invades deeper part of follicle - get swelling and redness - w/ or w/o pustules - more painful and may scar

Derm Bacterial Flashcards by Ann C

the majority of skin infections are caused by

staphylococcus or streptococcus

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all bacterial skin infections are diagnosed how?

clinically: means didn’t run any test, labs, biopsies, etc. Just used clin info

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most skin infections are treated how?

empirically

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Folliculitis - define & what causes it

infection of hair follicle, most caused by staph

-some, non sterile, can be caused by irritation

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Gram neg folliculitis

occurs during treatment of scene with abx

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hot tub folliculitis

-causes

caused by pseudomonas aeruginosa

causes pruritic or tender follicular pustules
within 1-4 days of being in a hot tub

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causes of nonbacterial folliculitis

something irritating follicle like tight jeans, oils, etc (is non sterile)

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in what population is folliculitis more common

more in diabetics, AIDS, immunocompromised

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S/S of folliculitis

itching & burning in hair areas, pustules in hair follicles, most on inner thighs, buttocks. also face, scalp, legs

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superficial folliculitis

surface can often see hair in center

tender or painless
heals w/o scarring
often without tx

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deep folliculitis

invades deeper part of follicle

get swelling and redness
w/ or w/o pustules
more painful and may scar

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Differential diagnosis

-use hx to figure out what?

bacterial vs. non bacterial (in hot tub recently, areas of shaving, areas of irritation, etc)

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Do you need lab tests with folliculitis

usually no

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treatment of folliculitis

get rid of the cause

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treatment of superficial folicullitis

can get better spontaneously, topical abs, benzoyl peroxide

-oral abs if local doesn’t work, or have fever, or involves nose or upper lip

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treatment of deep folliculitis

oral abx

-first generation cephalosporins, macrocodes, fluoroquinolones

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treatment of hot tub folliculitis

will go away eventually, may give abx in severe cases, may use antipruritic to make pt. feel better

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treatment of gram negative folliculitis (acne on abx and cultured)

treat like severe acne

-dermatologist

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What happens if folliculitis infection spreads?

get furuncle or carbuncle

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furuncle

abscess or boil

-deep seated infection involving entire hair follicle and adjacent tissue

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carbuncle

several furuncles in hair follicles next to each other joining together to make one big mass with multiple areas of drainage

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nonpharmacologic treatment of furuncles/carbuncles

moist heat helps come to a head and localize larger lesions
incise & drain after mature
*I&D most important

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S/S of furuncles/ carbuncles

pain! purulent!

usually abscess gets bigger, then fluctuant, then softs & opens
spontaneously drains in 1-2wks

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pharmacologic treatment of furuncles/carbuncles

I&D most important

abx given that kill staph
treat more if the pt. is SICK, immunocompromised or diabetic or something

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cellulitis

poorly demarcated infection of dermis & subcutaneous tissue -foot cellulitis especially common and problematic in diabetics

How does cellulitis usually "get in"

most common gets in from fissure in toe web from tinea pedis, but can be from any skin break: surgical wounds, trauma, ulcerations

cellulitis pathophys (what causes it)

usually staphylococcal or group A beta hemolytic streptococcal - MRSA - nonsuppurative

most common site of cellulitis

lower leg most common, | but can be anywhere

S/S of cellulitis

``` Painful erythematous! confluent, hot patch with advancing borders -fever -increased WBCs -malaise ```

what can happen if cellulitis continues to grow?

bacteremia and septicemia, possible shock | bacteria gets in blood and makes pt. more ill

Labs & diagnostics for cellulitis

(healthy adults just treat, but culture for DM or immunocompromised) - if you're going to culture, do it BEFORE abs - culture pus, or blood, skin biopsy if need full thickness

differential diagnosis for cellulitis (what life threatening things can look like cellulitis)

- deep venous thrombosis | - necrotizing fasciitis

nonpharmacologic tx of celulitis

mark line around area of redness to ensure it's getting better/shrinking and not worse/spreading

pharmacologic tx of cellulitis

If limited involvement, give oral abx. | -Parenteral abs if extensive or progressive

Impetigo

contagious and autoinoculable skin infection caused by staph or strep -can be bulls or non-bulbous

most common age/spread of impetigo

commonly children 2-5 -spread direct person to person contact -you can inoculate yourself "infantigo"

S/S impetigo

* honey-colored crust - lots of types of lesions possible (macules, vesicles, bulla) - when remove the crusts/scrape them off

labs for impetigo

culture to confirm dx and check for MRSA

nonpharmacologic tx of impetigo

soak or scrub to get rid of pus under crusts

pharmacologic tx of impetigo

limited or small infections can try mupirocin or reapamulin | -most often use oral abx

patient education for impetigo

don't share towels, need to clean bathrooms with bleach for fam members, etc

complications of impetigo

small risk of kidney disease if strep is the cause

Erysipelas

very superficial cellulitis with SHARPLY DEMARCATED BORDER, very HOT -caused by strep

what causes erysipelas

STREP

S/S of erysipelas

- pain, malaise, chills, fever - most often on cheek - becomes smooth, demarcated glistening, smooth hot plaque

labs for erysipelas

WBCs elevated, blood cultures may be positive

Treatment for erysipelas

IV abs against strep

complications with erysipelas

few with rapid treatment | -without treatment could be life-threatening

Scalded Skin Syndrome (SSS)

certain STAPHYLOCOCCAL species releases an exotoxin that has systemic effect - causes upper level of skin to blister - TOXOGENIC

What age do you see sss

children

presentation of SSS

diffuse redness of skin with scaling

differential diagnosis of sss

stevens-johnson syndrome (lose all skin)

treatment of sss

anti-staphylococcal antibiotics

complications of scalded skin syndrome

heals without scarring, low mortality

Scarlet Fever

strep throat WITH A RASH! - aka scarletina - due to GABHS infection - often from resp. infection but may be food borne

What causes rash in scarlet fever

circulating toxin, not disseminated bacterial infection

What is scarlet fever usually associated with?

``` localized infection (e.g. strep pharyngitis) -may have red strawberry tongue ```

Scarlet Fever Rash

- sandpaper rash - very red scarlet appearance - first on upper trunk & axillae, then generalized, more prominent in flexural areas

scarlet fever complications

- otitis media - pneumonia - septicemia - osteomyelitis - rheumatic fever - acute glomerulonephritis

scarlet fever tx

- penicilin/amox - erythromycin if allergic to cilins - goal of tx to prevent complications and maybe limit disease course