Bact skin inf

Bacterial skin inf

Bacterial skin inf is the single most common diagnosis among those with skin problems. The most common bacterial skin inf is impetigo (superficial pyoderma)

Group A beta hemolytic streptococcus commonest cause of skin inf Colonization of unbroken skin by GABS precedes pyoderma by 10 days Intradermal inoculation by insect bite, scabies or minor trauma leads to impetigo, ecthyma &cellulitis

Cutan bact inf

Colonization or pyoderma may predispose the child to later pharyngeal colonization with the same strain Staph aureus spread from the nose to normal skin and then infect the skin Clinically the 2 lesions cannot be distinguished

S.Pyogenes

Noninvasive strains

Invasive trainss

impetigo

pharyngitis

Pyrogenic exotoxins

proteinase

Spreading factors

nephritogenic

Rheumatogenic strain

Scarlet fever

Necrotizing cellulitis/fascitis

Cellulitis erysipelas

psgn

Rheumatic fever

Toxic shock syndrome

Bact skin inf

Those with recurrent inf should be evaluated for immunodef (neutrophil dysfunction)

 Impetigo: bullous non bullous Non bullous accts for >70% of the cases Tiny vesicle or pustule forms and rapidly develops into a honey colored crusted plaque Inf spreads by towels, fingers, clothings

Contact sports

 Little or no pain, no erythema, no constitutional symptoms

 Bullous impetigo: infants and young children Caused by coagulase-positive staph aureus Flaccid transparent bullae develop on the skin of face, buttocks, trunk, perineum, & extremities. Neonatal bullous impetigo can begin in the diaper area

 Culture of fluid from an intact blister should yield the causative lesion. Complications are potential but rare: OM septic arthritis,pneumonia &septicemia

 Deeper soft tissue inf may occur. Erysipelas is an acute well demarcated inf of the skin with lymphagitis involving the face (ass with pharyngitis) &extremities (wounds). The skin is erythematous &indurated The advancing borders are raised& firm Ass with fever, vomiting& irritability

Bact skin inf

CELLULITIS Strept cellulitis is a painful, erythematous, indurated inf of the skin and subcut tissue usually follows some injury to the skin Proteinase producing strain causes a more severe type of necrotizing fascitis or myositis Also more common in diabetics & immunocompr

Bact skin inf

Organisms : St.Pyogenes &S.aureus. many other org can cause Presents as local edema, warmth erythema &tenderness.the margins are indistinct Regional adenopathy,constitutional S/S fever, chills &malaise

Bact skin inf

Complications : OM, sep arthritis, bacteremia, necrotizing fasciitis Treatment :specific antibiotics,after proper evaluation , cultures from the site In a newborn a full septicemic work up Cover for strep and staph

Necrotising Fasciitis (Meleneys streptococcal gang, Fourniers

Is a destructive invasive infection of skin, subcutaneous tissue &deep fascia with relative sparing of muscle. Bacteriology could be polymicrobial or monomicrobial due to group A Beta Haemolytic Strep. Common sites are genetalia, groin & lower abdomen. Pts are unwell, febrilewith areas of subcutaneous induration & erythema.Necrotic patches of skin develop.

Bact skin inf

Treatment is by wide excision of all effected soft tissue, anibiotics and supportive treatment. Wide skin deffects will need surgical procedures to repair them. Mortality is high and increases if surgical excision is delayed. Risk factors are D.M., malnutrition,obesity, steroids & immune defecieny.

 Vaginitis :beta hemolytic strep. Are a common cause of vaginitis in prepubertal girls.pts usually have a serous discharge& marked erythema & irritation of the vulvar area,discomfort in walking &urination

 Perianal dis: perianal strep cellulitis produces local itching,pain,blood streaked stools, erythema & proctitis.

Bact skin inf

Staph scalded skin syndrome (Ritter dis) Agent :staph aureus phage grp 2 str.71,55 Predominantly in infants& children<5 yrs Range of dis from local bullous impetigo to generalized cutaneous lesions with systemic involvement Malaise, fever, irritability

Bact skin inf

The scarlatiniform erythema develops diffusely & is accentuated in flexural & periorificial areas Conjuntivas : inflammed, discharge may be purulent Skin is brightly erythematous& rapidly wrinkled Severe cases- sterile flaccid blisters & erosions develop diffusely

Bact skin inf

Nikolsky sign may be positive(areas of epidermis separate in response to gentle shear force As large sheets of epidermis peel away,moist glistening denuded areas may get sec infected ,fluid &electrolyte imbalances Healing without scarring in 10 14 days

Bact skin inf

Antibiotics :orally or parenterally with semisynthetic penicillinase- res penicillin Gently moisten the skin and cleanse with Burow or Dakin soln or N saline Emolient application for lubrication to decrease discomfort Recovery is rapid Complications-Pneum,sept,cellulitis,fluid& electrolyte imbalincreased morbidity

Bact skin inf

Ecthyma :resembles non bullous impetigo in onset and appearance Gradually deeper,into the dermis, more chronic inf and forms an ulcer with elevated margins Ulcer becomes obscure by a dry heaped up crust that contributes to the persistence of inf and scar formation Spread :autoinoculation

Lesions may be as large as 4 cm Frequently on legs Predisposing factors :as impetigo Causative agent: GABHS (staph is cultured sec pathogen) Crust softened by warm compressions & removed by antibact soap Syst antibiotic tt as in impetigo

Bact skin inf

Blastomycosis like pyoderma Exuberant cutaneous reaction to bact inf in children who r malnourished and immunosupp Organism: GABHS,staph aureus

Various clinical presentations of Staph. Skin infections.

Boil (fruncle)- is an infection of hair root including sebaceous gland which usually proceeds to suppuration and central necrosis. Boils are common on face, neck and head. Boils are infrequently associated with overwork, worry, debelity or may be presenting feature of D.M. Stye is due to infection of an eyelash follicle, if suppuration occurs removal of eyelash will allow drainage.

Various clinical presentations of Staph. Skin infections.(ct)

Carbuncle- is an infective gangrene of subcutaneous tissue which usually occurs in the nape of neck. The subcutaneous tissue becomes painful and indurated, overlying skin is red. Unless the condition is aborted by prompt treatment extension occurs and after few days areas of softening appear, skin sloughs out and discharges pus. Usually there is one large central slough and surrounded by a rosette of smaller area of necrosis. Treatment is as for boil.

Lupus vulgaris (T.B. of skin)

Occurs between the age of 10-25 face being the site of election. One or more cutaneous nodules appear with cogestion of surrounding skin. Extension occurs very slowly but ulceration is likely to follow sooner or later.The resulting ulcer heals in one area as it expands to another. The mucous membrane of mouth and nose could be attacked primarily or as extension from face. Treatment is by ATT, lesion can be excised if healing is slow. Squamous cell carcinoma tend to occur in scars.

Lupus vulgaris

Advance Lupus vilgaris