CELLULITIS
•Superficial Spreading Infection of Skin (without pus)•Key features:
–Skin: redness, edema, warmth, pain, +/-hemorrhage into skin •Redness has well demarcated, but often irregular border; may spare
portions of the skin in unpredictable pattern
•Edema gives skin a smooth, taut appearance
•Inflammation disrupts blood vesls, causing petechiae,
nonblanching erythema, ecchymos or hemorrhagic blisters
•+/-Lymphangitic streaking
–Systemic: fever, chills, tachycardia, hypotension, leukocytosis
(35-50%)
•NOTE: 30-80% or patients are afebrile
CELLULITIS
•Predisposing factors:
–Advanced age, obesity, past episode of cellulitis
(annual recurrence 8-20%)
–Local predisposing factors: venous insufficiency,
edema, disruption of skin surface (ulceration,
trauma, eczema, toe-web space maceration) •Offending organisms
–Streptococci groups A, B, C, F and G: 75-90%
煎牛肉的做法–Staphylococcus aureus(typically MSSA): 10%
CELLULITIS: CULTURE?•Blood cultures: positive in <5% of cas
•Needle aspirates: positive in 5-40%
•Punch biopsy culture: positive in ~20%
•Swabs of open lesions: difficult to parate pathogenic organisms from colonizers
–Culture via aspirate or punch biopsy reasonable in
immunocompromid hosts failing to respond to empiric
therapy, otherwi cultures typically unnecessary陪伴是最好的教育
CELLULITIS: ANTIBIOTICS
•Oral therapy equivalent to IV in most patients who are not riously ill
•Empiric Strep + MSSA coverage: Penicillina-resistant penicillin (e.g. dicloxacillin)
•If improved by 5 days of oral ABX, an additional 5 days is not necessary
•When to cover for MRSA: “purulent cellulitis,”, riously ill patients, other sites of MRSA, failure to respond to
coverage for MSSA
CELLULITIS: MANAGEMENT •Address predisposing factors:
–Tinea pedis, stasis dermatitis, trauma, etc
–Tinea pedis-Consider chronic topical antifungals to web spaces
•Leg elevation
•Role of antiinflammatory medications?
–Ibruprofen400 mg q6hours for 5 days
–Prednisone 40 mg daily for 7 days
•Frequent recurrences: consider twice daily oral penicillin or erythromycin
STAPH FOLLICULITIS AND FURUNCLES •Cutaneous abscess associated with follicles
•Key features: central pustule with surrounding erythema. Often multiple lesions.
•S. aureus is typical offender (MSSA or MRSA)–Patients often harbor the offending strain in nares,
umbilicus or perineum
STAPH FOLLICULITIS AND FURUNCLES •Drainage (I&D) is treatment of choice
•Send swab culture from drainage流浪作业
保持的英文•Swab nares, umbilicus and perineum to check colonization
–Consider decolonizing strategies:
•Mupirocin intranasal TID x5 days
•Chlorhexidine(Hibeclens) washes or Dilute bleach baths
(1/4-1/2 cup bleach in 1/2 tub of bath water)
IMPETIGO and ‘IMPETIGINIZATION’
•Impetigo: superficial skin infection by S. aureus or Group A strep
•‘Impetiginization’: staph condarily infecting another primary skin condition (e.g. atopic dermatitis)
•Key features:‘honey-crusted’ plaques, may e fine scale-crust at periphery
IMPETIGO and ‘IMPETIGINIZATION’
•Management:
–Swab culture for nsitivities
–If minor/localized: topical antimicrobials (e.g.
mupirocin ointment) or sodium hypochlorite
compress (Dakin’s solution)
–If more extensive: oral ABX w/ empiric MSSA
coverage x5 days (consider MRSA coverage if
past MRSA infection)老年人教育
PERIANAL STREPTOCOCCAL
CELLULITIS
•Localized streptococcal skin infection; children <10 most affected
•Key features: perianal or perineal erythema with sharp demarcation +/-fissures and crust
•Swab culture needed to document Group-A Strep; S. aureus can be causative organism with identical prentation
EVERDAY INFECTIONS…梨怎么写
PART 2
H HERPES SIMPLEX VIRUS
电信诈骗案件•Key features:
–Grouped vesicles or vesiculopustules(cloudy vesicles) on an erythematous ba
–Recurrent episodes affecting the same anatomic area •Diagnostic tests:
–Tzanck prep:
•scrape ba of ulcer after un-roofing vesicle, dab lightly onto slide, stain with methylene blue or giemsa(a nuclear stain), evaluate under 40x for
multinucleated keratinocytes模板专项施工方案
–Viral culture, PCR or Direct Fluorescent Antigen Testing:
•Un-roof vesicle and vigorously scrape or swab ba
•If no intact vesicles, scrape or swab ba of ulcer
–Serum HSV1 or 2 Antibody screening? Not for dx active dia •Majority of population is HSV1 Ab positive, so not a good diagnostic test for whether a skin ulcer, blister, skin finding is due to HSV1
