Tx Flashcards
SSSS DOC
Dicloxacillin conb w fluid tx and supportive
tx TSS
Systemic antibiotics such as vancomycin wc may be combined w nafcillin in critically ill adult parents. vigorous fluid tx.
drainage of s aurraus infected site
major dx criteria: widespread macular erythwmatous eruption.
usuaally by s aureaus
mortality in non menstrual- upto 20%.
mentrual- 5%
catheters, undergoing infection.
rapidly progresive destructive soft tissue infection.
NSAID.
case fatality rate-!30%
procalvitonin indicator of severe bacterial infection. may be a biologic marker for toxic shock syndromes.
H:
Tss - snnl ( spongiosis, neutrophil, necrotic keratinocytes, lymphocytes)
mNif: strepp tss- isolation of group a beta hemokytic strep and 2 or more of the ff. renail impairment, coagulopathy; hepatic inv, ards, generalized erythematous macular eruption that may desquamate and soft tissue necrosis, myositis or gangrene.
Ecthyma tx
Cleaning w soap and water after soaking off crust w compress ff by app of mupirocinc retapamulin, bacitracin ointment twice daily.
oral dicloxacillin or 1st generation cephalosporin.
more strep than staphy pyoderma.
begins as vesicle pr vesiculopustule that enlarges and in a few days thickly crusted.
when crust removed there is a superficial saucer shaped ulcer w raw base and elev edges.
scarlet fever tx
scarlet - PED
penicillin
erythromycin
Dicloxacillin
children
dev the eruption 24-48 hours agter onset of paryngeal symptoms. tondils red edemarous and covered w exudate. tongue white coating. reddened hypertrophid papilla “strawberry white apprearance”
4-5th day- coating disappears and toung is bright “red strawberry tongue”
cutaneous eruption begins on neck then spreads to the trunk and then lastly extremities. widespread erythema are 1-2 mm papules wc give skin a sand paper qlty. linear petechial eruption( pastia lines) often present in antecubital and axilarry folds.
facial flusshing and circumoral palor.
eruption prod by erythrogenic exotoxin prod grup a strep.
Erysipelas
acute b hemol group a strep.
Strep c and g- adult
Step group B - child
Penicillin systemic atleast 10 days.
ice bag.
cold compress.
st anthonys fire.
PML- 20,000 cells/mm or more.
intense inflammation w vesicles or bullae.
most common site/ Face and legs.
Cellulitis
75% streptococci.
Tx. dicloxacillin or cephalexin for 5 days.
nacrotizing fasciitis
tx surgical debrid
IV antibiotics
mortality rate 20%
those in abd wlal has higher mortality rate.
MRI most definitice conf test.
path: Microaeropholic B helolytic strep, hem staph, coliforms, enterococci, pseudomonas, bacteroides
necrotiIng infection of fascia. may folow trauma or surgery. within 24 hiurs redness pain and edema quickly progress to central patches of dusky blue discoloration. by 4th or 5th say these purple areas become gangreneous.
both aerobic ans anaerobic cultures should always be taken.
2cm incision dwn the fascia- lack of bleeding, murky discharge and lack of resistance to probing finger are ominous signs.
blistering distal dactilytis
Group a b hem strep
tense superficial blisters
on tender erythematous base.
over volar fat pad of phalanx of finger and thumb.
2-16 yo.
Perianal dermatitis
Penicillin or erythromycin comb w a topical antiseptic or antibiotic is tx of choice.
group a strep.
duration 14-21 days.
post tx swab and urinalysis to monitor for post strep glomerulonephritis are recommended.
Streptococcal intertrigo
Group a b hemolytic strep
Top antibiotics and oral penicillin.
infants and child may dev fiery red erythema and maceration in neck axillae and inguinal folds.
no satellite lesions.
may be painful and fould order
may be mistaken for candidal intertrigo- but strep are more painful and macerated a d lack satellite pustules.
Strep iniae
Fish patho- strep iniae
fever lumphangitis cellulitis
(SI- FLC) without skin necrosis.
penicillin
erysipeloid of rosenbach
Erysipelothrix rhusiopathiae
Prnicillin 1g/day for 5-10 days, or
ampicillin 500mg 4x a day best txa for loc disease.
if pen cannot be used, imipinem, piperacillin tazobac.
(PIP)
systemic 12-20 mill units/ day of IV penicillin for up to 6 weeks.
sharply madginated kfyen polygonal patch of purplish erythema.
1st symptom is pain at site of inoculation. ff by swelling and erythema. sharply defined slightly elev zone tagt extends peripherally as the centrail portion fades away.
migratory nature. new purplish red patches appear at nearby areas. j
Anthrax
asypromatic exposed- prophyl tx w 6 week course doxycycline or ciprofloxacin.
aggressive and systemic lesions- iv tx
cutaneous- ciprofloxacin 500 mg or doxy 100 mg teice a day for 60 days.
inflamm papule beg 3-7 days after inoculation.
bulla surr by intense edema and infiltration forms within another 24-36 hours. ruptures spont. and black eschar is visible.
PUSTULES ALMOST NEVER PRESENT.
bacillus 3 virulence fagtor:
polyglutamate acid capsule inhibiting phahocytosis
edema toxin
lethal toxin.
culture
Listeriosis
Ampi genta DOC.
TMP SMX- alter.
Cutaneous diphtheria
Doc- Erythromycin 2g/day
IM diphtheria antitoxin 20000a 40000U after a conjunctival test.
in severe cases; Iv Penicillin G 600,000 U/day for 14 days.
rifampin 600mg/day for 7 days will eliminate dipth carrier state.
ulcer punched out and has hed rolled elevated edges and pale blue tinge. leathery grayish membrane covering.
Corynebacterium jeikeium
DOC vancomycin
Van jeik
Erythrasma
Triad of erythrasma : Corynebacterium, pitted keratolysis, trichomycosis axillaris.
woods lamp: coral red f
top erythro sol or top clindamycin.
Oral erythro 250mg 4x a day for 2 weeks.
and clarithro single 1g dose.
Arcanobacterium haemolyticum
pharyngitis in young adult.
exanthem is ery morbilliform kr scarlatinifkrm eruption on trunk and extremities.
tx of choice: Erythromycin. severe high dose penicillin G.
Intertrigo
bact: Strep, staph, pseu, corynebacterium.
demarcated fiery red moist shiny surface and a foul smell w an absence of satellite lesions.
Bot toxin type A used to dry out arras pred to recurrent disease. castellani paint as antibact ointment, low po top strroid and top tacrolimus reduce inflam.
in conjunction w antifungal or antimicrobial agent. huhu.
Pitted keratolysis.
Kytococcus sedentarius.
tx: Top erythromycin; mupirocin; clindamycin.
PK-MEC
Miconazole or clotrimazole cream and whitfield ointment are effective alt.
benzoyl peroxide gel and 10-20% sol aluminum chloride.
Gas gangrene (Clostridial myonecrosis)
surgical debrid.
intensive antibiotic tx w IV penicillin G and clindamycin.
Clinda resistant C perfringens- Vancomycin.
gas bubbles (hydrogen)!
Meleney gangrene.(Chronic undermining burrowing ulcers)
Wide excision and grafting primary tx.
imipenem and meropenem as adj tx for polymicrobial infections
fournier gangrene of penis and scrotm
Group a strep or w mixed enteric bacilli and anaerobes
antibiotixs. Surg deb; and general support.
bet 20-50 yo.
Actinomycosis.
Pen G 10-20 MU/ day for 1 month. ff by 4-6 g/day of oral penicillin for another 2 months.
Eosinophillic clubs comp of immunoglobulins are seen at periphery of granule(Splendore Hoeppli phenomenon)
most often on cervicofascual area. middle aged men.
oropharyngeal actinomycosis- actinomyces israelii and a gerencseriae.
Nocardiosis
DOC cutaneous nocardial infection: TMP SMX 5-10mg/kg/day in 2-4 divided doses for 3 months or 6 months if immunocompromised.
(NO-TS)
Minocycline is an alternative.
Imipenem plus TMP SMX or amikacin are effectively used in combination for disseminated infection.
(NO- ITS/A)
beg a pulmo infection.
skin inv is 10% of disseminated cases. in form of abscess; erosion, vesiculopustular lesions.
Noc brasiliensjs most common cause if lrimary cut disease.
N. asteroides usually reponsible for disseminated form of nocardiosis.
SDA- white colonies wc later become chalky and orange colored.
Ecthyma gangrenosum
Pseudomonas.
IV ANTI pseudomonal penicillin.
add of G CSF to stimulate both proliferation and differentiation of myeloid precursors.
buttoks or extremities.
vesicle/pustule- Black nexrotic centers w ulcers.
Green nail syndrome
Onycholysis of distal port of nail.
soak finger in 1% acetic acid sol 2x a day- helpful.
trimming of onycholytic nail playe ff by neosporin 2x a day.
Gram neg toe web infection.
P.aeruginosa.
early- topical antifungal.
however w scaling; peeling lrogress to white maceration soggy scaling bad odor edema and fissuring. tx must also include top antibiotics, or acetic acid compress.
full blown gram neg toe web infection w wide spread denudation and erythema purulence and edema req systemic antibiotics. 3rd gen ceph or fluoroquinolone.
Pseudomonas folliculitis ( Hot tub folliculitis)
folliculitis usually involutes within 7-14 days without tx.
3rd gen ceph or fluoroquinolone such as cipro or ofloxacin may be useful.
chlorination of water/ at ph 7.2-7.8
External otitis.
70% of cases- P aeruginosa.
Local antipseudomonal and antiinflam cortisporin otic sol or suspension, ir 2% acetic acid compress w topical steroid.
App of otic domeboro solution after swimming eill help prevent recurrence.
Candida and aspergillus. Antifungal sol (ciclopiroxolamine) Comb w steroid sol are affective for otomycosis.
facial nerve palsy in 30%
Malacoplakia.
granuloma may arise as masllike lesions ir nodules abscesses or ulcerarions. favro perineum but also affect abd wall, thoraz and extremities and axillla.
h: Foamy eosinophillic hansemann macrophages: contain calcified conentrically laminated intracytoplasmic bodies (‘ michaelis gutmann) Scattered immunoblasts neutrophils and lymphocytes are found in dermis.
Fluoroquinolone (cipro( ofloxacin)
(MAL-F)
H influenzae
bluish or purplish red cellulitis of face. acc by fever in child younger 2 yrs.
cefotaxime and ceftriaxone/
HI(-Tri tax)
h influenza type B.
Chancroid
h ducreyi.
tender ulcer in genitalia and painful inhuinal adenitis that may suppurate:
men.
inflam macule or pustule 1-5 days or rarely as long as 2 weeks after intercourse. gen appear on distal penis or perinatal area in men. vulva cervix or perianal area in women.
H: Ulcer inc a suprficial necrotic zone w an infiltrate const of neutrophils lymphocytes and rbc. ducreyi bacilli may or may not be seen in secretions.
culture/ def dx.
tx.: Azithromycun 1g orally singe dose or Ceftriaxone 250mg IM single dose; Erythromycin 500mg 4x a day for 7 days, ciprofloxacin 500mg orally 2x a day for 3 days:
Granuloma inguinale
progressive indolent serpigenous ulcerarions of groind pubes genitalia and anus.
painless. beefy red.
genitalia 90%f inguinal region 10, anal 5-10. distal sites 1-5.
Gram negative klebsiella granulomatis.
direct inoculation.
H: epidermis is replaced by serum fibrin and PMN leukocytes. periphery pseudoepitheliomatous hyperplasia.
Tx: Azithromycin 1g ince weekly for atleast 3 weeks.
alt: TMP SMX 1 double strength tablet; Ciprofloxacin 750mg or doxycyline 100mg twice daily or erythromycin 500mg 4x daily. all minimum of 3 weeks.
additioj if IV aminoglycoside such as gentamycin 1mg/kg every 8 hrs considered if lesions do not respond w 1st few days in HIV infected pxs.
GI 3.
Gonococcal dermatitis
Ceftriaxone 125mg single IM dose w single dose azithromycin 1g orally is recommended.
Gonococcemia
horrhaguc vesiculopustular eruption bouts of fever arthralgia or actual arthritis of one or several joints. tiny sparse erythematous Or hemorrhagic base or purpuric macules. identical to meningoccemmia
neisseria gonorrhea
Disseminated : ceftri 1g/day IV plus Azithro 1g oral min of 1 week.
meningococcemia
fever chills hypotensioj meningitis. petechial eruption most on trunk or lower extremity. prgress to ecchymoses, bullous hemorrhagic, ischemic lesions.
young children males
tx Iv ceftria 2g twice a day or penicillin G 300000 u/kg/day upto 24 MU/day for 7 days. DOC.
One dose cipro 500mg is given after initial course of antibiotics to clear nasal carriage.
rifampin 600mg q12 hours for 2 days is an alt prophylactic tx for children
ceftriaxone single IM dose of 250mg for preg women.
Vibrio vulnificus
raw oysters.
Begin w 24-48 hours of exposure with localized tenderness followed by erythema edema and indurated plaques.
occur in almost 90% of patients and are most common oj lower extremities.
DOC:
Doxycycline and ceftriaxone.
VV ( dox-Tri)
Chromobacteriosis and aeromonas
Chromobacteriim violaceum most common species. prod violet pigment.
Best tx; fruoroquinolone with aminoglycoside.
after several weeks of parenteral antimicrobial tx. an oral agent (tmp smx, tetracycline and fluoroquinolone) is given for 2-3 months.
CHROM AF TTF
aeromonas hydrophilia - ciprofloxacin.
AH PRO
Salmonellosis
inc 1-2 wks
onset fever chills headache constripation bronchitis.
after 7-10 days. rose colored macules or papukes “rose spots” 2-5mm appear on anterior trunk bet umbilicus and nipples. appear in crips each feoup of 10-20 lesions lasting 3-4 days. 2-3 week duration of exanthem. rose spots in 50-60% of patients.
tx; cipro or ceftri
shigellosis
fruoroquinolone
(SHI-F)
MSM may dev a furuncle on the penis caused by shigella flexneri.
Helicobacter cellulitis
Tx ciprofloxacin
fever bacteremia cellulitis arthritis.
H. cinaedi / H. canis.
predisposing- HIV, alcohOL, DM, malignancy.
rhinoscleroma
Chronic inflam granulomatosous of upper respi char by sclerosis deformity remission debility.
limited to nose pharynx adjacent structures.
nodules are first small hard subepidermal ad freely movable but gradually fuse to form sclerotic plaques tagt adhere to underlying parts. ulcerstion is common. stony hardness. dusky purple or ivory color.
kleb pneumo sso rhinoscleromatis.
Mikulicz cells occ hyaline degenerated plasma cell.
russell body w few spindle cells and fibrosis.
best bisualized in warthin starry silver stain.
tx.
usually progressive and resistant to tx.
fluoroquinolones. 3-4 mos.
R/F.
Pasteurellosis
Amoxicillin- clavulanate 875/125 mg twice daily.
PAST AC
P. haemolytica
P. Multicoda
Glanders
Burkholderia mallei.
those who handle horses mules and donkeys.
inflam papule or vesicle that arises at the site of inoculation rapidly brcomes nodular or pustular and ulcerative and forms irregular excavation.
respi mucous membranes are susceptible to glanders. accidental inhalation, catarrhal symptoms are 1st present. there may be epistaxis or mucoud nasal discharge - char feature of the disease.
nodules called farcy buds
tx: immediate surgical excisionof inoculated lesions and antibiotics. Amox- clav, doxycyline or tmp smx upto 5 mos.
Gland DAT
Melioidosis ( whitmore disease)
Burkholderia pseudomallei
acute pulmonary and septic form.
south east asia.
dx: Recovery of bacillus from the skin lesions or sputum. serologic test.
tx: acute septicemic: ceftaz, merop, imipenem for 2 weeks. ff by maintenance tx w tmp smx oral. 3-6 months.
Mel- TIM, T
Catscratch
B henselae
primary skin kesiins appear win 3-5 days agter cat scratch. present in 50-90 of pxs.
resemble insect bute but not pruritic.
Biopsy: Granulomatous inflammation with central stellate necrosis
lymphadenopathy is hallmark of disease.
Epitrochleae and axillary lyphadenopathy most common (50%), cervical 25. inguinal 18.
fluctuant lymph nodes should be aspirated.
tx: Azithromycin 500mg first day ff by 250 mg for 4 days in adults,
(Cat- AZI)
biopsy of LN- Grabulomatous inflamm w central stellate necrosis.
Trench fever
B quintana
person to person by body louse.
fever initally lasts about 1 week and then recurs every 5 days. headache neck shin back pain. endocarditis may occur.
tx: Comb of IV gentamycin and oral doxycyclin.
TRE GD
Bacillisry angiomatosis
b henselae and quintana.
occurs in immunosuppression.
T cells usually less than 50
elev LDH, elev ALP, elev hepatocellular enzymes; N bilirubin.
resembles pyogenix granuloma.
distringuished from progenic granuloma by neutrophils throughout lesion not jst on surface like in PG.
tx: clarithro 500mg twice daily or azithromycin 250mg daily. 6 months.
(BA- Cla - AZI)
a jarish herxheimer reaxtion may occur on 1st dose of antibiotix.
Oroya fever and verruga peruana
Oroya, carrion dx- acute febrile stage
verruga peruana/ chronic delayed stage.
Bartonella bacilliformis transmitted by a sandfly usually lutzomyia verrucarum.
humans only known reservoir.
severe hemolytic anemia, leukopenia, thrombocytopenia.
untreated fataljty rate 40-88%. w antibiotic tx 8
giemsa stain- identifying bacteria and erythrocyte.
tx. chloramphenicol 2g/day
(OC)
salmonella coinfection- Most frea cause of death.
Plague
Yersinia pestis.
milder form: Initial manif are general malaise, fever, pain or tenderness in regional lymph node most often on inguinal or axillary regions.
principal animal hosts: rock dquirrels, prairie dogs, chipmunks, marmots, skunks, deer mice, wood rate, rabbit, hares.
transmission: Contact w infected rodent fleas or rodents, pneumonic spread or infected exudates. Xenopsylla cheopis (oriental rat flee! vector in human outbreaks.
tx: Y pestis are gentamycin and streptomycin. SHOULD BE IV.
YP SG
Rat bite fever
contact w rats or rodents wc carey spirillum minor and strepbacillus moniliformis
Strep moniliformis/ US, septicemia
spirillum minor- asia. sodoku
strep- shorter incubation- 10 days. when chills and fever occurS within 2-4 days, generalized morbilkiform eruption appears.
S minor- longer incubation 1-4 weeks. bite site inflammed and ulcerated. lymphangitis.
begins w erythematous macules on abd resembling rose spots wc enlarge become purplish red and form extensive indurated plaques.
6% of untreated die.
dx confirmed by culture. from blood or joint aspirate.
tx: amoxicillin clavulanic 875/125.
RB AC
tularemia
known as ohara disease or deer fly fever.
febrile dx cause by Francisella tularensis.
most common: ulceroglandular.
sudden onset chills headsche leukocytosis after 2-7 days incubation.
freq sources if human infection handling of wild rabbits l, bute of deer flies or ticks.
Bite of ticks: Dermacentor andersoni, Amblyomma americanum, deer fly- chrysops discalis. def dx: staining smears.
4x rise in tited is diagmostic. 1:160 or greater is diagnostic of past or current infection.
PCR.
main histo feature: Granuloma.
tx; streptomycin IV DOC
ALT: IV Gentamycin, oral doxy, or ciprofloxacin.
brucellosis
Undulant fever.
eatpacking industry. risk arenthose in contact w infected animals or animal products.
pet owners, pasteurized milk.
biopsy: non caseating granuloma.
dx by culture of blood bm or granuloma confirmed by elisa or agglutination titer.
(Bruce- Elisa)
tx doxycyline and gentamycin.
BRUCE DG
rickettsial dx
Natural reservoir blood sucking arthropod.
dx: clinical
confirmed by indirect fluoresence antibody testing.
R IFAT
may be verified by western blot or PCR.
tx: doxycyline 100mg twice a day for 7 days.
Epidemic typhus
infestation by body lice ( pediculus humanus var corporis)
spares face palm sole.
while louse feeds in the persons skin it defcates. the organisms in the feces are scratched into the skin. after 5 days, pink macular eruption appears on trunk and axillary folds and rapidly spreads ro rest of body. macules may later brcom hemorrhagic and gangrene of fingers toes and earlobes may occur.
serologic testing using IFA and western blot for paecificity is positive after 8-12th say of illness.
tx Doxyclycline 100 mg twice a day for 7 days.
MRSA TX
Clindamycin
Tmp smx
doxycycline
MRSDA DRUGS
Clinda
tmp smx
doxycycline
doxycycline not for
group A strep
differentiate janeway lesions and osler
Osler- Tender, erythematous nodule on fingertips
janeway- non tender, angular hemorrhagic lesion on palms and soles
impetigo etio
50-70% s aureaus
the rest s pyogenes
new born impetigo
group b strep
strains of nephritis
Type 49, 55,57,60.
M2 strain.
group a beta heno strep are sometimes followed by
AGN
impetigo prg
good in child
bad adult
2-5% of IMPETIGO HAVE AGN. most freq before 6yo.
prev carrier state of staph in nares (impetigo)
Mupi ointment on anterior nares 2x a day daily or
10 day course of rifampin and dicloxacillin ( for MSSA)
or tmp smx ( MRSA)
impetigo of bockhart
superficial folliculitis w thin walled pustules at the follicle orifices.
tx folliculitis
1st gen ceph
penicillinase resistant penicillin (eg dicloxacillin) unless MRSA
MRSA/ tmp smx, clinda, doxycycline, minocycline, linezolid.
places inside nares 2x a day inside the nares twice saily throughout the course of isotret tx. eliminates or red risk of nasal carriage of S. Aureus.
bacitracin ointment
paronychia etio
S aureaus s pyogenes pseudomonas proteus anaerobes
yeast- candida
tx paronychia
top or oral Af -50% recovery rate.
Miconazole comb w topical steroid cream or ointment in candidal chronic paronychia.
tx acutely inflamed pyogenic paronychia abscess
Incised and drained.
tz acute suppurative paronychia
spec if shows pyogenic cocci.
a semisynthetic penicillin or cephalosporin w excellent staph activity given orally.
if not effectivensuspect - mrsa or mixed anaerobic bacteria.
botromycosis
S aureaus p aerugunosa e colu proteus bacteroides strep
pyomyositis
fever ans muscle pain.
s aureus abscess in deep large striated muscles. presents w fever and muscle pain.
hematogenous origin.
most frrq area- thigh.
HIV/ Deltoid then quadriceps.
drainage of abscess and app systemic antibitoics are recomm tx.
SSSS
age
neonates < 5 yers old. rarely on adult.
SSSS diff from sjs and ten- Based on level of epidermal separation. Sss not affrct mucous membranes.
skin sep at granular layer unlike Ten which is at th3 dej.
lesions morensuperficial less severe.
healing mire rapid.
exfoliative txin a and B
spare palms and soles. and mucous mem.
+nikolsky
Exfoliative toxins a b d specifically cleave desmoglein 1. the target antigen of autoantibodies.
ssss prog
excellent in children m but mortality in adult reach 60%
chronic recurrent erysipelas, chronic lympangitis aid in prevention of recurrence.
compression therapy
erythema marginatum
spreading patchy erythema that migrates peripherally and forms polycyclinc configusrions. evanescent.
spares face.
skin biopsy: perivasc and interstitial pPMN LEUKOCYTE predominance.
asynptomatic and resolve spont
Typhus subtypes
Louse borne endemic typhus- r prowazekii
mouse, cat, rat flea- borne - r typhi.
scrub typhus, mite borne- r tsutsugamushi
endemic typhus-
(murine typhus
natural inf od rats and mice by r typhi.
rat flea ( xenopsylla cheopis)
car fleA ctenocephalides felis.
same manif as epidemic typhus but less severe. Nd gangrene does not supervene.
peak incidenceE summer and fall.
tx same as epidemic typhus.
scrub typhus
tsutsugamushi fever.
fever chills intense headache skin lesions and pneumonitis.
primary lesion:erythematous papule at site of mite bite. most often in scrotum, groin, or ankle. becomes indurated multilocular vesicle rests atop the papule. necrotic ulcer and eschar surr indurated erythema.
regional kymphadenopathy.
erythematous macular eruption begins in trunk extends peripherally and fades in few days. deafness and tinnitus in 1/5 of untreated pxs.
vector: trombiculid red mite (chigger)
tx tetracycline.
