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SDNP dcnp infections Flashcards

1
Q

Cellulitis pathogen

A

Group A streptococcus, S. aureus: adults
Haemophilus influenzae B: children under 3

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2
Q

Cellulitis treatment

A

Management: Systemic abx for staph and strep organisms: 1st gen cephalosporins, dicloxacillin
severe cases IV nafcillliin
* Children: IV ampicillin with chloramphenicol, cefuroxime, ceftriaxone
* Consider Rifampin ppx for families w susceptible a child under 4 years, or day-care where systemic H. influenza B has occurred

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3
Q

Erysipelas etio/presentation

A
  • Acute inflammatory form of cellulitis
  • May originate in a traumatic or surgical wound
  • Group A streptococci most responsible organisms
  • Prodrome: flu-like symptoms; develop red, tender, firm spots that rapidly increase in size, uniformly elevated, shiny patch w raised border
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4
Q

Erythrasma pathogen

A
  • Cornybacterium minutissimum
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5
Q

Erythrasma therapies

A
  • Imidazole creams bid x 2 wk: miconazole, clotrimazole, econazole
  • Topical abx: erythromycin, clindamycin, fusidic acid cream
  • Severe cases: Erythromycin 250mgqidx2weeks
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6
Q

Erythrasma tests

A
  • Woods lamp (UVA): coral red fluorescence
  • Potassium hydroxide (KOH): concomitant yeast/fungus: stain w methylene blue: chains of bacilli
  • Extensive: screen for diabetes mellitus: fasting glucose, hemoglobin A1c
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7
Q

Furuncle: abscess/boil

A
  • Involves a hair follicle
  • S. aureus most common pathogen
  • Pearl: no fever or systemic symptoms
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8
Q

Carbuncles: aggregates of infected follicles

A

Involves mult hair follicles; deep dermis and subq tissue
* abx/antiseptic cleansers, mupirocin inside nostrils
Recurrent/resistant infection: tx all family members, culture for MRSA, clindamycin, rifampicin, cephalosporins
Pearl: Malaise, chills, fever precede or occur during active phase

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9
Q

Bullous impetigo

A
  • Most common in infants and children
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10
Q

Non-bullous impetigo

A

Children> adults

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11
Q

Impetigo therapy (may resolve spontaneously)

A
  • Topical mupirocin: effective for both staphylococci and streptococci.
  • Topical retapamulin (Altabax) approved for infections caused by S. aureus; not MRSA.
  • Widespread infections> oral antibiotics.
  • Cloxacillin, dicloxacillin, or cephalexin for 5-10 days for rapid healing
  • Azithromycin for 5 days once daily is effective and better tolerated than erythromycin or cloxacillin; may improve compliance.
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12
Q

Impetigo tx that’s NOT effective

A
  • Erythromycin not effective d/t strains of resistant staph
  • Penicillin inadequate since many
    infections have mixed staph and strep
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13
Q

Impetigo info

A
  • NCAA/NFHSS return to play guidelines: No moist, exudative or draining lesions
  • Poststreptococcal glomerulonephritis: rare, may occur 1-3 weeks after infection of streptococcal impetigo
  • Most commonly asymptomatic
  • Occurs between 6-10 years of age
  • Strep infections are precursors of guttate psoriasis
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14
Q

Herpes zoster complications

A
  • Ramsay-Hunt syndome: vestibulocochlear nerve
  • Ophthalmic branch of trigeminal nerve: HZ ophthalmic
  • Herpes zoster multiplex: occurs along 2 noncontiguous dermatomes
  • Herpes zoster multiplex: more than 2 dermatomes
  • Postherpetic neuralgia: neuropathic sx one or more months beyond resolution
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15
Q

Herpes zoster therapy

A
  • Acyclovir 800 mg q 4 h x7-10days
  • Famciclovir 1000mg q 8 h x 7 days (not in
    immunosuppressed)
  • Valacyclovir 1000 gm q 8 h x 7 days
  • Foscarnet 40 mg/kg IV: resistant to Acyclovir
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16
Q

Staphylococcal Scalded Skin Syndrome (SSSS) presentation

A
  • Acute onset of tender erythema, quickly develops large, thin, superficial bullae in periorificial and flexural areas.
  • Desquamation and fissures around the
    mouth/eyes: “sad old man” facies
  • Oral mucosa and conjunctiva not involved
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16
Q

Herpes zoster pearls

A
  • Burrows soaks alleviate cutaneous symptoms
  • Patients with active vesicular lesions can spread infection
  • Consultations: neurology, ID, ophthalmology
  • Shingrix: decreases r/o zoster & PHN
  • Ppx in immunocompromised: 3-6 months acyclovir prophylaxis for transplant patients
  • Patients w AIDS: acyclovir prophylaxis not recommended
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16
Q

SSSS course

A
  • Oral mucosa & conjunctiva NOT involved
  • Children < 6 y/o, d/t lack of immunity to the toxins and renal immaturity causes poor clearing of toxins; also seen in immunocompromised adults with renal impairment.
  • Children are seldom septic
  • Desquamation and healing in 7-10 days
  • Skin & blood cultures are usually negative in children and positive in adults.
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17
Q

SSSS diagnostics

A
  • Nikolsky’s sign +: extension of a bullae resulting from lateral pressure induces skin separation.
  • Biopsy to rule out TEN if uncertain; SSSS biopsy shows splitting of the granular layer of the epidermis
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18
Q

SSSS antibiotics

A

Oral antibiotics
* Dicloxacillin
* Erythromycin
* Cephalosporins
* Clindamycin
* Sulfamethoxazole/trimethoprim
* Vancomycin
* Corticosteroids are contraindicated

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19
Q

SSSS Pearls

A
  • Avoid wet dressings: may cause drying & cracking of skin
  • Refer to nephrology for immunocompromised adults with renal involvement
  • +Nikolsky sign
  • Spares mucous membranes
  • Resolves without scarring
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20
Q

Hansen’s Disease

A
  • Leprosy, mycobacterium leprae
    Acral neuropathy
    5 disease types:
    Tuberculoidleprosy (TT)
    Borderlinetuberculoidleprosy(BT)
    Midborderlineleprosy(BB)
    Borderline lepromatousleprosy (BL)
    Lepromatous leprosy (LL)*
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21
Q

Hansen’s Disease Pearls

A
  • M. leprae cannot be grown in culture
  • No serologic test for diagnosis
  • Stigma may be worse than disease
  • Can lead normal lives with appropriate therapy
  • Non-infectious within 72 hours of beginning therapy
22
Q

Condyloma acuminata (HPV)

A
  • HPV types 6 and 11 can cause laryngeal papillomatosis in infants; treating the pregnant mother with Cryotherapy consistently may help reduce the number of warts.
23
Q

Condylomata acuminata tx pregnancy

A
  • Cryosurgery: LN2 is effective in treating smaller lesions, and safe during pregnancy.
  • Laser therapy, YAG or CO2: good for primary and recurrent lesions, safe for pregnant patient who have failed LN2 and trichloracetic therapies..
24
Q

Condylomata acuminata tx NOT pregnancy

A
  • Podoflox 0.5% (condylox): not in pregnancy
  • Interferon alfa-2b: Not for use during pregnancy
  • 5-fluorouacil 5%:. Not to be used during pregnancy.
  • Imiquimod: Lowest recurrence rate; not first-line therapy
  • Sinecatechins 15% (Veregen): MoA unknown

Pregnancy can cause warts to grow d/t hormone changes and immune suppression; should be treated after the first trimester.

25
Q

Gardasil

A
  • The CDC Advisory Committee on Immunization Practices recommends the HPV vaccine Gardasil for M/F between ages of 11-16 years. Effective in prevention of HPV types 6,11,16, and 18.
26
Q

Condylomata acuminata education

A
  • Transmission is through sexual contact
  • Educate patients about risk factors including infection and cancer
  • Condoms should be used when warts are visible or during treatment, or abstinence is advised
  • Patients should notify all sexual contacts to be evaluated
  • Patients should be followed every 2-4 weeks during treatments until no lesions are noted, then every 3-6 months
  • Appropriate PAP smears and STD tests should be performed
27
Q

Condylomata acuminata pearls

A
  • Frustrating disease characterized by frequent recurrences
  • Patients should be treated respectfully and non- judgmentally
  • Application of a gauze- soaked pad over suspicious lesions for 5-10 minutes reveals sharply demarcated lesions with white opacity
28
Q

Gianotti-Crosti Syndrome (Papular Acrodermatitis of Childhood)

A

Self-limiting dermatitis triggered by viral infections:
* most often Epstein-Barr
* Hepatitis B
* CMV
* RSV
* Parvovirus 19
Spring, early summer, children 6 months to 14 years
* Often prodrome low-grade fever, URI
* Resolves in 3-8 weeks

29
Q

Gianotti-Crosti presentation

A
  • Symmetric, pink/brown flat- topped papules or vesicles on buttocks and spread to face and extensors. Trunk typically spared
  • May be pruritic
  • Koebner phenomenon reported
30
Q

Molluscum contagiosum (DNA poxvirus)

A
  • Palms and soles not involved
  • Genital only lesions in children: high suspicion of child abuse
  • Red halo: BOTE sign (beginning of the end)
31
Q

Molluscum education

A
  • Tx takes multiple visits over 1 month or +
  • Do not share bath or towels.
  • Children may attend school and daycare
  • Cover lesions likely to come in contact w others
  • Avoid sexual activity until lesions resolved.
  • Maintain skin integrity, prevent auto-inoculation
  • NCAA return to play: lesions curetted or removed; site covered
  • NFHS return to play: 24 hours post curettage; site covered
32
Q

Molluscum contagiosum tx

A
  • Individualize tx
  • Tx mult lesions in children conservatively to prevent scarring
  • Genital lesions in adults should be treated to prevent transmission through sexual contact.
  • Cantharidin: generally tolerated. Gently drop cantharidin on lesion, cover with tape, wash with soap and water in 2-24 hours.
  • Liquid Nitrogen: Usually not tolerated in cases with multiple lesions, especially in children.
  • Curettage: In the presence of few lesions, gently curette papules. This may result in scars and should not be utilized in cosmetic areas. Topical anesthesia may be needed in children.
  • Salicylic acid 2% applied daily without occlusion
  • Trichloracetic acid 35-50%
  • Off-label: Tretinoin, imiquimod
33
Q

Molluscum contagiosum pearls

A

Pearls
* Usually self-limited.
* Goal of treatment is to avoid scarring
* Often a tincture of time is the only
treatment needed
* Refer to ophthalmology for lesions in the
periocular area

34
Q

Measles (Rubeola)

A
  • Prodrome: fever, malaise, cough, conjunctivitis. Ill-appearing
  • Koplik’s spots: bluish-white elevations on buccal mucosa
  • Exanthem: erythematous maculopapular eruption, from scalp to forehead,
    posterior ears, face, neck, to trunk and extremities. Fades in same progression
  • Incubation: 10-12 days
35
Q

Measles (Rubeola) ddx

A
  • Other morbilliform eruptions: Rubella, erythema infectiosum, pityriasis rosea, infectious mono
  • DRUG
  • Papulosquamous disorders: psoriasis, guttate psoriasis
36
Q

Small pox (variola virus)

A
  • Variola Major: mortality 30%
  • Variola Minor: mild illness, mortality <1%
  • Prodrome: fever, malaise, abd pain, chills, HA, vomiting
  • 2-4 days: macules and papules in mouth, face, extremities, spread to trunk, including palms and soles
  • Lesions all same stage of development
37
Q

Small pox (variola virus)

A
  • Contact local public health officials for handling and evaluation
  • Supportive therapy
  • TPOXX (tecovirmat) app by FDA in 2018: Emergency Use authorization
    *Strict standard, contact, and Airborne precautions
  • Category A bioterrorism agent
38
Q

Verrucae

A
  • Benign epidermal neoplasms caused by HPV
  • Affects 10% of children. Peak incidence 12-16
  • Most are transient but recurrence common, especially in immunocompromised patients
  • Lesions may koebnerize
  • Risks: close personal contact: lesions spread by skin-to-skin contact or skin-to-mucosa contact; indirectly by contact with contaminated surfaces: wrestling mats, swimming pools, showers
39
Q

Wart sub-types

A
  • Common warts: Hands most commonly involved, but may appear anywhere
  • Filiform warts: Single or multiple projections, most common around the mouth and face
  • Flat warts: Flesh colored to pink flat or slightly elevated; few to multiple; usually on the face and areas that are shaved: beard area in males and legs in females
  • Plantar warts: on the plantar surface (palms and soles); usually on pressure points: head of the metatarsal bones or heels
  • Mosaic warts: Cluster of many warts, usually flat with black dots; usually on the heels
  • Periungual and subungual warts: around and under the nail
40
Q

Warts treatment

A
  • Salicylic acid: OTC, available in liquid form and patches, removes surface keratin; preg cat C, therefore avoid during pregnancy
  • Cryotherapy: LN2 most common office procedure; poorly tolerated in young children; requires mult tx spaced 2-3 wks apart; TOC during pregnancy
  • 35-50% trichloroacetic acid: causes immediate superficial tissue necrosis
  • Cantharidin: extract of the blister beetle causes epidermal necrosis and blistering;
    painless application, but can form painful blister; often referred to as “Blister Juice”
  • Retinoids: useful for flat warts; tx may take months
  • IL immunotherapy: Bleomycin: high risk for infection and scar; do not use during pregnancy
  • Surgical excision ablative laser
  • Curettage and desiccation
  • Snip or shave excision for filiform warts
  • Off-label Therapies: Imiquimod cream, 5-fluorouracil, intralesional squaric acid and Candida, duct tape, cimetidine 30 mg/kg/day
41
Q

Warts management

A
  • Often spontaneous resolution in 1-2 years: do not necessarily need to be treated
  • Treat if lesions are painful, interfere with daily activities, or are multiplying
  • In-office therapies most effective when combined with home treatment
  • NCAA (National Collegiate Athletic Association) and NFHS (National Federation of State High School Associations) return to play rules for athletes: face: cover with mask; Nonface: cover or curette
42
Q

Warts pearls

A
  • Don’t make the tx worse than the condition: don’t leave a scar
  • Tx take consistent tx for wks or mons
  • Home tx are most effective after soaking lesion in warm water to soften skin and allow better penetration of medications; paring with pumice weekly removed keratotic skin
43
Q

Fungal infections (candidiasis)

A
  • Increased risk with TH17 biologic use, immunocompromised
  • Dx based on clinical presentation
  • Microscopy w KOH: budding hyphae, pseudo yeast cells; quickest and least expensive
  • Fungal culture: gold standard to diagnose
    fungal infections can take 2-6 weeks for results
    *Biopsy with Periodic acid- Schiff (PAS): helpful to rule out tinea if clinical presentation and microscopy are not conclusive
44
Q

Candidiasis tx

A
  • Maintaining dryness necessary for intertriginous candidiasis
  • Burrow’s compresses
  • Absorbent powders (Zeasorb AF 1%)
  • Loose-fitting clothes, frequent diaper
    changes
  • Antifungal topical medications: Polyenes,
    and azoles.
  • Nystatin, miconazole, clotrimazole,
    ketoconazole, Econazole
  • Oral medications: fluconazole (Diflucan),
    itraconazole (Sporonox)
45
Q

Candidiasis pearls

A
  • Refer to ID specialist for wide-spread infections
  • Examine every pt w candidiasis for oral thrush
    Education
  • Teach pts the risks of recurrence.
  • Keep skin dry w powders & frequent clothing changes
  • Pts should be re- evaluated if there is no
    response to tx in 10-14 days
46
Q

Fungal infections (Tinea)

A
  • Dermatophyte infection most commonly caused by Trichophyton, Microsporum, and Epidermophyton
  • Advancing erythematous border with scale and central clearing
47
Q

Majocchi Granuloma

A

dermatophyte invasion of hair follicles

48
Q

Tinea Barbae

A

Terbinafine 250mg/day x 2-4 weeks
Griseofulvin 500 mg/day x 2-4 weeks or 150 mg weekly x3- 4 weeks
Fluconazole 200 mg daily x 1-2 weeks

49
Q

Tinea Capitis
NCAA/NFHS return to play: Oral antifungal>14days

A

Griseofulvin: 15 mg/kg/day ultramicrosized x3-6 wks
Terbinafine 3-6 mg/kg/day x 6 weeks
Itraconazole 25-200 mg/kg x 23 days

50
Q

Tinea with Kerion
NCAA return to play: Oral antifungal>14days

A

Appropriate abx w + culture
Off-label oral prednisone 0.05-1 mg/kg/day x 10-14 days

51
Q

Tinea Cruris

A

Topical antifungals

52
Q

Tinea Manuum and Tinea Pedis
NCAA/NFHSReturntoPlay: Norestriction

A

Topical antifungals
Terbinafine 250 mg/day x 6 weeks
Itraconazole 400 mg/day x 4 weeks
Fluconazole 150 mg /week x 3-4 weeks

53
Q

Tinea Unguium (Onychomycosis)

A

Systemic antifungals treatment of choice
Topical meds high noncompliance rate

54
Q

Majocchi Granuloma

A

Terbinafine125-250 mg/day x 2-4 weeks Itraconazole 25-200 mg/kg x 2-4 weeks

Dcnp (5 decks)

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