Skin, Soft Tissue, and Bone Infections IMPETIGO, ABSCESSES, CELLULITIS, AND ERYSIPELA
Feb 08, 2016
Skin and Soft-Tissue Infections
Skin, Soft Tissue, and Bone InfectionsIMPETIGO, ABSCESSES, CELLULITIS, AND ERYSIPELAObjectivesDifferentiate the various types of skin and soft tissue infections and there clinical presentation
Name pathogens commonly involved in skin and soft tissue infections
Recognize specimens that are acceptable and unacceptable for different types of skin and soft tissue infections
Describe the microscopic and colony morphology and the results of differentiating bacteria isolates in addition to other non-microbiological investigation
Discuss antimicrobial susceptibility testing of anaerobes including methods and antimicrobial agents to be tested
Describe the major approaches to treat of skin and soft tissue infections either medical or surgicalConsiderations in Skin and Soft Tissue InfectionLocalization layer(s) of tissue involved
Localized vs. multifocal
Disseminated vs. symmetrical
Acute, chronic or sub-acute
Deep involvement
Hematogenous vs. exogenous
Host factors, exposures
General Rules in Skin InfectionPustules, tender painful papule or nodule with fluctuance Pyogenic esp. Staph
Spreading erythema, painful , recent onsetStrep, Pasteurella
BitesCat (Pasteurella), dog (Capnocytophaga), human (Eikenella)
Linear nodulesTularemia, Mycobacterium, Sporothrix, Nocardia
VesiclesHerpes, RickettsialpoxSystemic toxicity, pain out of proportion to appearance Necrotizing fasciitis
BullaeVibrio, Capnocytophaga, Campylobacter
GangrenePolymicrobial including Clostridia, enteric GNR
EscharMolds, anthrax, tick borne, septicemia
PurpuraMeningococcus, Strep, Staph
PetechiaeRickettsia, CMV,EBV, HIV (acute)
Classic associations in Skin InfectionMastectomyGroup A strepFish TankM. marinumFresh waterAeromonasThorn, mossSporothrixNeutropenic, moist areaPseudomonasNeutropenic, tender nodulesCandidaSplenectomyCapnocytophagaCirrhosisVibrioPalms, solesSyphilis, RickettsiaEscharMolds, anthrax, RickettsiaLymphadenopathyBartonella, Tularemia
FindingOrganism(s)7Skin Infection: Geographic FactorsLyme disease
Blastomycosis
Yersinia pestis
Coccidioides
Ehrlichia
Vibrio, mycobacteria
LeishmaniaFever and Rash: Life threatening AssociationsPetechial lesions - meningococcal, rickettsial sepsis
Mucosal involvement Stevens-Johnson syndrome
Bullae Toxic epidermal necrolysis, Vibrio
Purpura meningococcus, staph, strep, or pneumococus (purpura fulminans)
Ecthyma gangrenosum Gram negative sepsis
Miscellaneous clues to Etiology of Skin infectionUrticaria hepatitis B (autoimmune reaction)
Slapped cheek, sock and glove purpura Parvovirus
Hemorrhagic pustules Neisseria
Nail puncture foot Pseudomonas
Amoxicillin EBV
Chronic severe atopy, severe burns HSV
Intrathoracic or intraabdominal involvement Actinomycosis, TB
Underlying osteomyelitis S. aureus, Bartonella
Lung and /or CNS involvement Nocardia, endemic mycoses, mycobacteria
Fever and Rash: Important ConsiderationsHistory must include risk factor assessment concurrent diseases, medication, travel, occupational/recreational exposure, animals
Thorough exam including entire skin area, mucosa, lymph nodes
Infectious and non infectious diseases can coexist
Skin biopsy for culture and histology rarely contraindicated
Acute retroviral syndrome self-inflicted lesions often not consideredAdequate differential diagnosis requiresHistoryPatients immune statusThe geographical localeTravel historyRecent trauma or surgeryPrevious antimicrobial therapyLifestyleAnimal exposure or bites
Physical ExaminationSeverity of infection
InvestigationCBCs, ChemistrySwab, biopsy Radiographic proceduresLevel of infection and the presence of gas or abscess
Surgical exploration or debridementDiagnostic and therapeutic
13
RAJAN S Cleveland Clinic Journal of Medicine 2012;79:57-66Impetigo
Impetigo is a common skin infection
Facial impetigoCauses, incidence, and risk factorsCaused by streptococcus or staphylococcus bacteriaMRSA is becoming a common cause
The skin normally has many types of bacteria on it
Intact skin is an effective barrierkeeps bacteria from entering and growing in the body
When there is a break in the skinbacteria can enter the body and grow therecausing inflammation and infection Breaks in the skin may occur with:
Animal bitesHuman bitesInjury or trauma to the skinInsect bites
Impetigo may also occur on skin where there is no visible break
It is most common in childrenparticularly those in unhealthy living conditions
In adultsit may follow other skin disorders or a recent upper respiratory infectionsuch as a cold or other virus
It is similar to cellulitisbut it only involves the top layers of the skin
Impetigo is contagious, meaning it can spread to others
You can catch this infection if the fluid that oozes from the blisters touches an open area on your skin18SymptomsA single or possibly many blisters filled with puseasy to pop and when broken leave a reddish raw-looking base (in infants)
Itching blisterFilled with yellow or honey-colored fluidOozing and crusting over
19Rashmay begin as a single spotbut if person scratches, it may spread to other areas
Skin lesions on the face, lips, arms, or legs, that spread to other areas
Swollen lymph nodes near the infection (lymphadenopathy)
Signs and testsDiagnosis is based mainly on the appearance of the skin lesion
A culture of the skin or lesion usually grows the bacteria Streptococcus sp. or Staphylococcus sp.
The culture can help determine if MRSA is the causespecific antibiotics are used to treat this infection21TreatmentThe goal is to cure the infection and relieve the symptoms
A mild infection may be treated with a prescription antibacterial cream
More severe cases may require antibiotics, taken by mouth
Wash (do not scrub) the skin several times a day, preferably with an antibacterial soap, to remove crusts and drainage22Expectations (prognosis)The sores of impetigo heal slowly and seldom scar
The cure rate is extremely highthe condition often comes back in young childrenComplicationsKidney failurepost-streptococcal glomerulonephritisrare
Many patches of impetigoin children
Permanent skin damage and scarringvery rare
Spread of the infection to other parts of the bodycommon24PreventionPrevent the spread of infection
use a clean washcloth and towel each timedo not share towels, clothing, razors, and other personal care products with other family memberswash hands thoroughly after touching the skin lesions
Good general health and hygiene help to prevent infection25Thoroughly clean minor cuts and scrapes with soap and clean water
You can also use a mild antibacterial soap
Impetigo is contagious, so avoid touching the draining (oozing) lesions
26
Infected impetigo
Bullous impetigoMainly seen in children younger than 2 years
Involves painless, fluid-filled blistersmostly on the arms, legs, and trunksurrounded by red and itchy (but not sore) skin
The blisters may be large or small
After they break, they form yellow scabs28
BullaeBullous impetigoEcthymaEcthyma is a skin infection similar to impetigo
It is often called "deep impetigobecause it occurs deep inside the skin
30Causes, incidence, and risk factorsEcthyma is most often caused by the bacteria Streptococcus sp.
Sometimes, Staphylococcus sp. bacteria causes this skin infection
The infection may start in skin that has been injured due to a scratch or insect bite
It often develops on the legsSymptomsThe main symptom of ecthymaa small blister with a red border may be filled with pus
The blister is similar to that seen in persons with impetigothe infection spreads much deeper into the skin
After the blister goes away, a crusty ulcer appearsSigns and testsYou can usually diagnose this condition simply by looking at patient skin
In rare casesthe fluid inside the blister may be sent to a labor a skin biopsy may be done
TreatmentYou will usually prescribe oral antibiotics
Very early cases may be treated with topical medications
More advanced forms may need intravenous antibiotics
Placing a warm wet cloth over the areacan help remove ulcer crusts
You may recommendantiseptic soap or peroxide washes to speed recovery34Expectations (prognosis)Unlike impetigoecthyma can sometimes result in scarringComplicationsSpread of infection to other parts of the body
Permanent skin damage with scarringPreventionCarefully clean the skin after an injurysuch as a bite or scratch
Avoid scratching or digging at scabs and sores
Typical ecthyma lesions of the lower extremities
The stages of ecthymaThe lesion begins as a pustule that later erodes and ultimately forms an ulcer
Skin abscessA skin abscess is a build up of pus in or on the skin
An abscess is a collection of pus (neutrophils) that has accumulated within a tissue
an inflammatory process in response toan infectious processor other foreign materials
It is a defensive reaction of the tissueto prevent the spread of infectious materials to other parts40CausesSkin abscesses are common
They occur when an infection causes pus to collect in the skin
Skin abscesses may occur after:
A bacterial infection (often staphylococcus)A minor wound or injuryBoilsFolliculitis
A skin abscess may occur anywhere on the body
The problem affects people of all ages41SymptomsSymptoms may include:
Fever or chills, in some casesLocal swelling around the infected spotHard of tissue (induration)Skin lesion that may be an open or closed sore, or domed noduleRedness, tenderness, and warmth in the areaFluid drainageExams and TestsYou could diagnose the problem by looking at the affected area
The drainage from the sore may be sent to the lab for a culture
This can help identify the cause of the infection
TreatmentYou can apply moist heatto help the abscess drain and heal faster
DO NOT push and squeeze on the abscess
The health care provider may cut open the abscess and drain it
You may need to describe antibiotics by mouth to control the infection44Outlook (Prognosis)Most skin abscesses can be cured with proper treatment
Infections caused by MRSA are do not respond to regular antibiotics and need special medicinesPossible ComplicationsSpread of infection in the same area
Spread of the infect in the blood and throughout the body
Tissue death (gangrene)PreventionKeep the skin around minor wounds clean and dry to prevent infection
Call your health care provider if you notice signs of infection
Take care of minor infections promptly
Abscess
Back Abscess48