thraot, rhinitis.
diagnostics for rubella?
Not necessary. no clinical basis. but could do CBC, culture from pharynx. OgM antibody.
tx rubella?
self limitiing. rest and fluids. contagious 7 days post rash onset. tylenol.
measles description?
incubation 7-14 days. first sign is high fever (> 104), prodrome - maliase, anorexia, and triad of 3 C’s (conjuctivitis, cough and coryza.)
enanthem - appears 2-4 days after onset of prodrome. koplik spots, lasts 5-7 days before fade into coperry brownhyperpigementation that desquamate.
rash - 14 days after exposure, blanching macules and papules on face. within 48 hours coalesce into patches and plaques and spread to trunk and extremitieies, palms, ans soles.
total time - 7-10 days!
diagnostics for measles?
clinical pciture. can do IgM and IgG. PCR. viral swab.
tx measles?
vitamin A, support of fluids.
what are koplik spots?
bluish grey specks or grains of sand with red base spots inside cheeks during measles.
scarlet fever description?
caused by GABHS complication. onset of fever, sore throat, HA, n/v, abdominal pain, mayalgias. rash appears 12-48 hours after fever on neck and travels. feels like sand paper
day 1 -5 white strawberry tongue, red strawberry tongue next.
edaematous exudative tonsils.
desquamation occurs 7-10 days after rash resolution.
scarlet fever diagnostics?
throat culture. titer!
tx scarlet fever?
PCN VK or erythromycin x 10 days.
or cingle PCN GB IM.
can consider first generation cephalosporin.
Kawasakis disease description?
acute febrile vasculitis syndrome of early childhood, could lead to CAA. most often starts with prolonged fever. irritability,
THEN! 3 stages - acute, subacute, and convalescent.
acute - abrupt fever for 7-14 days, 102 -104. Non responsive to antipyretics. nonexudative bilateral conjunctivitis, anterior uveitis, erythema and edema on hands and feet. strawberry togue. lymphadenopathy.
subacute stage - fever abated. week 406. desquamation of digits, thromboyctosis, and CA develop.
convalescent phase - 3 mo. all normal except nails might have grooves.
Diagnostic of Kawasakis dx?
4 of the five clinical features.
- peripheral extremity changes (redenneing edema or desqaumation)
- polymorphous rash
- oropharyngeal changes - erythema, fissuring, crusting of lips, strawberry otngue, diffuse mucosal injection
- bilateral nonexudative painless bulbar cinjuctivitis
- acute nonpurulet cervical lymphadenopathy. usually unilaeral.
FEBRILE!!! (fever, enanthem, bulbar conjcutivits, rash, internal organ involvement, lymphaden, extremitiy changes)
labs: ESR, CRP, alpha 1 antitrypsin.
manage kawasakis?
ecg! at time, 2 weeks, and 6-8 weeks. on presentation.
tx kawasakis?
full dose IVIG. high dose ASA.
resistent to IVIG - methtrexate or cyclophophamide,
risk of Coronary aneurysm - infliximab, antiplatet, anticoag
erythema infectiosum description.
slapped cheek appearance and lacy exanthem r/t human parovirus B19 and erythrovirus.
symptoms od erythema infectiosum?
HA, fever, sore throat, pruritis, coryza, abdominal pain, arthralgias.
phase 1 - exanthem and slapped cheek fades over 2-4 days. nasal and perioral and periorbital sparing.
phase 2 - erythematous maculopapular rash on extremitis and trunk and that fades to lacelike reticular pattern
phase 3- freq clearing and recurrences for weeks or months due to stimulus. can have polyarthropathy.
diagnostics of erythema infectio?
clinical presenation alone. IgM, dot blot, PCR,
tx of erythema infectio?
self limiting. NSAIDS for symptoms. topical antipruritics and oral anithistamines. fluids and rest.
roseola description?
common 9-12 month old infant. HHV - 6 causing agent.
onset with fever. 3 days later, defervescence and morbilliform rash. rose -pink macules and maculopapules.
nonspecific complaints. common febrile seizure.
daignostics roseola infantum?
IgM, immunoblot. work up for seizures if indicated.
tx for roseola?
self limiting. antipyretics.
