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Skin & soft tissue infections chap. 122

Skin & soft tissue infections chap. 122. Inflammation of the conjunctivae; membranes that line the surface of the eye Infection; allergy; mechanical/chemical irritation Keratoconjunctivitis involves cornea as well Table 122-1 Neonate most common Chlamydia trachomatis

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Skin & soft tissue infections chap. 122

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  1. Skin & soft tissue infectionschap. 122

  2. Inflammation of the conjunctivae; membranes that line the surface of the eye • Infection; allergy; mechanical/chemical irritation • Keratoconjunctivitis involves cornea as well • Table 122-1 • Neonate most common Chlamydia trachomatis • Child most common Adenovirus; Hemophilus sp. conjunctivitis

  3. Clinical features: • Photophobia • Ocular pain • Ocular pruritus • FB sensation • Crusting of eyelids • Conjunctival erythema conjunctivitis

  4. Duration of sxs 2-4 d • Examine both eyes • Visual acuity • Visual fields • EOM fxn • Periorbital area • Eyelids w/ eversion • Conjunctivae • Cornea with fluorescein staining • Pupillary reflex • Anterior chamber • Fundus conjunctivitis

  5. Diagnosis: • Erythema & inc. secretions (+/- chemosis) • Purulent discharge more common with infectious • Fluorescein will not stain eye unless it picks up herpes simplex or adenovirus keratitis • Visual acuity normal • May be assoc with URI • May be only manifestation of KD or measles • Neonates should have gm stain of discharge conjunctivitis

  6. Table 122-2, -3 • Complications • Corneal ulceration & scar formation • Esp with herpes simplex & N. gonorrhoeae • Treatment • Fig. 122-1; table 122-4 • Herpes – acyclovir; consult ophtho • N. gonorrhoeae – single dose ceftriaxone 125mg IM • C. trachomatis - erythromycin PO (50mg/kg/d) for age < 3 mos; older kids just topical drops conjunctivitis

  7. Superficial bacterial infxn of skin confined to epidermis • 2 types: • Impetigo contagiosa • Bullous impetigo (less common; S. aureus) • Most common peds skin infxn seen in ED • Prevalence greatest in age < 6 yo • Most common orgs: GABHS or S. aureus impetigo

  8. Clinical features: • No assoc systemic manifestations (i.e. fever, malaise) • Regional LAD • Begins as erythematous papule, then small vesicles with progression to crusted lesions • “honey-colored” • Face is most common (b/w nose and upper lip) • Bullous impetigo are superficial bullae filled w/ purulent material impetigo

  9. Treatment • Oral axbx (cephalexin 50mg/kg/d) • Topical axbx (mupirocin AAA bid) • Keep areas clean & dry daily • Complications • Glomerulonephritis (if strep is causative org) • Cellulitis • Lymphadenitis impetigo

  10. Inflammation of paranasal sinuses • Maxillary • Ethmoid • Frontal • Sphenoid • Infectious or allergic • Acute, subacute or chronic • Major orgs: S. pneumo, M. cat, nontypable H. flu sinusitis

  11. Ethmoid & maxillary sinuses present at birth Frontal & sphenoid sinuses do not become aerated until 6-7 yo Most frequent offenders are viral URI & allergies; less common are CF, trauma, choanal atresia, deviated septum, polyps, FB, tumors Bacteria normally colonize the nasopharynx but when a disruption in barrier allows orgs to ascend through ostia & multiply w/in sinuses sinusitis

  12. Clinical features • Headache • Bilat nasal mucopurulent discharge • Fever • Localized swelling +/- erythema • Facial tenderness • CT sinuses imaging modality of choice for sev dz • Can confirm with gm stain of aspirated secretions sinusitis

  13. Treatment • Oral axbx (table 122-6) for 10-14 d • Amoxicillin (80mg/kg/d) is DOC • 2nd/3rd gen cephalosporins; augmentin • Severe sinusitis may req IV axbx • ceftriaxone (50-100mg/kg/d) • Complications • Periorbitalcellulits; orbital cellulitis/abscess • Osteomyelitis (Potts puffy tumor) • Epidural, subdural or brain abscesses • Meningitis • Cavernous sinus thrombosis sinusitis

  14. Infxn of skin & subQ tissues • Extends below dermis, but does not involve muscle or bone • 2 specific body regions may help predict most likely pathogens • Trunk & extremities (S. aureus; Strep pyogenes) • Face (H. flu if unimmunized; S. aureus & Strep pneumo) • Table 122-7 cellulitis

  15. Clinical features • Local inflammatory response at site of infxn • Erythema, edema, warmth, tenderness • h/o preceding wound or complaint related to loss of fxn • Fever unusual (except infxn caused by H. flu type B) • Table 122-8 cellulitis

  16. Treatment • Oral axbx (dicloxacillin or cephalexin) • Signs of sepsis or systemic involvement require IV axbx and admission (also age < 6 mos) • Table 122-9 • Complications • Regional lymphadenitis • Local spread • Bacteremia (spread to CNS, epiglottis, joints, pericardium) cellulitis

  17. Periorbital – cellulitis involving tissues anterior to orbital septum • Orbital – cellulitis within orbit • Age < 3 yo are more likely to become bacteremic • Most common orgs • S. aureus • S. pneumo • H. flu Periorbital/orbital cellulitis

  18. Clinical features • Periorbital area swollen & red • Proptosis • Limitation of EOM fxn (orbital) • Fever (periorbital) • Leukocytosis • Positive blood cxs • CT reveals inflammatory mass Periorbital/orbital cellulitis

  19. Treatment • IV axbx • Admission • Blood cxs • Age < 6 mos, consider LP • Complications • Metastatic bacterial dz (meningitis) • Subperiosteal abscess (surgical emergency) • Intracranial extension rare Periorbital/orbital cellulitis

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