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Cutaneous Bacterial Infections
 

Cutaneous Bacterial Infections

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    Cutaneous Bacterial Infections Cutaneous Bacterial Infections Presentation Transcript

    • Cutaneous Bacterial Infections Nastaran Tavakoli Guilan University of medicine
    • IMPETIGO :
      • There are two classic forms of impetigo:
      • 1)Nonbullous impetigo
      • 2)Bullous Impetigo
    • Nonbullous impetigo:
      • More than 70% of cases
      • Lesions typically begin on the skin of the face or on extremities that have been traumatized
      • A tiny vesicle or pustule forms initially
      • Rapidly develops into a honey-colored crusted plaque that is generally <2 cm in diameter
    • Nonbullous impetigo                                                                                 
    •  
    • differential diagnosis :
      • viral (herpes simplex, varicella-zoster)
      • fungal (tinea corporis, kerion)
      • parasitic infestations (scabies, pediculosis capitis),
    • Etiology:
      • Staphylococcus aureus
      • Group A β-hemolytic streptococci (GABHS)
      • Generally spread from the nose to normal skin
    • Bullous Impetigo :
      • This is mainly an infection of infants and young children
      • Always caused by S. aureus
      • Ruptured bullous impetigo
    • Bullous Impetigo
      • Flaccid, transparent bullae develop most commonly on skin of the face, buttocks, trunk, perineum, and extremities
      • Rupture of bullae occurs easily
      • Neonatal bullous impetigo can begin in the diaper area
    • Bullous Impetigo
    • Bullous Impetigo
    • Bullous Impetigo
    • DIAGNOSIS:
      • Cultures of fluid from an intact blister or moist plaque
      • Nonbullous impetigo has histopathologic findings similar to those of the bullous variant, except that blister formation is slight
      • Nonbullous impetigo has histopathologic findings similar to those of the bullous variant, except that blister formation is slight
    • Differential diagnosis :
      • In neonates:
      • Herpetic infection
      • Early scalded skin syndrome
      • In older children:
      • Allergic contact dermatitis
      • Burns
      • Erythema multiforme
      • Pemphigus
      • Bullous pemphigoid
    • COMPLICATIONS: (Very rare)
      • Osteomyelitis
      • Septic arthritis
      • Pneumonia
      • Septicemia
      • Nephritogenic strains of GABHS may result in acute poststreptococcal glomerulonephritis
    • TREATMENT :
      • Mupirocin (Applied topically 3 times daily for 7–10 days)
      • Oral erythromycin ethylsuccinate (30–50 mg/kg/24 hr for 7–10 days)
      • Topical fusidic acid
      • Systemic therapy with a β-lactamase–resistant oral antibiotic (for patients with widespread involvement)
    • SUBCUTANEOUS TISSUE INFECTIONS
      • The principal determination for soft tissue infections is whether it is non-necrotizing or necrotizing
    • CELLULITIS:
      • Characterized by infection and inflammation of loose connective tissue
      • With limited involvement of the dermis and relative sparing of the epidermis
      • More common in individuals with lymphatic stasis, diabetes mellitus, or immunosuppression
    •  
    • Etiology :
      • Streptococcus pyogenes and S. aureus are the most common etiologic agents
      • In neonates, group B streptococci or, rarely, Escherichia coli are the causal organisms
      • In patients who are immunocompromised or have diabetes mellitus, a number of other bacterial or fungal agents may be involved
    • Clinical Manifestations :
      • An area of edema
      • Warmth
      • Erythema
      • Tenderness
      • Regional adenopathy and constitutional signs and symptoms of fever, chills, and malaise are common
    • Diagnosis :
      • Aspirates from the site of inflammation
      • Skin biopsy
      • Blood cultures
    • Treatment :
      • Cellulitis in a neonate should prompt a full sepsis evaluation
      • β-lactamase-stable antistaphylococcal antibiotic such as methicillin (vancomycin is another choice)
      • Aminoglycoside such as gentamicin
      • Cephalosporin such as cefotaxime
    • STAPHYLOCOCCAL SCALDED SKIN SYNDROME:
      • Occurs predominantly in infants and children younger than 5 yr of age
      • Onset of the rash may be preceded by malaise, fever, irritability, and exquisite tenderness of the skin
      • Scarlatiniform erythema
      • accentuated in flexural and periorificial areas
      • The conjunctivas are inflamed and occasionally become purulent
      • Circumoral erythema
      • Radial crusting and fissuring around the eyes, mouth, and nose
      • Nikolsky sign
      • Initially in the flexures and subsequently over much of the body surface
    • May lead to:
      • Secondary cutaneous infection
      • Sepsis
      • Fluid and electrolyte disturbances
      • The desquamative phase begins after 2–5 days of cutaneous erythema
      • Healing occurs without scarring in 10–14 days
    •  
    • ETIOLOGY AND PATHOGENESIS :
      • Phage group 2 staphylococci
      • Foci of infection include the:
      • Nasopharynx
      • Less commonly, the umbilicus, urinary tract, a superficial abrasion, conjunctivae, and blood
      • The clinical manifestations of staphylococcal scalded skin syndrome are mediated by:
      • Hematogenous spread, in the absence of specific antitoxin antibody of staphylococcal epidermolytic or exfoliative toxins A or B
    • DIAGNOSIS :
      • Cultures should be obtained from all suspected sites of localized infection and from the blood
      • Frozen biopsy specimen of the desquamating epidermis
      • Tzanck preparation
    • TREATMENT :
      • Semisynthetic penicillinase-resistant penicillin
      • Clindamycin (to inhibit bacterial protein (toxin) synthesis)
      • The skin should be gently moistened and cleansed
      • Emollient
      • Topical antibiotics are unnecessary
      • Thanks for your attention