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Cutaneous Bacterial Infections

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  • 1. Cutaneous Bacterial Infections Nastaran Tavakoli Guilan University of medicine
  • 2. IMPETIGO :
    • There are two classic forms of impetigo:
    • 1)Nonbullous impetigo
    • 2)Bullous Impetigo
  • 3. 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
  • 4. Nonbullous impetigo                                                                                 
  • 5.  
  • 6. differential diagnosis :
    • viral (herpes simplex, varicella-zoster)
    • fungal (tinea corporis, kerion)
    • parasitic infestations (scabies, pediculosis capitis),
  • 7. Etiology:
    • Staphylococcus aureus
    • Group A β-hemolytic streptococci (GABHS)
    • Generally spread from the nose to normal skin
  • 8. Bullous Impetigo :
    • This is mainly an infection of infants and young children
    • Always caused by S. aureus
    • Ruptured bullous impetigo
  • 9. Bullous Impetigo
  • 10.
    • 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
  • 11. Bullous Impetigo
  • 12. Bullous Impetigo
  • 13. Bullous Impetigo
  • 14. 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
  • 15.
    • Nonbullous impetigo has histopathologic findings similar to those of the bullous variant, except that blister formation is slight
  • 16. Differential diagnosis :
    • In neonates:
    • Herpetic infection
    • Early scalded skin syndrome
    • In older children:
    • Allergic contact dermatitis
    • Burns
    • Erythema multiforme
    • Pemphigus
    • Bullous pemphigoid
  • 17. COMPLICATIONS: (Very rare)
    • Osteomyelitis
    • Septic arthritis
    • Pneumonia
    • Septicemia
    • Nephritogenic strains of GABHS may result in acute poststreptococcal glomerulonephritis
  • 18. 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)
  • 19. SUBCUTANEOUS TISSUE INFECTIONS
    • The principal determination for soft tissue infections is whether it is non-necrotizing or necrotizing
  • 20. 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
  • 21.  
  • 22. 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
  • 23. Clinical Manifestations :
    • An area of edema
    • Warmth
    • Erythema
    • Tenderness
    • Regional adenopathy and constitutional signs and symptoms of fever, chills, and malaise are common
  • 24. Diagnosis :
    • Aspirates from the site of inflammation
    • Skin biopsy
    • Blood cultures
  • 25. 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
  • 26. 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
  • 27.
    • Scarlatiniform erythema
    • accentuated in flexural and periorificial areas
    • The conjunctivas are inflamed and occasionally become purulent
    • Circumoral erythema
  • 28.
    • Radial crusting and fissuring around the eyes, mouth, and nose
    • Nikolsky sign
    • Initially in the flexures and subsequently over much of the body surface
  • 29. May lead to:
    • Secondary cutaneous infection
    • Sepsis
    • Fluid and electrolyte disturbances
  • 30.
    • The desquamative phase begins after 2–5 days of cutaneous erythema
    • Healing occurs without scarring in 10–14 days
  • 31.  
  • 32. 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
  • 33.
    • 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
  • 34. 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
  • 35. 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
  • 36.
    • Thanks for your attention

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