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.
