Skin Infections Diagnosis And Treatment Pdf
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Family physicians frequently treat bacterial skin infections in the office and in the hospital.
- Skin and Soft Tissue Infections
- The Microbiology of Skin, Soft Tissue, Bone and Joint Infections, Volume 2
- Outpatient Management
Your skin is your body's largest organ. It has many different functions, including covering and protecting your body. It helps keep germs out. But sometimes the germs can cause a skin infection.
Skin and Soft Tissue Infections
Family physicians frequently treat bacterial skin infections in the office and in the hospital. Common skin infections include cellulitis, erysipelas, impetigo, folliculitis, and furuncles and carbuncles.
Cellulitis is an infection of the dermis and subcutaneous tissue that has poorly demarcated borders and is usually caused by Streptococcus or Staphylococcus species. Erysipelas is a superficial form of cellulitis with sharply demarcated borders and is caused almost exclusively by Streptococcus. Impetigo is also caused by Streptococcus or Staphylococcus and can lead to lifting of the stratum corneum resulting in the commonly seen bullous effect.
Folliculitis is an inflammation of the hair follicles. When the infection is bacterial rather than mechanical in nature, it is most commonly caused by Staphylococcus. If the infection of the follicle is deeper and involves more follicles, it moves into the furuncle and carbuncle stages and usually requires incision and drainage. All of these infections are typically diagnosed by clinical presentation and treated empirically.
If antibiotics are required, one that is active against gram-positive organisms such as penicillinase-resistant penicillins, cephalosporins, macrolides, or fluoroquinolones should be chosen.
Children, patients who have diabetes, or patients who have immunodeficiencies are more susceptible to gram-negative infections and may require treatment with a second- or third-generation cephalosporin. Bacterial skin infections are the 28th most common diagnosis in hospitalized patients.
The percentage of office visits for cellulitis was 2. Knowledge of the presentation, histopathology, and microbiology for each type of infection is important for proper care of the patient. The presentation, etiology, and current management of these diseases are presented. Cellulitis is a painful, erythematous infection of the dermis and subcutaneous tissues that is characterized by warmth, edema, and advancing borders Table 1.
Cellulitis commonly occurs near breaks in the skin, such as surgical wounds, trauma, tinea infections Figure 1 , or ulcerations, but occasionally presents in skin that appears normal.
Patients may have a fever and an elevated white blood cell count. Cellulitis can occur on any part of the body. Among the patients in the cohort above, the most common sites of cellulitis were the legs and digits, followed by the face, feet, hands, torso, neck, and buttocks data taken from primary physician diagnosis codes from January 1, to December 1, for health plan members of Intermountain Health Care, Salt Lake City.
Fiery red, painful infection of superficial skin with sharply demarcated borders. In otherwise healthy adults, isolation of an etiologic agent is difficult and unrewarding.
If the patient has diabetes, an immunocompromising disease, or persistent inflammation, blood cultures or aspiration some physicians inject sterile nonpreserved saline before aspiration of the area of maximal inflammation may be useful. Marking the margins of erythema with ink is helpful in following the progression or regression of cellulitis Figure 2.
Outpatient therapy with injected ceftriaxone Rocephin provides 24 hours of parenteral coverage and may be an option for some patients. The patient should be seen the following day to reassess disease progression. Most cases of superficial cellulitis improve within one day, but patients who exhibit thickening of the dermis usually take several days of parenteral antibiotics before significant improvement occurs.
Antibiotics should be maintained for at least three days after the resolution of acute inflammation. A parenteral second- or third-generation cephalosporin with or without an aminoglycoside should be considered in patients who have diabetes, immunocompromised patients, those with unresponsive infections, or in young children. Recurrent episodes of cellulitis or undergoing surgery, such as mastectomy with lymph node dissection, can compromise venous or lymphatic circulation and cause dermal fibrosis, lymphedema, epidermal thickening, and repeated episodes of cellulitis.
These patients may benefit from prophylaxis with erythromycin, penicillin, or clindamycin Cleocin. Periorbital cellulitis is caused by the same organisms that cause other forms of cellulitis and is treated with warm soaks, oral antibiotics, and close follow-up. Haemophilus influenzae type b Hib in young children was a significant concern until the widespread use of the Hib vaccine and coverage with a parenteral third-generation cephalosporin was used routinely.
Recently, some researchers have recommended no longer routinely covering for H. Orbital cellulitis occurs when the infection passes the orbital septum and is manifested by proptosis, orbital pain, restricted eye movement, visual disturbances, and concomitant sinusitis.
Complications include abscess formation, persistent blindness, limited eye movement, diplopia, and, rarely, meningitis. Perianal cellulitis is caused by group A beta-hemolytic streptococcal infection and occurs most often in children. A study 13 of children with perianal cellulitis found a mean age of onset of 4.
Ninety percent of patients presented with dermatitis, 78 percent with itching, 52 percent with rectal pain, and 35 percent with blood-streaked stools. Despite 10 days of oral antibiotics primarily penicillin or erythromycin , the recurrence rate was high at 39 percent.
If there is recurrence, the presence of an abscess should be considered, with needle aspiration of the site for bacteriology being more accurate than a skin swab. Erysipelas Figure 3 , also known as St. Anthony's fire, usually presents as an intensely erythematous infection with clearly demarcated raised margins, and often with associated lymphatic streaking Table 1. Common sites are the legs and face.
The incidence of erysipelas is rising, especially in young children, the elderly, persons with diabetes, alcoholic persons, and patients with compromised immune systems or lymphedema. Erysipelas is caused almost exclusively by beta-hemolytic streptococcus and thus can be treated with standard dosages of oral or intravenous penicillin. However, most physicians treat this infection the same as cellulitis, which is outlined earlier. Adjunctive treatment and complications are the same as for cellulitis.
Impetigo is most commonly seen in children aged two to five years and is classified as bullous or nonbullous Table 1. The nonbullous type predominates and presents with an erosion sore , cluster of erosions, or small vesicles or pustules that have an adherent or oozing honey-yellow crust. The bullous form of impetigo presents as a large thin-walled bulla 2 to 5 cm containing serous yellow fluid. It often ruptures leaving a complete or partially denuded area with a ring or arc of remaining bulla Figure 5.
More than one area may be involved and a mix of bullous and nonbullous findings can exist. Nonbullous impetigo was previously thought to be a group A streptococcal process and bullous impetigo was primarily thought to be caused by S. Studies 16 , 17 now indicate that both forms of impetigo are primarily caused by S. If the infection is a toxin-producing, phage group II, type 71 Staphylococcus the same toxin seen in Staphylococcus scalded skin syndrome, a medical emergency where large sheets of the upper epidermis slough off , large bullae will form as the toxin produces intradermal cleavage.
A study 19 published in concluded that topical mupirocin Bactroban ointment is as effective as oral erythromycin in treating impetigo. However, because the lesions of bullous impetigo can be large and both forms of impetigo can have satellite lesions, an oral antibiotic with activity against S. Because of developing resistance, erythromycin is no longer the drug of choice. Food and Drug Administration for treating skin and soft tissue infections. As with other diseases involving Streptococci, there is a small chance of developing glomerulonephritis, especially in children aged two to six years.
Presenting signs and symptoms of glomerulonephritis include edema and hypertension; about one third of patients have smoky or tea-colored urine. Streptococcal glomerulonephritis usually resolves spontaneously although acute symptoms and problems may occur.
Impetigo can be spread by direct person-to-person contact, so appropriate hygiene is warranted. Nasal carriage of S. Hair follicles can become inflamed by physical injury, chemical irritation, or infection that leads to folliculitis Table 1. Classification is by the depth of involvement of the hair follicle. The most common form is superficial folliculitis that manifests as a tender or painless pustule that heals without scarring.
Multiple or single lesions can appear on any skin bearing hair including the head, neck, trunk, buttocks, and extremities.
Associated systemic symptoms or fever rarely exist. These lesions typically resolve spontaneously. Topical therapy with erythromycin, clindamycin, mupirocin, or benzoyl peroxide can be administered to accelerate the healing process.
Staphylococci will occasionally invade the deeper portion of the follicle, causing swelling and erythema with or without a pustule at the skin surface. These lesions are painful and may scar. This inflammation of the entire follicle or the deeper portion of the hair follicle isthmus and below is called deep folliculitis.
Oral antibiotics are usually used in the treatment and include first-generation cephalosporins, penicillinase-resistant penicillins, macrolides, and fluoroquinolones. Gram-negative folliculitis usually involves the face and affects patients with a history of long-term antibiotic therapy for acne. Pathogens include Klebsiella, Enterobacter, and Proteus species.
It can be treated as severe acne with isotretinoin Accutane , but use of isotretinoin is associated with major side effects, including birth defects. Multiple pustular or papular perifollicular lesions appear on the trunk and sometimes extremities within six to 72 hours after exposure Figure 6 , and mild fever and malaise may occur. Lesions in the immunocompetent patient typically resolve spontaneously within a period of seven to 10 days.
Folliculitis caused by contamination of undertreated water in a hot tub or whirlpool. Furuncles and carbuncles occur as a follicular infection progresses deeper and extends out from the follicle Table 1. Commonly known as an abscess or boil, a furuncle is a tender, erythematous, firm or fluctuant mass of walled-off purulent material, arising from the hair follicle.
These lesions may occur anywhere on the body, but have a predilection for areas exposed to friction. Furuncles rarely appear before puberty.
The pathogen is usually S. Typically, the furuncle will develop into a fluctuant mass and eventually open to the skin surface, allowing the purulent contents to drain, either spontaneously or following incision of the furuncle. Carbuncles are an aggregate of infected hair follicles that form broad, swollen, erythematous, deep, and painful masses that usually open and drain through multiple tracts.
Constitutional symptoms, including fever and malaise, are commonly associated with these lesions but are rarely found with furuncles. Loculations should be broken with a hemostat. The wound may be packed usually with iodoform gauze to encourage further drainage. In severe cases, parenteral antibiotics such as cloxacillin Tegopen , or a first-generation cephalosporin such as cefazolin Ancef , are required.
The majority of bacterial skin infections are caused by the gram-positive bacteria Staphylococcus and Streptococcus species. Antibiotics are used empirically with consideration for resistance patterns. Current antibiotic recommendations include penicillinase-resistant penicillins, first-generation cephalosporins, azithromycin, clarithromycin, amoxicillin-clavulanic acid, or a second-generation fluoroquinolone in the skeletally mature patient.
Gram-negative coverage with a second-, third-, or fourth-generation cephalosporin is usually indicated in children under three years and in patients with diabetes or who are immunocompromised.
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The Microbiology of Skin, Soft Tissue, Bone and Joint Infections, Volume 2
Pharmacy teams can help prevent transmission and promote good sexual health practices through identifying patients at risk. In , the World Health Organization estimated there were 87 million new cases of gonorrhoea worldwide, with 54, new diagnoses made in England and 3, in Scotland during the same year  ,  , . Guidance published by Public Health England PHE in suggested that pharmacists could help alleviate some of the current burdens on the system, because of their accessibility to deprived communities and the trusted relationship they enjoy with the local communities they interact with daily . Pharmacies are a source of healthcare advice for patients in the community. Pharmacists can refer patients to sexual health services and are opportunistically able to promote good sexual health practices.
'Not only should Skin Infections: Diagnosis and Treatment be in every medical and departmental library, but the practicing physician might consider this book as.
Explore the latest in skin infections, including the microbiology and susceptibility of nosocomial and community-acquired infections. This cross-sectional survey characterizes the knowledge, attitudes, and practices of international experts in the management of pain in patients with hidradenitis suppurativa. This cross-sectional study examines the demographics, clinical features, treatment, associated comorbidities, and outcomes in a large cohort of pediatric patients with hidradenitis suppurativa. This case-control study examines the burden of ocular comorbidities in patients with hidradenitis suppurativa. This cross-sectional study uses data from the nationwide Netherlands Twin Register to assess the heritability of hidradenitis suppurativa.
Recent data suggest that MRSA as a cause of skin infections in the general community remains at high probability.
The Microbiology of Skin, Soft Tissue, Bone and Joint Infections: Volume 2 discusses modern approaches in diagnosis, treatment, and prophylaxis of skin, soft tissue, bone, and joint infections. The volume has been divided into three sections. The first section includes chapters on diagnosis, treatment, and prophylaxis of skin and soft tissue infections. It discusses antimicrobial and surgical treatment of wounds, diabetic foot, and different soft tissue infections. Ten chapters are devoted to cutaneous and musculoskeletal infections in special groups of patients, which have their own specificity, i.
If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. Please consult the latest official manual style if you have any questions regarding the format accuracy. Mycotic infections are traditionally divided into two principal groups—superficial and deep. In this chapter, only the superficial infections are discussed: tinea corporis and tinea cruris; dermatophytosis of the feet and dermatophytid of the hands; tinea unguium onychomycosis ; and tinea versicolor.
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