Bacterial Infections Updated PDF

BACTERIAL INFECTION S Dr.Barzan khalid Sharaf Lecturer in college of medicine / university of Duhok.  Synopsi s Etiology Impetigo contagiosa Bullous impetigo Staphylococcal scalded skin syndrome Ecthyma Superficial folliculitis Deep folliculitis Furunculos...

BACTERIAL INFECTION S Dr.Barzan khalid Sharaf Lecturer in college of medicine / university of Duhok.  Synopsi s Etiology Impetigo contagiosa Bullous impetigo Staphylococcal scalded skin syndrome Ecthyma Superficial folliculitis Deep folliculitis Furunculosis Carbuncle  Etiology staphylococcus aureus Stretococcus Non pyogenes follicular Localis Bullous ed impetigo Impetigo Impetigo contagiosa contagiosa Ecthyma Spreadi Follicul Ecthyma ng ar Erysipel Superficial as folliculitis Celluliti Deep folliculitis s Furuncle Carbuncle IMPETIGO CONTAGIOSA  Etiolo gy Caused either by staphylococcus aureus/streptococcus pyogenes Recurrent impetigo accounts for Scabies Pediculo sis Dermatophytic  Clinical features Primarily affects school children MORPHOLOGY Thin walled blister on an erythematous base, ruptures rapidly to form an area of exudation and honey coloured crusts. Lesion spreads peripherally without central healing and many lesions may coalesce to form polycyclic lesions. Removal of crust reveals erosion.  Fate:Crust falls leaving erythema, which fades out without scarring. Lesions are usually multiple. Regional lymphadenopathy and occasionally constitutional symptoms.  Sit e Face, especially around mouth and nose Complications Post streptococcal glomerulonephritis Eczematisation  Investigat ions Gram stain of exudate shows polymorphs with intracellular and extracellular gram positive cocciin chains/clusters. Culture of pus helps to establish the etiological agent. Differential Diagnosis Bullous impetigo Treatmen t Localised Extensive lesions lesions Local hygiene Systemic Topical antibiotics antibiotics -- fusidic acid Mupiroc in BULLOUS IMPETIGO Etiolo gy Caused by certain strains of staphylococcus aureus Clinical features Seen in infants  MORPHOLOGY Bullae with turbid collection of fluid without an erythematous halo. Rupture after a few days to form thin, varnish like crusts. Lesions may heal in the centre to form annular plaques. Mucous membranes may be involved. Complicat ions Staphylococcal scalded skin syndrome Investigations Gram stain:: polymorphs with intracellular and extracellular gram positive coccii in clusters. Culture:: Staphylococcus aureus Differential Diagnosis Impetigo contagiosa Treatmen t Localised Extensive lesions lesions Systemic antistaphyloco Local hygiene ccal Topical antibiotics antibiotics -- sodium fuzidate -- flucloxa cillin Mupirocin STAPHYLOCOCCAL SCALDED SKIN SYNDROME  Etiolo gy Staphylococcus aureus infection present at different sites Ear::otitis media Lungs:: pneumonitis Skin:: trivial wounds  Clinical features Infants Acute in onset with fever and skin tenderness. Followed by peeling of skin in thin sheets. Clinically skin appears scalded. Mucous membranes spared. Investigat ions Gram stain Pus culture Differential Diagnosis Toxic epidermal necrolysis Treatm ent Supportive and nursing measures. Agressive treatment, initially with iv antistaphylococcal antibiotics followed by oral therapy. ECTHYMA Etiolo gy Deeper infection caused by either streptococcus pyogenes/Staphylococcus aureus or both. Predisposing factors::poor hygiene Malnutritio n Minor injuries Clinical features Small bulla/pustule appears on an erythematous base and soon forms a crusted, indurated, tender plaque, with an erythematous, edematous areola. Removal of adherent crust reveals an irregular ulcer. Lesions heals without scarring. Sit es Buttocks Thighs Legs Treatment Local hygiene Systemic antibiotics -- penicillin SUPERFICIAL FOLLICULITIS Etiolo gy 3 types Infectious -- Staphylococcus aureus Chemical -- occupational/cosmetic exposure Mechanical -- pseudofolliculitis (after shaving) in the beard region Post waxing folliculitis Clinical features Dome shaped follicular pustules Sit es Legs Beard region:: pseudofolliculitis Thighs and deltoid region:: post waxing folliculitis Treatment Infectious -- topical antibiotics Chemical and mechanical -- topical steroid antibiotics DEEP FOLLICULITIS Etiolo gy Staphylococcus aureus Clinical features Deep seated, erythematous perifollicular papules and pustules. Sit es Beard area Scalp Treatment Systemic antibiotics FURUNCULOSIS (BOILS) Etiolo gy Deep seated follicular and perifollicular infection. Caused by staphylococcus aureus; culminating in to necrosis. Clinical features Adolescent boys Usually 1-2 tender, firm, red, follicular nodules which become necrotic and discharge their central core. Lesions heal with barely perceptible scarring. Occasionally lymphadenopathy and fever. Sit es Hair bearing sites -- face Axillae Buttocks Perineal region Investigations Treatmen t Acute episodes Chronic, recurrent Hot fomentation furunculosis Appropriate antibiotics Appropriate Surgical incision antibiotics and drainage of Treat carrier state pus with topical mupirocin or CARBUNCL E Etiolo gy Staphylococcus aureus induced. Deep infection of contiguous hair follicles. Freequent in diabetics and patients on steroid therapy. Clinical features Adult males Constitutional symptoms like fever always present. Tender, indurated, lobulated, intensely erythematous plaque discharging pus from many openings. Back is the commonest site of involvement. Investigat ions Pus culture sensitivity. Rule oot diabetes. Treatment Drainage of deep seated pockets of pus.. Aggressive treatment with flucloxacillin or other penicillinase -- resistant antibiotics. ERYSIPELAS Etiolo gy Streptococcus pyogenes Enters through a superficial break in the skin. Superficial infection. Reccur, if there is pre-existing lymphedema or venous stasis. Clinical features MORPHOLOGY Acute erythematous, warm, indurated rapidly spreading plaques. Margin is sharply defined and superficial vesiculation may occur 9n the plaque. Constitutional symptoms are invariable and start before the onset of skin lesions. Sit e Lower limbs; less frequently.upper limb and face. Lymphangitis and lymphedema predispose to development of recurrent lesions. Complications Facial erysipelas, if left untreated, may prove fatal. Recurrences may occur in the same area Treatme nt Symptomatic Specific treatment treatment Rest Acute Limb elevation episodes:: Non steroidal parenteral anti-inflammatory penicillin drugs to relieve Penicillin sensitive pain and reduce patients:: CELLULITI S Etiolo gy Streptococcus pyogenes Enters through superficial break the skin. Deeper infection. Recurrent cellulitis occur, if there is pre-existing lymphedema or venous stasis. Clinical features Erythematous, warm, indurated, rapidly spreading plaques. Lesion is ill-defined and deeper. Constitutional symptoms are invariable and start before the onset of skin lesions. Sit e Lower limbs; less frequently.upper limb and face. Lymphangitis and lymphedema predispose to development of recurrent lesions. Complications Recurrences may occur in the same area and result in lymphedema. Treatme nt Symptomatic Specific treatment treatment Rest Acute Limb elevation episodes:: Non steroidal parenteral anti-inflammatory penicillin drugs to relieve Penicillin sensitive pain and reduce patients:: Let's recall Etiology Impetigo contagiosa Bullous impetigo Staphylococcal scalded skin syndrome Ecthyma Superficial folliculitis Deep folliculitis Furunculosis Carbuncle