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Dermatology > Lecture 3: Infections > Flashcards

Lecture 3: Infections Flashcards

1
Q

MCC of bullous impetigo

A

Staph Aureus & GAS

Both MSSA and MRSA (GAS and as)

Results in scalded skin syndrome

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2
Q

MC demographic for bullous impetigo

A

Newborn and older infants

bullies and babies

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3
Q

MC demographic for non-bullous impetigo

A

All ages

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4
Q

Presentation of non-bullous impetigo

A
  • Painful and tender
  • Erosions with crusts
  • 1-3 cm lesions
  • Central healing
  • Regional LAN
  • Scattered, discrete lesions
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5
Q

What is autoinoculating?

A

Kid scratches vesicle, spreads to a different area.

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6
Q

Presentation of bullous impetigo

A
  • No erythema
  • Vesicles => bullae
  • Yellow => dark brown
  • negative Nikolsky sign

Collapse of bullae in 1-2d

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7
Q

How is bullous impetigo dx?

A

Clinically, BUT often use Gram stain & culture

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8
Q

Tx of impetigo

A
  • Warm water soaks followed by topical mupirocin
  • 7d abx for widespread (keflex or erythromycin)
  • MRSA = doxy
  • Critically ill with MRSA = vanco or linezolid
  • Bullous or severe = PO
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9
Q

Patient education for impetigo

A
  • Good hygiene
  • Mupirocin in any skin breaks
  • Avoid contact with others in first 24h of abx use
  • BPO wash
  • Ethanol or isopropyl gel for hands

BPO = benzoyl peroxide

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10
Q

How soon should you f/u for impetigo?

A

1 week

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11
Q

First line systemic tx for impetigo

A
  • Systemic: dicloxacillin/augmentin/cephalexin
  • If PCN allergic: macrolides

dicey IM

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12
Q

Define folliculitis

A

Infection of hair follicle +/- pus in the ostium of the follicle

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13
Q

What does folliculitis become if it progresses? Most common organisms?

A
  • Becomes abscesses or furuncles
  • Staph, Pseudomonas hot tub, Viral , fungal, syphilis
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14
Q

How is folliculitis dx?

A
  • Clinical, but it can be confirmed with
  • Gram stain
  • C&S
  • KOH if fungal suspected
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15
Q

Tx of folliculitis

A
  • Mild: warm compresses, BPO wash
  • Moderate: topical abx = clinda or mupirocin
  • Severe MSSA: Keflex
  • Severe MRSA: Doxy or bactrim x10d

almost all superficial MRSA seems to be doxy

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16
Q

What are the typical causative organisms for an abscess related to folliculitis?

A

MSSA or MRSA

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17
Q

When is abx therapy indicated for an abscessed folliculitis?

A
  • Single >= 2cm
  • Multiple
  • Surrounding cellulitis
  • Immunosuppression and other comorbidities
  • S/S toxicity
  • Inadequate response
  • Indwelling medical device
  • High risk of transmission
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18
Q

When is surgery considered for I&D?

A
  • Very large
  • Located on palms (nerves?)
  • Soles (nerves?)
  • Nasolabial areas
  • Genitalia
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19
Q

What is a furuncle?

A

Acute, deep seated, red, hot, tender nodule or abscess

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20
Q

Presentation of a furuncle

A
  • Nodule with cavitation after drainage
  • Staphylococcal folliculitis
  • Any hair bearing region
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21
Q

Management of a furuncle

A
  • Warm compresses
  • Erythema = need abx
  • Bactrim
  • Clinda
  • Doxy

7d take the car of uncles to BCD

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22
Q

What is a carbuncle?

A

Deeper connection of interconnected furuncles

A car of furuncles

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23
Q

MC location for carbuncles

A
  • Nape of neck
  • Back
  • Thighs

trunk of the car

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24
Q

Management of uncomplicated carbuncle

A
  • Bactrim
  • Clinda
  • Doxy

7d take the car of uncles to BCD

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25
Q

When to admit for carbuncle and DOC?

A
  • Toxic
  • Rapid progression
  • No improvement after 24-48h of PO ABX
  • DOC: Vanco 1-2g IV daily

Deep = vanco

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26
Q

What is necrotizing fasciitis?

A
  • Flesh eating disease
  • Rapid progression of infection with extensive necrosis of soft tissues and overlying skin
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27
Q

MCC of necrotizing fasciitis?

A
  • GABHS
  • Pseudomonas
  • Clostridium

Polymicrobial

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28
Q

MC demographic and risk factors for necrotizing fasciitis?

A
  • Middle aged 30-40s
  • DM, ETOH abuse, Liver dz, CKD, malnutrition

Often begins with non-penetrating minor trauma

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29
Q

Presentation of necrotizing fasciitis

A
  • Severe pain out of proportion
  • Skin hyperthesia
  • Cyanosis
  • Skin pallor
  • Muscle weakness
  • Foul smelling exudate
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30
Q

As necrotizing fasciitis develops, what does it appear as?

A
  • Cyanotic
  • Vesicle and bullae appearance
  • Black eschar with surrounding irregular border
  • Fever and systemic symptoms
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31
Q

Clinical red flags for necrotizing fasciitis?

A
  • Severe, constant pain out of proportion to PE
  • Erythema turning into dusky gray
  • Malodorous, dirty dishwater discharge
  • Gas in the soft tissues
  • Edema beyond erythema
  • Rapid progression
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32
Q

Tx of necrotizing fasciitis

A
  • Debridement
  • Broad spectrum ABX: carbapenem, unasyn, clinda, vanco for MRSA, all depends on gram stain and C&S
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33
Q

What is erysipelas?

A

Acute, superficial infection of the dermis and dermal lymphatic vessels

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34
Q

MC demographic and etiology of erysipelas?

A
  • GABHS
  • MC in young children or older adults
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35
Q

How does erysipelas present?

A
  1. Prodrome of fever, chills, anorexia, malaise
  2. General signs of sepsis potentially
  3. Lesions that are painful/tender/hot, bright, red, edematous plaques with sharp borders
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36
Q

What is cellulitis?

A

Acute infection of the dermis and subcutaneous tissue

37
Q

Etiology of cellulitis and MC demographic

A
  • Staph and GABHS
  • Cat/dog: Pasteurella multocida
  • Freshwater: aeromonas
  • MC: middle aged adults
38
Q

Presentation of cellulitis

A
  • Prodrome
  • General signs of sepsis potentially
  • Painful/red/hot/tender
  • bright red
  • Indistinct/irregular borders

Erysipelas has sharp borders and is superficial

39
Q

RFs for cellulitis

A
  • Minor skin trauma
  • Body piercing
  • IVDU
  • Tinea pedis infection
  • Animal bites
  • PVD
  • Immunosuppressed
  • Lymphatic damage
40
Q

Dx of cellulitis

A

Clinical

Workup of labs and imaging mainly for systemic or r/o abscess

41
Q

Indications for admission for cellulitis

A
  • Systemic presentation
  • Rapidly spreading
  • Progression after 48h of abx
  • Unable to tolerate PO
  • Comorbidities of immunosuppression/liver/heart/renal failure
42
Q

IV management for cellulitis/erysipelas

A
  • MRSA: vanco 1st, dapto 2nd
  • MSSA: cefazolin, clinda, nafcillin

Extra deep

43
Q

Oral management for cellulitis/erysipelas

A
  • MRSA: clinda 1st, amox + bactrim or doxy
  • MSSA: keflex, nafcillin, clinda
44
Q

Bite or water exposure requires different management in regards to erysipelas & cellulitis. What are the ABX?

A
  • Dog/cat bite: augmentin (animal are augmented)
  • Human bite: Eikenella = broad spectrum (augmentin)
  • Freshwater = cipro for aeromonas (fresh cod)
  • Saltwater = doxy for vibrio (salty duck)

If Eik bites, you need broad coverage

45
Q

Etiologies for lymphangitis

A
  • Acute: GAS, staph, HSV
  • Chronic: mycobacterium marinum

marinating

46
Q

Tx of lymphangitis

A
  • Dicloxacillin or 1st gen cephalo (keflex)
  • MRSA: clinda or bactrim

Dependent on sensitivity

47
Q

Followup for lymphangitis

A

24-48h after, checking for improvement

48
Q

MCC of cutaneous candidiasis and MC demographic

A
  • MCC: candida albicans
  • MC in neonates and seniors
49
Q

RFs for cutaneous candidiasis

A
  • Obesity
  • DM
  • Local occlusion/moisture
  • Steroid/abx use
  • Hyperhidrosis
  • Incontinence
50
Q

Presentation of cutaneous candidiasis

A
  • Pruritic
  • Tender/painful
  • Macerated
  • Erythematous
  • Satellite lesions
51
Q

How is cutaneous candidiasis dx?

A

KOH prep

fungus need KOH

52
Q

Tx of mild-mod cutaneous candidiasis?

A

Topical antifungals: keto, eco, clotri, miconazole

53
Q

Tx of severe cutaneous candidiasis?

A

Oral antifungals: fluconazole x 2-3 wk

54
Q

What is balanitis?

A
  • Inflammation of the Glans penis
  • MC in uncircumcised men with poor hygiene
55
Q

What is a dermatophyte?

A

Unique group of fungi capable of infecting non-viable keratinized cutaneous structures (stratum corneum, nails, hair)

56
Q

3 genera of dermatophytes

A
  • Trichophyton (MC) in hair and fails
  • Microsporum
  • Epidermophyton
57
Q

Where are dermatophytes MC in? Transmission methods?

A
  • MC in the scalp or children or intertriginous areas of young/older adults
  • Transmission:
  • Person to person is MC
  • Animals
  • Soil is least common
58
Q

What are the tinea locations?

A
  • Tinea pedis: feet
  • Tinea cruris: groin
  • Tinea corporis: trunk/extremities
  • Tinea manuum: hands
  • Tinea facialis: face
  • Tinea capitis: hair
  • Tinea barbae: facial hair
  • Onychomycosis: nails
59
Q

What are the 3 classifications of dermatophyte transmission?

A
  • Person to person = anthropophilic
  • Animal to human = zoophilic
  • Environmental = geophilic
60
Q

How are dermatophytes tested?

A
  • KOH prep showing hyphae and spores
  • Woods lamp with black light will show microsporum
  • Fungal cultures (more definitive but takes days-weeks)
  • Dermatopathology skin biopsy (more sensitive but need an entire skin biopsy)
61
Q

Tx of tineas

A
  • Topical Imidazoles: clotrim, mico, keto
  • Topical Allylamines: naftifine, terbinafine
62
Q

Systemic tx of dermatophytes

A
  • Imidazoles PO: Itra, keto, flucon
  • Allylamines: Terbinafine
63
Q

Who is tinea capitis MC in?

A

AA children

64
Q

What is ectothrix?

A
  • A grey patch with a scaly appearance
  • Hair shafts are broken off and brittle
  • An infection OUTSIDE of the hair shaft
65
Q

What is endothrix?

A
  • Black dot appearance
  • Infection within the hair shaft
66
Q

How does non-inflammatory tinea capitis appear?

A
  • Scaling
  • Pruiritis
  • Alopecia
  • Adenopathy
67
Q

How does inflammatory tinea capitis present?

A
  • Painful
  • Tender
  • Alopecia
68
Q

How do the black dots appear in tinea capitis?

A
  • Broken off hairs => swollen shafts
  • Diffuse and poorly circumscribed
  • MCC: T tonsurans or violaceum

TVs in the house (endothrix is inside)

69
Q

What is kerion?

A
  • Inflammatory mass in which remaining hairs are loose
  • Boggy, purulent, inflamed nodules, and plaques
  • Crusting and matting
  • MCC: T. verrucosum and mengatophytes (heals with scars)

very mangy kerion

70
Q

What is favus?

A
  • Latin for honeycomb
  • Perifollicular erythema and matting of hair
  • Malodorous and scarring
71
Q

Which tinea does not fluoresce?

A

T tonsurans

not light cause it weighs a ton

72
Q

Tx of tinea capitis

A
  • PO antifungals: terbinafine or griseofulvin (take with greasy meal)
  • Antifungal ketoconazole shampoo
73
Q

What is tinea cruris/jock itch commonly seen with?

A

Tinea pedis

Athletes and jocks

74
Q

How does tinea cruris present?

A
  • Large scaling, well-demarcated plaques
  • Central clearing
  • Papules/pustules at margins
75
Q

Tx of tinea cruris

A
  • Topical keto or econazole
  • Griseofulvin if above fails
76
Q

What is tinea corporis?

A
  • RING WORM
  • Wrestler’s infection
77
Q

Presentation of tinea corporis

A
  • sharply marginated plaques
  • Vesicles and papules
  • Central clearing
78
Q

Tx of tinea corporis

A
  • Topical antifungals
  • Oral antifungals (if big): terbinafine x 4 wks
79
Q

How does tinea pedis/athlete’s foot present?

A
  • Erythema
  • Scaling
  • Maceration
  • +/- bullae formation diagnosed tinea
80
Q

4 subtypes of tinea pedis

A
  • Interdigital
  • Moccasin
  • Inflammatory
  • Ulcerative
81
Q

How does interdigital tinea pedis present?

A
  • Dry scaling
  • Maceration
  • Fissuring, esp with hyperhidrosis
  • MC between 4th and 5th toe
82
Q

How does moccasin tinea pedis present?

A
  • Well demarcated
  • Scaling with erythema
  • Papules at margins
  • Fine white scaling
  • Hyperkeratosis, which is MC on soles/lateral borders of feet and occurs bilaterally
83
Q

How does inflammatory tinea pedis present?

A
  • Vesicles or bullae with clear fluid
  • Presence of pus = secondary bacterial infection
  • Ruptures will leave erosions with ringlike border ID reaction can occur
  • MC on the sole, instep, and webspaces
84
Q

How does ulcerative tinea pedis present?

A

Extension of interdigital tinea pedis onto plantar and lateral foot, presenting with a secondary bacterial infection

85
Q

Tx of tinea pedis

A
  • Topical: ketoconazole & econazole BID x 2-4wk
  • Oral best for hyperkeratosis: terbinafine
86
Q

What is tinea versicolor?

A
  • AKA pityriasis versicolor
  • Not a dermatophyte infection
  • MC in adolescents, due to an overgrowth of malassezia furfur

NOT CONTAGIOUS

87
Q

How does tinea versicolor typically present?

A
  • Macules w/ w/o scale
  • Patches w/ w/o scale
  • Plaques w/ w/o scale
  • Hypo/hyperpigmentation
  • Erythema
88
Q

What does KOH prep show for tinea versicolor?

A

Hyphae and budding yeast spaghetti and meatballs

very colored

89
Q

Tx for tinea versicolor

A
  • Selenium sulfide or zinc pyrithion
  • Topical antifungals: ketoconazole

PO only if topicals fail

Dermatology (12 decks)

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