Factores de risco e tratamento do herpes zóster

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Questions and Answers

Cal dos seguintes factores de risco é considerado común para a dor severa?

Rash leve

Sexos masculinos

Dor moderada

Idade maior de 60 anos (correct)

Que tratamento debería considerarse para un paciente cunha dor severa que non responde a analxésicos básicos?

Paracetamol

Ibuprofeno

Calor local

Gabapentina (correct)

Que vacina está en desuso para a prevención do virus zoster?

Zostavax (correct)

Vacina rinovirus

Vacina varicela

Shingrix

Que acción se debe tomar en caso de compromiso da rama oftálmica debido ao virus zoster?

Aplicar ungüento e esperar Signup and view all the answers

Cantos doses de Shingrix son necesarias para a prevención efectiva do virus zoster?

Dúas doses separadas por 2-6 meses Signup and view all the answers

Que tipo de condición está relacionada con 'gingivoestomatitis'?

Herpes labial Signup and view all the answers

Cal dos seguintes termos describe un tipo de neuralxia?

Neuralgia postherpética Signup and view all the answers

Que condición non está mencionada como relacionada co herpes?

Neoplasicos Signup and view all the answers

Cual é un exemplo de unha complicación do herpes?

Neuralgia postherpética Signup and view all the answers

Que tipo de condición se clasifica como 'neoplasicos'?

Condicos Signup and view all the answers

Cal é a principal diferenza entre a foliculite superficial e a foliculite profunda?

A foliculite profunda pode extenderse a tecidos circundantes formando forúnculos. Signup and view all the answers

Que antibiótico é recomendado para o tratamento da foliculite profunda cando se considera un caso resistente?

Flucloxacilina Signup and view all the answers

Cal das seguintes opcións non é parte do diagnóstico diferencial para a foliculite?

Forúnculo Signup and view all the answers

Que medida é fundamental para o tratamento da foliculite, ademais do emprego de antibióticos?

Corrixir factores predisponentes. Signup and view all the answers

Cal é a función principal da mupirocina nasal no contexto de portadores?

Previr a propagación de infeccións. Signup and view all the answers

Cal é un síntoma característico da infección por pyogenes?

Placa eritematosa brillante Signup and view all the answers

Cales son os antibióticos recomendados como tratamento sistémico para a infección?

Clindamicina Signup and view all the answers

Que cambio sería necesario se non hai resposta despois de 48 horas de tratamento?

Engadir cloxacilina á terapéutica Signup and view all the answers

Cal sería a principal diferencia entre erisipela e celulitis?

Erisipela ten bordes netos e palpables Signup and view all the answers

Que clase de lesión cutánea é típica na erisipela?

Placa eritematosa quente Signup and view all the answers

Que paciente debería ser hospitalizado para tratamento por vía intravenosa?

Un paciente con erisipela facial Signup and view all the answers

Cales son os signos de inicio agudo da infección?

Calofríos e fiebre Signup and view all the answers

Que aspectos son característicos das lesións cutáneas na erisipela?

Aspecto de 'pel de laranxa' Signup and view all the answers

Que microorganismo causa o impétigo vulgar?

Estafilococo aureus Signup and view all the answers

Cales son as fases da evolución cutánea do impétigo vulgar?

Macula eritematosa → vesícula → pústula → erosión Signup and view all the answers

Cual é o tratamento tópico recomendado para o impétigo vulgar?

Mupirocina 2% 3 veces ao día Signup and view all the answers

Que característica diferencial ten o impétigo ampollar comparado co impétigo vulgar?

Ampollas flácidas e transparentes Signup and view all the answers

Que ocorre se a toxina epidermolítica do estafilococo aureus se difunde de forma hematógena?

Síndrome de piel escaldada estafilocócica (SPEE) Signup and view all the answers

Cales son os síntomas iniciais do síndrome de piel escaldada estafilocócica (SPEE)?

Fiebre e eritema macular Signup and view all the answers

Que antibiótico sistémico se recomenda para pacientes alérxicos á penicilina?

Eritromicina Signup and view all the answers

Cual é o principal síntoma que se observa co signo de Nikolsky na SPEE?

Desprendemento da pel por fricción Signup and view all the answers

Study Notes

Risk Factors for Shingles

50% of those over 60 years old will develop shingles
Women are more likely to get shingles
Prodomal pain before the rash is a risk factor
Severe pain is a risk factor
Severe and widespread rash is a risk factor

Treatment for Shingles

Wear loose-fitting cotton clothing
Maintain social activities
Tricyclic antidepressants
Gabapentin/Pregabalin
Opioids
5% lidocaine patches
Referral to a pain clinic

Shingles Prevention and Referral

Zostavax: live attenuated virus, contains a higher concentration than the varicella vaccine
Shingrix: Recombinant zoster virus, can be given to immunocompromised patients
It is recommended to get the Shingrix vaccine if you are 50 years old or older
Two doses are recommended, separated by 2-6 months

Referral for Shingles

More than one dermatome affected
Hemorrhagic or necrotic lesions
Ophthalmic branch involvement
Refer to an ophthalmologist
Immunosuppressed patients

Impetigo Vulgar

Caused by Staphylococci aureus and Streptococci pyogenes
Commonly found in exposed areas, such as the face, periorificial area of the mouth and nose.
Presents as an erythematous macule, followed by a vesicle, pustule, and erosion
Superficial crusting is a characteristic finding, with the crust being yellow and honey-colored (melicerica)
Differential diagnoses include herpes simplex, eczema, insect bites, and varicella

Impetigo Vulgar Treatment

Local hygiene and debridement
Topical antibiotics:
- Mupirocin 2% 3 times a day
- Fusidic acid 2% twice a day for 1 week
- Chloramphenicol
Systemic antibiotics:
- 1st generation cephalosporin (Cefadroxil) 30mg/kg/day divided every 12 hours for 10 days
- Flucloxacillin 50mg/kg/day divided every 8 hours
- If penicillin allergic:
  - Erythromycin 30-50mg/kg/day divided every 6 hours
  - Azithromycin 10mg/kg/day for 5 days

Bullous Impetigo

More common in folds and young children
Caused by Staphylococcus aureus
Commonly found on the face and body
In infants and newborns, it can occur in the diaper area.
Vesicles quickly progress to flaccid, transparent bullas
Bullous lesions have sharp margins without an erythematous halo
A halo of scales may be present
Bullous lesions rupture easily, leaving behind dry, shiny erosions
Healing is faster than impetigo vulgaris
If the epidermolytic toxin spreads hematogenously, it can lead to Staphylococcal Scalded Skin Syndrome (SSSS)
SSSS presents as a generalized form of bullous impetigo.

Staphylococcal Scalded Skin Syndrome (SPEE)

Patients present with systemic involvement: sudden onset of irritability and fever
Macular erythema, which often starts around the mouth and in folds
Skin is sensitive and the rash generalizes
Nikolsky's sign (+) (skin peels off with friction)
Wrinkled skin
Formation of flaccid bullas 24-48 hours after the onset
Large erosive areas that are moist and eventually crust over
Thin crusts are shed, with desquamation (particularly in folds) 3-5 days after onset
Hands and feet are also involved
Crusting and radiating fissures (particularly around the mouth)
SPEE leads to keratinocyte necrosis

Treatment of Staphylococcal Scalded Skin Syndrome (SPEE)

Eradicate the infectious focus
Intravenous antibiotics (cloxacillin, vancomycin if MRSA)
Skin and fluid management
Diagnosis and treatment of carriers (nasal mupirocin)

Differential Diagnoses of Staphylococcal Scalded Skin Syndrome (SPEE)

Scarlet fever
Kawasaki disease
Staphylococcal toxic shock syndrome
Toxic epidermal necrolysis (TEN)

Folliculitis

Inflammation of the hair follicle
Divided into superficial and deep folliculitis

Superficial Folliculitis

Affects the distal portion of the hair follicle
Small papules or pustules (1-4mm in diameter) are present, with an erythematous base
Pruritus is common

Deep Folliculitis

Causes erythematous and tender papules of larger size with central pustules
Can extend to the surrounding tissue, forming a furuncle

Folliculitis Differential Diagnosis

Multiple differential diagnoses.

Treatment of Folliculitis

Correct predisposing factors
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, Anthrax

Abscess is a localized collection of pus
Furuncle is an abscess involving a hair follicle
Anthrax: clusters of furuncles
Commonly caused by Staphylococcus aureus (furuncle) and, less commonly, Streptococcus pyogenes (beta-hemolytic group A)

Furuncle

Occurs in adolescents and young adults
Presents with cellulitis, fever, and chills
Rash is erythematous, shiny, edematous, warm and tender, with rapid progression
'Orange peel' appearance characterized by well-defined and palpable borders
Vesicles, bullae, pustules, and purpuric superficial lesions are present
Differentiation from cellulitis is important as cellulitis is diffuse and not palpable

Treatment of Furuncle

Systemic antibiotics for 10 days:
- Flucloxacillin or cefadroxil
- If penicillin allergy: macrolides or clindamycin
Hospitalization for severe or facial cases: IV antibiotics
- Penicillin sodium 2-4 million units every 6 hours
- If no response after 48 hours: add cloxacillin
- 1st generation cephalosporin 1-2g every 8 hours
- If patient responds favorably after 72 hours: cefadroxil 1g every 12 hours orally

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Description

Este cuestionario analiza os factores de risco para desenvolver herpes zóster, así como os tratamentos e as medidas de prevención recomendadas. Aprenderás sobre a importancia das vacinas e a derivación adecuada en pacientes complicados. Ideal para profesionais da saúde e interesados na epidemioloxía das enfermidades virais.