Factores de risco e tratamento do Herpes Zoster
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Questions and Answers

Que grupo de idade ten un risco elevado de padecer a enfermidade relacionada co virus zoster?

  • Menores de 50 anos
  • Entre 30 e 50 anos
  • Maiores de 60 anos (correct)
  • Adolescentes de 13 a 19 anos

    • Cal é un tratamento recomendable para o alivio do dor severo asociado co virus zoster?

  • Antidepresivos tricíclicos (correct)
  • Antibióticos
  • Vacunas preventivas
  • Aspirina

    • Que vacina é considerada desfasada e pode ser administrada a pacientes inmunosuprimidos?

  • Vacuna de varicela
  • Zostavax (correct)
  • Shingrix
  • Vacuna influenza

    • Cal das seguintes condicións require derivar a un oftalmólogo?

    <p>Compromiso da rama oftálmica</p> Signup and view all the answers

    Cal é a dose recomendada para a vacina Shingrix contra o virus zoster?

    <p>Dúas doses separadas por 2-6 meses</p> Signup and view all the answers

    Que tratamento é adecuado para un caso grave de ectima?

    <p>Penicilina sódica 2-4 mill c/6h + cloxacilina 1g c6h</p> Signup and view all the answers

    Cal dos seguintes factores non é un factor predispoñente para a portación de S aureus?

    <p>Alto consumo de azucre</p> Signup and view all the answers

    Cal dos seguintes síntoma non está asociado co antrax?

    <p>Conxestión nasal</p> Signup and view all the answers

    Que tipo de infección é a erisipela?

    <p>Infección superficial da dermis e plexo linfático</p> Signup and view all the answers

    Que tratamento é recomendado para cubrir anaerobios en asociación cunha úlcera crónica?

    <p>Metronidazol + ciprofloxacino</p> Signup and view all the answers

    Cal é o antibiótico endovenoso recomendado para o tratamento de MRSA?

    <p>Vancomicina</p> Signup and view all the answers

    Que tipo de foliculite se caracteriza por pápulas eritematosas sensibles e pústulas na porción distal do folículo piloso?

    <p>Foliculite superficial</p> Signup and view all the answers

    Cal é a principal medida de tratamento para as foliculitis?

    <p>Corrixir factores predisponentes</p> Signup and view all the answers

    Cal é a principal diferencia entre un forúnculo e un absceso?

    <p>O forúnculo implica compoñentes de pello, mentres que un absceso non.</p> Signup and view all the answers

    Cales son os antibióticos tópicos recomendados para o tratamento da foliculite?

    <p>Mupirocina 2% e ácido fusídico</p> Signup and view all the answers

    Que bacteria son responsables do impetigo vulgar?

    <p>Estafilococo aureus e estreptococo piógeno</p> Signup and view all the answers

    Que tratamento tópico se recomenda para o impetigo vulgar?

    <p>Mupirocina 2% 3 veces ao día</p> Signup and view all the answers

    Cales son as principais características do impetigo ampollar?

    <p>Presenza de ampollas flácidas e transparentes</p> Signup and view all the answers

    Que condición se pode desenvolver se a toxina epidermolítica do impetigo buloso se difunde de forma hematóxica?

    <p>Síndrome de pel escaldada estafilocócica (SPEE)</p> Signup and view all the answers

    Cal é o principal síntoma do síndrome de pel escaldada estafilocócica (SPEE)?

    <p>Eritema macular con febre</p> Signup and view all the answers

    Que tipo de tratamento antibiótico sistémico se recomenda para pacientes alérxicos a penicilina?

    <p>Eritromicina</p> Signup and view all the answers

    Que condición se caracteriza por un signo de Nikolsky positivo?

    <p>Síndrome de pel escaldada estafilocócica (SPEE)</p> Signup and view all the answers

    A que grupo de idade é máis común o impetigo ampollar?

    <p>Recén nacidos e lactantes</p> Signup and view all the answers

    Cal é a clínica característica do erisipela?

    <p>Placas eritematosas brillantes e edematosas</p> Signup and view all the answers

    Que tratamentos antibióticos son recomendados para o erisipela?

    <p>Flucloxacilina ou cefadroxilo durante 10 días</p> Signup and view all the answers

    Cales son os síntomas que caracterizan a infección por estreptococo do grupo A?

    <p>Vesículas e pústulas</p> Signup and view all the answers

    Que se debe considerar ao hospitalizar un paciente con erisipela?

    <p>Se a infección é grave ou facial</p> Signup and view all the answers

    Cál é a principal diferenza entre erisipela e celulitis?

    <p>A erisipela ten bordes netos e palpables</p> Signup and view all the answers

    Que signo é indicativo de erisipela na piel?

    <p>Aspecto de 'piel de naranja'</p> Signup and view all the answers

    Ao tratar un paciente con erisipela, que antibiótico se pode usar se hai alerxia a PNC?

    <p>Macrólidos como a eritromicina</p> Signup and view all the answers

    Cales son as possíveis complicacións da erisipela sen tratamento adecuado?

    <p>Infeccións secundarias</p> Signup and view all the answers

    Study Notes

    Risk factors for Herpes Zoster (Shingles)

    • Age (50% over 60 years old)
    • Female sex
    • Prodromal pain
    • Severe pain
    • Severe, disseminated rash

    Herpes Zoster Treatment

    • General Treatment:
      • Cotton and loose clothing
      • Maintain social activities
    • Medication:
      • Tricyclic antidepressants
      • Gabapentin/pregabalin
      • Opioids
      • Lidocaine 5% patches
    • Refer to a pain clinic if pain is severe

    Herpes Zoster Prevention

    • Zostavax vaccine:

      • Live attenuated virus, more concentrated than varicella vaccine
      • Discontinued

    • Shingrix vaccine:

      • Recombinant zoster virus
      • Can be given to immunocompromised patients
      • 2 doses separated by 2-6 months
      • For individuals 50 years old or older

    Herpes Zoster Referral

    • More than 1 dermatome affected
    • Hemorrhagic, necrotic lesions
    • Involvement of the ophthalmic branch:
      • Refer to an ophthalmologist
      • Use eye ointment
    • Disseminated lesions
    • Immunocompromised patients

    Impetigo Vulgar

    • Caused by Staphylococcus aureus and Streptococcus pyogenes
    • Commonly seen in exposed areas (face), periorificial (mouth, nose)
    • Characterized by:
      • Erythematous macule → vesicle → pustule → erosion
      • Superficial crust with a yellowish color (honey-colored)
    • Differential diagnosis:
      • Herpes simplex
      • Eczema
      • Insect bites
      • Varicella

    Impetigo Vulgar Treatment

    • Local hygiene and crust removal
    • Topical antibiotics:
      • Mupirocin 2% three times a day
      • Fusidic acid 2% twice a day for one week
      • Chloramphenicol
    • Systemic antibiotics:
      • First-generation cephalosporin (Cefadroxil) 30 mg/kg/day divided every 12 hours for 10 days
      • Flucloxacillin 50 mg/kg/day divided every 8 hours
      • If allergic to penicillin:
        • Erythromycin 30-50 mg/kg/day divided every 6 hours
        • Azithromycin 10 mg/kg/day for 5 days

    Bullous Impetigo

    • More common in skin folds, especially in young children.
    • Caused by Staphylococcus aureus.
    • Commonly seen on the face, body, and in infants and newborns, it can also affect the diaper area.
    • Characterized by:
      • Rapid progression of vesicles to flaccid and transparent bullas
      • Sharp margins with no erythematous halo
      • Halo of scales
      • Easily rupture, leaving a dry, shiny erosion with a fine crust
    • Heals more rapidly than impetigo vulgaris

    Staphylococcal Scalded Skin Syndrome (SSSS)

    • Occurs when the epidermolytic toxin diffuses hematogenously, resulting in a generalized form of bullous impetigo.

    SSSS Features

    • Patient has general malaise: abrupt onset of irritability and fever
    • Macular erythema that begins on the face (periorificial) and in skin folds
    • Skin sensitivity
    • Generalized rash
    • Nikolsky's sign (+): Skin sloughs off with friction
    • Wrinkled skin
    • Flaccid bullas develop in 24-48 hours and detach, leaving large erosive areas with moisture that dries, forming thin crusts
    • Desquamation (in skin folds) for 3-5 days
    • Hands and feet are also involved
    • Crusts and radiating fissures around the mouth
    • Indicates keratinocyte necrosis

    SSSS Treatment

    • Eradicate the infectious focus
    • Intravenous antibiotics (Cloxacillin, Vancomycin for MRSA)
    • Skin care and electrolyte management
    • Diagnosis and management of carriers (Mupirocin nasal)

    Differential Diagnosis of SSSS

    • Scarlet fever
    • Kawasaki disease
    • Staphylococcal toxic shock syndrome
    • Toxic epidermal necrolysis (TEN) (caused by a drug)

    Folliculitis

    • Inflammation of the hair follicle

    Superficial Folliculitis

    • Involves the distal portion of the hair follicle
    • Papules or pustules 1-4 mm in diameter on an erythematous base
    • Pruritus

    Deep Folliculitis

    • Involves the hair follicle and surrounding tissue
    • Erythematous and tender papules larger in size with central pustules
    • Can extend into the surrounding tissue, leading to a furuncle (boil)

    Folliculitis Differential Diagnosis

    • Herpes simplex
    • Syphilis
    • Acne vulgaris
    • Gram-negative folliculitis (hot tub folliculitis)

    Folliculitis Treatment

    • Correct predisposing factors such as humidity, skin irritation
    • Wash with antibacterial soaps (triclosan or chlorhexidine 1%)
    • Topical antibiotics:
      • Mupirocin 2%, Fusidic acid for 7-10 days
    • Oral antibiotics:
      • Flucloxacillin: for extensive, resistant, or recurrent cases.

    Abscess, Furuncle, Carbuncle

    • An abscess is located in any area of the body, a furuncle involves hair follicles, and a carbuncle is a cluster of furuncles.

    Furuncles

    • Typically seen in adolescents and young adults
    • Caused by Staphylococcus aureus, anaerobic bacteria may occur in the inguinal region
    • More common in areas subject to friction: face, neck (nape), axillae, buttocks, thighs, and perineum
    • Predisposing factors: Staphylococcus aureus carriage, diabetes mellitus, obesity, immunosuppression, tight clothing, hyperhidrosis, poor hygiene

    Carbuncles

    • Involve subcutaneous tissue
    • Hard swelling with multiple openings that drain pus on the surface
    • Commonly seen in the nape, back, thighs
    • Symptoms: generalized malaise, pain
    • Can leave scars
    • Diabetcis are more susceptible to carbuncles.

    Furuncle and Carbuncle Treatment

    • Local heat and drainage
    • Systemic antibiotics:
      • Cloxacillin or flucloxacillin
      • First- generation cephalosporin
      • Amoxicillin-clavulanate
      • If allergic to penicillin, macrolides/clindamycin

    Ecthyma

    • Ulcerated form of non-bullous impetigo
    • Involves the epidermis and dermis
    • More common in the lower extremities (dorsal feet and anterior legs)
    • Usually only a few lesions
    • Treatment:
      • Macrolides or clindamycin.
      • Severe or facial cases require hospitalization and intravenous antibiotics:
        • Penicillin sodium 2-4 million units every 6 hours plus Cloxacillin 1 g every 6 hours or
        • First-generation cephalosporin: Cefazolin 1-2 g every 8 hours
        • If responds well after 72 hours, switch to cefadroxil 1 g every 12 hours orally.
        • For penicillin allergy: intravenous lincomycin followed by oral administration
      • Chronic ulcers require coverage for anaerobes and gram-negatives:
        • Metronidazole + Ciprofloxacin
      • If recurrent infections, use penicillin benzathine 1.2 million units monthly for 6 months or erythromycin 250mg every 12 hours for 3 months

    Erysipelas

    • Infection of the dermis and superficial lymphatic plexus (more superficial than cellulitis)
    • Caused by Streptococcus pyogenes (group A beta-hemolytic) and less commonly by Staphylococcus aureus, Streptococcus pneumoniae and Haemophilus influenzae
    • Presents with:
      • Generalized malaise, fever, chills (acute onset)
      • Erythematous, shiny, edematous, warm, and tender plaque that rapidly spreads
      • ‘Orange peel’ appearance
      • Well-defined, palpable margins (unlike cellulitis which has diffuse, non-palpable borders)
      • Superficial vesicles, bullae, pustules, and/or purpuric lesions

    Erysipelas Treatment

    • Systemic antibiotics for 10 days:
      • Flucloxacillin or cefadroxil
      • If allergic to penicillin, use macrolides or clindamycin
    • Severe or facial cases require hospitalization and intravenous antibiotics:
      • Penicillin sodium 2-4 million units every 6 hours
      • If no improvement after 48 hours, add cloxacillin
      • First-generation cephalosporin: 1-2 g every 8 hours.
      • If responds favorably after 72 hours, switch to cefadroxil 1 g every 12 hours orally.

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    Description

    A quiz sobre os factores de risco, tratamento e prevención do Herpes Zoster proporciona unha visión xeral dos síntomas, tratamentos e vacinas relevantes. A información incluída axuda a comprender mellor como abordar esta condición e a importancia da prevención. Ideal para estudantes de saúde e profesionais que buscan ampliar os seus coñecementos sobre o tema.

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