Your SlideShare is downloading. ×
0
The Skin and Beyond: Skin and Soft Tissue  Infections John Sinnott, MD, FACP Associate Dean, International Affairs Directo...
Pretentious Quote: …  [T]he skin has diseases, one of those diseases is man. Friedrich Nietzsche
In General: Skin Lesions     Tumors   Rashes
Melanoma: <ul><li>A  symmetric </li></ul><ul><li>B  order — irregular </li></ul><ul><li>C  olor — pigment variable </li></...
 
 
Skin Infections: LAYER INFECTION Epidermis Impetigo Dermis Erysipelas SubQ Cellulitis Fascia Fasciitis-(NSTI) Muscle Myosi...
Pathogens: <ul><li>Impetigo contagiosum – GAS </li></ul><ul><li>Impetigo bullosum – Staph </li></ul><ul><li>Erysipelas – G...
 
 
 
 
 
 
 
 
 
CA-MRSA: NB <ul><li>CA – MRSA is increasing and may become more like HA-MRSA </li></ul><ul><li>DM, prisoners, contact spor...
Variant Cellulitis: Bites or Water ! Human Bite: GAS anaerobes Dog Bite: C. canimorsus P. multocida Cat Bite: P. multocida...
 
 
 
 
 
 
 
 
 
 
Edwardsiella: Treatment   <ul><li>All Edwardsiella sensitive to:  </li></ul><ul><ul><li>Tetracyclines, aminoglycosides, mo...
 
Necrotizing Soft Tissue Infections:  “NSTI’S” <ul><li>Fournier’s gangrene </li></ul><ul><li>Clostridial anaerobic cellulit...
 
 
 
 
 
Gas in Soft Tissue: <ul><li>Non-bacterial Causes </li></ul><ul><ul><li>Trauma / Surgery </li></ul></ul><ul><ul><li>Air Inj...
 
 
 
Diagnosis NSTI’s: <ul><li>Serial exams! </li></ul><ul><li>Serial exams! </li></ul><ul><li>Soft tissue X- ray, MRI, CT </li...
Management and Therapy: <ul><li>Hemodynamic stabilization, nutrition, lytes, fluid resuscitation, oxygenation   </li></ul>...
37 y/o male with alcoholic cirrhosis admitted for RLE cellulitis; DX necrotizing fasciitis, BCX grew Group Strep A
37 y/o male with alcoholic cirrhosis admitted for RLE cellulitis; DX necrotizing fasciitis, BCX grew Group Strep A
37 y/o male with alcoholic cirrhosis admitted for RLE cellulitis; DX necrotizing fasciitis, BCX grew Group Strep A
Miscellaneous Dermatologic  Manifestations of Disease: <ul><li>Pseudomonas folliculitis </li></ul><ul><li>Herpetic Whitlow...
 
 
 
 
 
 
 
 
“ We know too much  and believe too little .” T. S. Elliot
END
END
END
 
 
Upcoming SlideShare
Loading in...5
×

The Skin

777

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
777
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
38
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Suspicious lesion
  • NSTI: change in terminology, necrotizing soft tissue infection
  • GAS – group A strep
  • impetigo
  • Group A strep
  • Impetigo bulosa staph, often MRSA is causative agent
  • Gram stain staph
  • Diabetic pt presents – what is DX?
  • Bacterial toxins treat with fluid support – pt recovering
  • Group A strep
  • Cellulitis after punching someone
  • Gram positive and neg – synergistic gangrene
  • Slowly enlarging lesion from dog bite
  • capnocytophasia
  • pasteurella
  • vibriovulnificus
  • vibrio
  • edwardseilla
  • NSTI: all four layers of tissue are dead
  • Cellulitis – arysipelas, necrotic muscle myositis, 4 layers dead synergistic gangrene
  • Gram stain – short and long gram neg rods, cocci
  • Bronze cellulitis – “pink lady” syndrome
  • Biopsy – muscle preading gram and gram neg rods
  • Transcript of "The Skin "

    1. 1. The Skin and Beyond: Skin and Soft Tissue Infections John Sinnott, MD, FACP Associate Dean, International Affairs Director, Signature Program in Allergy, Immunology and Infectious Disease Director, Division of Infectious Disease University of South Florida, College of Medicine
    2. 2. Pretentious Quote: … [T]he skin has diseases, one of those diseases is man. Friedrich Nietzsche
    3. 3. In General: Skin Lesions   Tumors Rashes
    4. 4. Melanoma: <ul><li>A symmetric </li></ul><ul><li>B order — irregular </li></ul><ul><li>C olor — pigment variable </li></ul><ul><li>D iameter > 0.5 cm </li></ul>
    5. 7. Skin Infections: LAYER INFECTION Epidermis Impetigo Dermis Erysipelas SubQ Cellulitis Fascia Fasciitis-(NSTI) Muscle Myositis-(NSTI)
    6. 8. Pathogens: <ul><li>Impetigo contagiosum – GAS </li></ul><ul><li>Impetigo bullosum – Staph </li></ul><ul><li>Erysipelas – GAS </li></ul><ul><li>Cellulitis – Staph, GAS </li></ul><ul><li>Fasciitis – GAS, Mixed </li></ul><ul><li>Myositis – Clostridia </li></ul>
    7. 18. CA-MRSA: NB <ul><li>CA – MRSA is increasing and may become more like HA-MRSA </li></ul><ul><li>DM, prisoners, contact sports are old risk groups; now everyone is at risk </li></ul>
    8. 19. Variant Cellulitis: Bites or Water ! Human Bite: GAS anaerobes Dog Bite: C. canimorsus P. multocida Cat Bite: P. multocida Saltwater: V. vulnificus M. marinum Fresh water: E. tarda A. hydrophila
    9. 30. Edwardsiella: Treatment <ul><li>All Edwardsiella sensitive to: </li></ul><ul><ul><li>Tetracyclines, aminoglycosides, most B-Lactams, cephalosporins, quinolones, antifolates </li></ul></ul><ul><li>All Edwardsiella resistant to: </li></ul><ul><ul><li>Macrolides, streptogramins, glycopeptides, rifampin, PRSP’s </li></ul></ul>Stock I, Wiedemann B. Natural Antibiotic Susceptibilities of Edwardsiella tarda, E. ictaluri, and E. hoshinae. Antimicrob Agents Chemother, 2001 August; 45 (8): 2245-2255. Harrison's Principles of Internal Medicine, 16th Edition. Kasper D, Braunwald E, Fauci A, et al, Eds. 134: 6. 2006
    10. 32. Necrotizing Soft Tissue Infections: “NSTI’S” <ul><li>Fournier’s gangrene </li></ul><ul><li>Clostridial anaerobic cellulitis </li></ul><ul><li>Clostridial gas gangrene </li></ul><ul><li>Necrotizing fasciitis </li></ul><ul><ul><ul><ul><li>Type 1 NF- polymicrobial (Fournier’s) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Type 2 NF- Grp A Strep (IVIG, HB O 2 ) </li></ul></ul></ul></ul>
    11. 38. Gas in Soft Tissue: <ul><li>Non-bacterial Causes </li></ul><ul><ul><li>Trauma / Surgery </li></ul></ul><ul><ul><li>Air Injection </li></ul></ul><ul><ul><li>H 2 O 2 Irrigation </li></ul></ul><ul><li>Bacterial </li></ul><ul><ul><li>Glucose Fermenting </li></ul></ul>
    12. 42. Diagnosis NSTI’s: <ul><li>Serial exams! </li></ul><ul><li>Serial exams! </li></ul><ul><li>Soft tissue X- ray, MRI, CT </li></ul><ul><li>Low threshold for surgery </li></ul><ul><ul><ul><ul><li>Full thickness frozen-section Bx </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Direct visualization </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Gram stain </li></ul></ul></ul></ul>
    13. 43. Management and Therapy: <ul><li>Hemodynamic stabilization, nutrition, lytes, fluid resuscitation, oxygenation </li></ul><ul><li>Early, aggressive and repetitive debridement </li></ul><ul><li>Early, aggressive and repetitive debridement </li></ul><ul><li>Hyperbaric tx </li></ul><ul><li>A-B’s </li></ul>
    14. 44. 37 y/o male with alcoholic cirrhosis admitted for RLE cellulitis; DX necrotizing fasciitis, BCX grew Group Strep A
    15. 45. 37 y/o male with alcoholic cirrhosis admitted for RLE cellulitis; DX necrotizing fasciitis, BCX grew Group Strep A
    16. 46. 37 y/o male with alcoholic cirrhosis admitted for RLE cellulitis; DX necrotizing fasciitis, BCX grew Group Strep A
    17. 47. Miscellaneous Dermatologic Manifestations of Disease: <ul><li>Pseudomonas folliculitis </li></ul><ul><li>Herpetic Whitlow </li></ul><ul><li>Herpes Gladiatorum </li></ul><ul><li>Molluscum Contagium </li></ul><ul><li>Seborrheic Dermatitis </li></ul><ul><li>Secondary Syphilis </li></ul>
    18. 56. “ We know too much and believe too little .” T. S. Elliot
    19. 57. END
    20. 58. END
    21. 59. END
    1. A particular slide catching your eye?

      Clipping is a handy way to collect important slides you want to go back to later.

    ×