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IN THE NAME OF THE MOST HIGH

IN THE NAME OF THE MOST HIGH. SKIN AND SOFT TISSUE INFECTIONS. PHYSICAL CHARACTERISTICS OF THE SKIN. Mechanical barrier of stratum corneum Relatively low PH(~5.5) Natural antibacterial substances in the secretions of sebaceous glands Relative dryness of normal skin Bacterial interference.

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IN THE NAME OF THE MOST HIGH

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  1. IN THE NAME OF THE MOST HIGH

  2. SKIN AND SOFT TISSUE INFECTIONS

  3. PHYSICAL CHARACTERISTICS OF THE SKIN • Mechanical barrier of stratum corneum • Relatively low PH(~5.5) • Natural antibacterial substances in the secretions of sebaceous glands • Relative dryness of normal skin • Bacterial interference

  4. PREDISPOSING FACTORS • Disruption of stratum corneum • Burn and bites • abrasion • Surgery • Vascular/pressure ulcer • Underlying condition (dermatitis ,HSV, varicella) • injections • Foreign body ( IV cath. Suture ) • Hair follicle : normal flora extrinsic bacteria

  5. PREDISPOSING FACTORS • Reduced vascular supply • Disruption of lymphatic or venous drainage • Compromised immune system

  6. IMPETIGO

  7. Etiology • gAS • Staphylococcus aureus (MRSA has been reported) • gCS rarely • gGS • Gbs (in newborn)

  8. Epidemiology • gAS: -hot,humid,summer weather (tropical, semitropical) -young children (2 – 5 y) -follows skin colonization by 10d -sporadic cases in cooler climates may be due to contagious spread from nasopharynx • Highly communicable • Related to PSGN but not ARF • S.aereus: -follow nasal colonization

  9. Predisposing factor • Poor hygiene • Crowding • Minor trauma (scratch) • Insect bite • Preexisting skin disease(dermatitis)

  10. Clinical manifestation • Red papule  Small vesicle pustulate  rupture  • Thick yellow stuck-on crusts • Usual site: face(around the nose and mouth) legs • Painless • Pruritic • Mild regional adenopathy • Minimal constitutional symptoms • Recovery without scar

  11. Bullous impetigo • S.aureus • Newborn and younger children • 10% of all cases of impetigo • Epidermal split caused by exfoliative toxin • More extensive lesions • 1-2 cm bullae containing neutrophils and organism • thin paper-like crusts

  12. TREATMENT • Topical mupirocin • PRP cloxacillin 250mg qid • 1st g. ceph. cephalexin 250mg qid • In the past penicillins (benzathin,oral P.V, amoxicillin) • in case of allergy: erythromycin • duration : 10d

  13. FOLLICULITIS

  14. General considerations • Etiology: Staphylococcus.aureus • Superficial infection within hair follicles & apocrine region • papule • small(2-5mm) • erythematous • Occasionally pruritic • Topped by a central pustule

  15. Treatment • Local measures saline compress topical antibacterials • Duration :until resolution of infection (5-7 d)

  16. Chronic folliculitis: • Uncommon except in acne vulgaris, • Constituents of the normal flora (e.g., Propionibacterium acnes) may play a role • Diffuse folliculitis: • Hot-tub folliculitis • Swimmer’s itch

  17. Hot-tub folliculitis • Pseudomona.aeruginosa: -contaminated swimming pools insufficiently chlorinated , 37-40°c -IP:48h -papulourticarialpustule -healing within 5 days -bacteremia has been reported

  18. swimmer’s itch • Exposure of skin to freshwater infested with avian schistosomes • Warm water and alkaline PH: suitable for mollusks(intermediate host) • Schistosomal cercariae penetrate hair follicles but quickly dies • Allergic reaction : intense itching and erythema

  19. Other less common forms • Enterbacteriaceae -complicate acne -during prolonged AB therapy • Candida -surrounding areas of intertriginous -pruritic satellite lesion -prolonged AB or C.S

  20. FURUNCLE&CARBUNCLE

  21. Furuncle • Deep seated (subcut.) necrotic infection • Extend from a hair follicle to a true abscess • Site:areas that are subject to friction and perspiration and contain hair follicles (buttock,face,neck) • Painful , firm, red nodule • Fever and constitutional symptoms • Subside after spontaneous drainage

  22. Carbuncle • Deep infection of a group of contiguous follicles • Site: back of the neck,shoulders,hip,thigh • More severe,necrotic and painful • External drainage along hair follicules • Intense inflammation of surrounding and underlying connective tissue • Fever ,malaise and leukocytosis

  23. Predisposing factors • Diabetes mellitus • Obesity • Blood dyscrasia • Corticosteroid therapy • Defect in neutrophil function

  24. Complication • Blood stream invasion • Infective endocarditis • Metastatic foci • Osteomyelitis • Upper lip,nose: spread to cavernous sinus

  25. Treatment • Systemic antibiotics esp. if cellulitis fever midface • Severe infection: nafcillin/cloxacillin 1-2g iv q4h cefazolin 1g iv q8h • Mild infection: cloxacillin/cephalexin 250-500mg po qid • Duration : 7-10d • Surgery: large and fluctuent

  26. Furuncle

  27. Furuncle

  28. Carbuncle

  29. ERYSIPELAS

  30. Etiology • gAStrep • Uncommonly gC & gGStrep • In newborns gBStrep

  31. Clinical manifestation • Site: formerly face was most common now distribution has changed: 70-80% lower extremity 5-20% face • Infants and elderly adults most affected

  32. Clinical manifestation • Abrupt onset • Rapid progression • Translocation of strep. laterally via lymphatics • Flaccid edema of the epidermis • Engorgement or obstruction of lymphatics

  33. Clinical manifestation • Bright,red swelling • Warm , intense pain • Raised,indurated,sharply demarcated margin • Peau d ‘ orange texture involvement of superficial lymphatic • Flaccid bullae during 2nd or 3rd day • Desquamation5-10 days in to the illness • Fever , leukocytosis is a feature • Extension to deeper soft tissue is rare

  34. Treatment • Mild,early: -procaine penicillin 1.2mu bid IM -penicillin.V oral -erythromycin in case of allergy • Severe : -penicillin.G 1-2mu q4h IV • If cellulitis is a D.Dx: -PRP(nafcillin,oxacillin) -1st g. ceph.

  35. Treatment • Swelling may progress despite appropriate treatment • Fever • Pain diminish • Intense red color

  36. CELLULITIS

  37. Etiology • S.aereus: • MRSA is rapidly replacing MSSA • gA strep. • gC strep sometimes • gG strep sometimes • Wide variety of exogenous bacteria

  38. Predisposing factor • S.aureus : central localized infection (e.g. abscess , folliculitis , infected foreign body , surgical or traumatic wounds) • Strep. : minor or inapparent breaks disrupted lymphatic drainage surgical wound infection(1st 24 h )

  39. Clinical manifestation • Pain and local tenderness • Hot • swollen • Erythema • Strep : more rapidly spreading frequently associated with fever and lymphangitis

  40. Clinical manifestation • Diffuse spreading infection • Involves skin and subcutaneous tissue (deeper than erysipelas) • Systemic signs (fever,malaise,chills) • Regional lymphadenopathy • Border not elevated ,not demarcated

  41. Diagnosis • If : drainage an open wound gram stain an obvious port of entry culture • In the absence of these findings definite diagnosis of etiology is difficult • Culture of needle aspiration and punch biopsy 20% • Blood culture <5%

  42. Differential diagnosis • Necrotizing fasciitis • Insect bite • Fixed drug eruption • DVT • FMF • Pyoderma gangrenosa • Sweet’s syndrome

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