1 / 40

Bacterial infections

Bacterial infections. Bacterial Skin Infections. Pyodermas Soft tissue infections Superficial. Pyodermas. Pus forming condition of skin Causative organism: Staphylococcus aureus Group A ß haemolytic streptococci (GAS) Primary

khuong
Download Presentation

Bacterial infections

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Bacterial infections

  2. Bacterial Skin Infections • Pyodermas • Soft tissue infections • Superficial

  3. Pyodermas • Pus forming condition of skin Causative organism: • Staphylococcus aureus • Group A ß haemolytic streptococci (GAS) • Primary Primary pyoderma is often idiopathic in nature (occurring without any predisposing cause), and may be a result of suppressed or compromised immune status. • Secondary Secondary occurs in pre-existing skin conditions such as eczemas, viral infections, scabies, etc.

  4. Impetigo • Superficial epidermal infection • Commonly seen in children • Staphylococcus aureus, GAS • Warmth, humidity, poor hygiene, Atopic dermatitis, diabetes mellitus • Variable pruritus, fever uncommonly • Clinical types: Impetigo Contagiosa, Bullous Impetigo

  5. Impetigo Contagiosa • Non Bullous impetigo Small vesicles quickly become pustules Erosions with yellow brown crust Scattered, discrete, may become confluent Sites : face, arms, legs

  6. Bullous Impetigo • Bullous Impetigo Vesicles / Bullae having turbid fluid Hypopyon sign No surrounding erythema Moist erosions Distribution Face, legs, arms Differential Diagnosis a) Erosion:dermatitis, scabies b) Bulla: Herpes zoster, bullouspemphigoid dermatitis herpetiformis, burns

  7. Ecthyma • Develops in neglected lesions e.g. trauma in diabetes mellitus • Pain, tenderness • Deep, crusted lesions - ulcerates • Tenderness, induration • Sites: legs & buttocks • Lymphadenopathy • Heals with scars

  8. Impetigo and Ecthyma • Diagnosis Mostly clinical; Gram’s stain, culture • Treatment General – antiseptic baths Topical: Antibacterials such as mupirocin Oral: GAS – erythromycin, cephalexin S. aureus– cephalexin, amoxycillin – clavulinic acid MRSA - ciprofloxacin, trimethoprim - sulphamethoxazole

  9. Infectious folliculitis • Infection of upper portion of hair follicle • Mostly Staphylococcus aureus • Predisposing factors: Shaving hairy areas, extraction of hair, occlusion, high temperature, humidity, diabetes mellitus • Progresses within days and extends upto months • Pruritic, mild pain • Lymphadenopathy rarely seen • Grouped papules/pustules confined to ostium of hair follicle • Minimal scarring, post inflammatory pigmentation seen

  10. Infectious folliculitis • Face - coexist with acne • Beard - Sycosisbarbae • Neck - Keloidalfolliculitis • Legs - involvement common in India • Trunk - Hot tub folliculitis, Pityrosporumfolliculitis

  11. Folliculitis - face • Superficial folliculitis with thin walled pustules at follicular orifice • Can present on scalp and face, especially seen at perioral areas • May arise at sites of trauma • Develops in crops and heals within few days • Most frequent cause Staphylococcus aureus

  12. Sycosisbarbae • Chronic, follicular, perifollicular, pustular, staphylococcal infection of the beard area • Develops as erythema, itching near upper lip or nose • Pin head sized pustules may develop, pierced by hair • Differential diagnosis: Dermatophytic infection, acne vulgaris, herpetic sycosis

  13. Keloidalfolliculitis • Keloid like papules and plaques on the occipital scalp and the back of the neck • Starts as chronic folliculitis and perifolliculitis • Heals with keloidal scars, sometimes with discharging sinuses • Painful and cosmetically disfiguring • Treatment : with topical antibacterials, Intralesional Steroids, • Prevention of trauma

  14. Chronic folliculitis • DCPA (Dermatitis crurispustulosa et atrophicians) • Chronic folliculitis seen especially in young Indian males • Involves anterior aspect of lower legs bilaterally; may extend upto the thigh • Recalcitrant, lasting for several years • Usually clears after development of atrophy

  15. Differential diagnosis of folliculitis • Fungal Pityrosporumfolliculitis Tineacapitis Tineabarbae • Viral Herpes simplex Molluscumcontagiosum • Syphilitic Secondary syphillis • Infestation Demodicidosis • Acneiform eruptions

  16. Management: Folliculitis • Diagnosis - Gram’s stain • KOH mount - Culture • Management - Prevention - Antibiotics Topical – Mupirocin, Clindamycin Oral as per culture and sensitivity studies

  17. Abscess, Furuncle and Carbuncle • Staphylococcus aureus • Predisposing factors - Chronic carrier states - Diabetes Mellitus - Obesity - Poor hygiene - Bactericidal defects (e.g. chronic granulomatous disease) - Hyper - IgE syndrome

  18. Abscess, Furuncle and Carbuncle • Abscess is circumscribed collection of pus • Furuncle is an acute deep necrotising infection of a hair follicle and perifollicular area • Carbuncle is a deep infection involving multiple contiguous hair follicles

  19. Clinical Presentation • Abscess Erythematous, warm, painful/tender Arises in the dermis, subcutaneous fat or muscle Tender nodule; central pus collection • Furuncle Arise in hair bearing area Firm tender nodule Central necrotic plug Usually follow staphylococcal folliculitis Abscess formation below necrotic plug

  20. Clinical Presentation • Carbuncle Evolution similar to furuncle Deep infection of a group of contiguous follicles with Staphylococcus aureus Sieve like openings draining pus

  21. Management • Grams’ stain and culture • Treatment Incision and drainage Systemic antibiotics • Recurrent furunculosis Due to persistent S. aureus Proper cleansing measures Nasal, inguinal, axillary and perianalmupirocin Rifampicin 600 mg PO for 7 - 10 days for MRSA

  22. Erysipelas and Cellulitis • Soft tissue infections – Acute, diffuse, edematous inflammation of dermis and subcutaneous tissue. • Erysipelas – Superficial soft tissue infection of dermis & upper subcutaneous tissue. Raised plaque with sharp margins. • Cellulitis – Inflammation of subcutaneous tissue. Not raised and no clear margins.

  23. Erysipelas and Cellulitis • GAS (erysipelas) or S. Aureus • Arises via a portal of entry in skin or mucous membrane • Fever with chills, malaise, local pain and tenderness • May become necrotising

  24. Clinical Presentation • Red, hot, edematous shiny plaque • Well demarcated border in erysipelas • Vesicles, bullae, erosions, abscesses and necrosis • Breaks in skin, chronic dermatitis

  25. Risk factors • Diabetes • Immunodeficiency • Drug and alcohol abuse • Cancer and chemotherapy • Chronic lymphedema • Cirrhosis • Neutropenia • Renal failure • Systemic atherosclerosis

  26. Management • Diagnosis Gram’s stain and culture Rule out systemic involvement by blood tests and imaging • Prognosis Favorable if treatment started early Hematological and lymphatic dissemination if treatment delayed • Treatment Supportive: rest, leg elevation, analgesia Appropriate antibiotics

  27. Superficial Cutaneous Infections • Affect stratum corneum • Overgrowth of normal flora • Three infections Erythrasma Pitted keratolysis Trichomycosisaxillaris

  28. Erythrasma • Corynebacteriumminutissimum • Humid climate and occlusion • Asymptomatic; occasional pruritus • Sharply marginated reddish brown patch/macules • Groin fold, axillae, intergluteal & submammary folds • Wood’s lamp: coral red fluorescence • Treatment: Erythromycin, oral and topical if extensive lesions. Topically azole antifungal agents-clotrimazole & miconazole for 2 weeks

  29. Pitted Keratolysis • Micrococcus sedentarius • Hyperhidrosis of feet; occlusive footwear • Asymptomatic, foot odour, itching • Discrete / confluent pits in toe webs or on heels • Treatment: Reduce moisture, absorbing powders, erythromycin oral/topical, benzoyl peroxide

  30. TrichomycosisAxillaris • Aerobic Corynebacteria • Adherent brown black, yellow, red concretions on hair shaft which can be hard, soft, nodular/more diffuse • Axillae and pubic areas • Underlying skin normal • Treatment: Shaving/ clipping/ topical antimicrobials

  31. Other Bacterial Infections • Paronychia • Periporitis • Staphylococcal scalded skin syndrome • Toxic shock syndrome • Scarlet fever

  32. Paronychia • Acute infection of the nail fold • Facilitated by cuticular damage. • Clinically manifested as painful swelling of the proximal/ lateral nail fold • Bacterial Culture and sensitivity helps in diagnosis • Differential diagnosis: Herpetic whitlow, fungal paronychia • Treatment involves incision and drainage; systemic and topical antibiotics

  33. Periporitis • Pustular lesion, mostly in children during summers, due to staphylococcal infection of sweat gland • Sites: face, buttocks, upper trunk, scalp • May progress to sweat gland abscess • Clinically present as erythematous deep seated nodules. May localize and rupture, leaving behind scar • Differential diagnosis: Furuncles, Miliariapustulosa • Treatment : topical &/or oral antibiotics. • Prevention: minimizing sweat retention in the affected area

  34. Staphylococcal Scalded Skin Syndrome • Generalized, confluent, superficially exfoliative disease • Mostly occurs in neonates and young children. • Due to action of exfoliativeexotoxins type A and B liberated by staphylococcus aureus. • Fever, skin tenderness and erythema involving the neck, groins and axillae followed by generalized desquamation. • Diagnosis by histopathology, immunofluorescence and frozen section of peeled skin. • Treatment: Immediate institution of appropriate antibiotic therapy such as methicillin, erythromycin.

  35. Toxic Shock Syndrome • Acute febrile multisystem disease • Mediated by one or more toxins elaborated by staphylococcus aureus • Occurs due to infections in wounds, catheters, nasal packs • Diagnosis: primarily clinical, supported by the confirmation of staphylococcal infection • Treatment: systemic antibiotics; Intensive supportive treatment

  36. Scarlet Fever • Streptococcal pharyngitis, tonsilliits or cellulitis causing diffuse erythematousexanthem because of pyrogenicexotoxin. • Manifested as red tonsils, strawberry tongue, diffuse erythema, Pastia’s lines, circumoral pallor with facial flushing. • ASO titre may be diagnostic • Treatment: systemic antibiotics

  37. Secondary Pyodermas • Secondary bacterial infections in pre-existing dermatological conditions • May complicate conditions such as scabies, pediculosis, atopic dermatitis and neurodermatitis • Treatment: appropriate oral and/or topical antibiotics; treat pre-existing disease

  38. Management of Pyodermas: General Principles • Identify, Assess and Treat Predisposing factors: • Poor hygiene, Malnutrition, Recurrent trauma, Diabetes mellitus, Pre existing skin diseases , Congenital and acquired Immunodeficiency • Investigations:(recalcitrant and recurrent infections) • For the identification of predisposing factors • Smear, Culture and Antibiotic Sensitivity test (SCABS).

  39. Management of Pyodermas: General Principles Topical Therapy: • Soaks /compresses: Condy’s solution (KMNO4), Burrow’s solution (aluminum chlorohydrate) • Topical Antiseptics: Chlorhexidine, Povidine iodine. • Topical antibiotics : Mupirocin, Framycetin, Sisomicin, Nadifloxacin, Neomycin, GentamicinPolymyxin B, Bacitracin, Fusidic acid. Systemic therapy : • Semi synthetic penicillins, Cephalosporins, Macrolides, Tetracyclines, Quinolones.

  40. Thank you

More Related