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softtissueinfections.pptx
- 1. Skin and SoftTissue Infections
- 2. • Infections in, –Skin – Subcutaneous tissue – Fasciae – Muscles
- 4. Erysipel as • Strep. Infectionsof dermis • Well demarcated, painful, erythematous • indurated plaques, Blisters & ulceration • Abrupt fever with chills • Face, legs • common in very young, old, debilitated patients • lymphoedematous • erysipelas and Cellulitis overlap often • Treatment: Penicillin IV/IM
- 5. Impetig o • A contagioussuperficial infection of the skin • Staphylococci or β-haemolytic streptococci • common in children • usually involves the skin of the face, often around the mouth and nose. • spread by direct contact • Minor abrasions and other skin lesions predispose to infections • Prevention is by good personal hygiene , particularly hand washing with soap.
- 6. • It hastwo forms: 1. Non-bullous Streptococcus pyogenes "honey-crust" lesions 2. Bullous Staphylococcus aureus rupture of the bullae "varnish-like" crust
- 8. Treatmen t • Usually self-limiting •Avoid precipitating factor (e.g., exfoliation) • Localized – topical fusidic acid tds. (for MRSA) • mild and localized – Topical antibiotic e.g.; topical mupirocin
- 9. • Other closecontacts should be examined • children should avoid school for 1week after starting therapy. • resistant to treatment or recurrent –take nasal swabs and check other family members. • Eradication of nasal carriage –Nasal mupirocin
- 10. Folliculiti s • Infections ofthe superficial part of the hair follicle • itchy or tender papules and pustules. • Staphylococcus aureus
- 11. • Small pustules oftenpierced by a hair • Legs, face – (sycosis barbae) • commoner in humid climates and when occlusive clothes are worn. • Extensive, itchy folliculitis in HIV infection.
- 12. Treatmen t • topical antiseptics •topical sodium fusidate • mupirocin containing ointment • oral antibiotics – flucloxacillin or erythromycin • If chronic – Detect and treat carrier state
- 13. Boils (furuncles) • Staph. Infectionsof the deeper part of hair follicle • most common on the face, neck, armpit, buttocks, and thighs • On central face – danger of cavernous sinus thrombosis • Tender, red, cone shaped swelling • heal with scarring • Recurrences may occur • Exclude carrier state • Treatment: Antibiotics • If large – need incision
- 14. CARBUNC LE • Deep staph.Infection of several adjacent hair follicle • cluster of boils that form a connected area of infection • neck, back, thighs • In diabetics & debilitated • Treatment – Antibiotics, – Surgical incision
- 15. Ecthym a • By bothstreptococci and staphylococci • Ulcer forms under a crusted surface of the infection • Heals withscarring
- 16. • Poor hygieneand malnutrition are predisposing factors • Minor injuries and other skin conditions determine the site • Treatment- – Improved hygiene and nutrition – Antibiotics (phenoxymethylpenicillin and flucloxacillin)
- 17. Celluliti s • Infection ofnormal skin flora or exogenous bacteria (S. aureus andß-haemolytic streptococci) • Deep skin or subcutaneous layer • Hx of Trauma and Ulceration • Organisms enter through breach in skin • Infection can spread to blood stream Bacteremia /septicemia.
- 18. Clinical features • Acute localisedpain • Oedema • lymphangitis &lymphadeniti s – Hot painful erythema streaking, progressing proximally from the affected area, tracking along lymphatics • +/- blister
- 20.
- 22. Investigation s • Swabs takenfrom relevant sites (from leading edge or aspirating blisters) • Gram stain and Blood cultures • Serological- – antistreptolysin O titre (ASOT) – antiDNAse B titre (ADB)
- 23. Manageme nt • Elevate limb. •Treat underlying Cause • Antibiotics – Phenoxymethylpenicill in – erythromycin – flucloxacillin (all 500 mg qds) – Vancomycin • Widespread – IV antibiotics (3–5 days) ,2 weeks (oral) • Recurrent – low dose antibiotic prophylaxis (phenoxymethylpenicilli n) – Linezolid MRSA Cellulitis – Clindamycin
- 24. Complications- Local • Blisters • Skinnecrosis • Thrombophlebeti cs • Lymphadenitis • Abscesses
- 25. • Bacteremia • Septicemia •Osteomyeliti s • Meningitis Complications- Systemic
- 26. Skin abscess • Subcutaneous • localized collectionof pus • surrounded by granulation tissue • Hx of – penetrating injury – infection of haematoma
- 27. • S. aureusis the common infecting organism • Poor hygiene is predisposing • Rx- incision and drainage Features : Celluliti s Swollen presen t Soft center feels like fluid underneath Painfu l T ende r Celluliti s Absce ss
- 28. Necrotizing fasciitis • Surgical emergency •Polymicrobial Infection of the fascia Type 1- E.coli, Pseudomonas, Proteus, Bacteroides, Clostridium Type 2- Streptococcus • May proceed rapidly to underlying muscle. • Diagnosis is often delayed • Primarily a clinical diagnosis • Rapid progression to septic shock • Mortality 30-50%
- 30. Clinical Features • Severe painat the site of initial infection • Tissue necrosis. • spreading erythema • pain • soft tissue crepitus – (infection tracks rapidly along the tissue planes) • Fever ,Tachycardia
- 31.
- 32. Clinical findings innecrotising fasciitis Early findings 1. Pain 2. Cellulitis 3. Pyrexia 4. Tachycardia 5. Swelling 6. Skin anesthesia Late findings 1. Severe pain 2. Skin discoloration (purple or black) 3. Blistering 4. Hemorrhagic bullae 5. Crepitus 6. Discharge of “dishwater” fluid 7. Severe sepsis or systemic inflammatory response syndrome 8. Multi-organ failure
- 33. • Treat aggressivelyand promptly • antibiotics –Type 1- –Broad-spectrum combination (amoxicillin , imipenem, levofloxacin) –Type 2 • benzylpenicillin and clindamycin
- 34. • urgent surgical exploration –Extensive debridement or – amputation (if necessary) Necrotizing fasciitis after debridement
- 35. •• Staphylococcal scalded skin syndrome exfoliateor epidermolytic toxin. • rapidly spreading tender erythema • Dermonecrosis • Outer layer of the epidermis peel off • Blistering • Ritter's Disease of the Newborn - most severe form of SSSS
- 36. • Affects – infants,immunosuppressed , renal disease, Malignancy • Mortality – higher in adult • Diagnosis – Clinical – Culture – Frozen section examination of skin – shows split • Treatment: IV antibiotics & nursing care or Self limiting.
- 37. Hidradenitis suppurativa • Infection inApocrine sweat glands • Common in Axillae and groin and in females • Multiple tender swellings • Enlarging and discharging pus • Recurrence • worse in obese individuals • Rx- – weight loss – oral retinoids (Vitamin A) – Zinc gluconate
- 38. Erythrasm a • Chronic skininfection of Corynebacterium • Macular wrinkled, slightly scaly pink ,brown or macerated white areas • armpits ,groin or between toe webs • Coral pink under Wood’slight • prevalent among diabetics, the obese, and in warm climates • Rx – Topical fusidic acid
- 39. Pyomyositi s • S. aureus& Streptococcus infection of the skeletal muscles • pus-filled abscess • most common in tropical areas- “ myositis tropicans” • can affect any skeletal muscle • most often infects the large muscle groups e.g.-quadriceps or
- 40. • Fever, Sepsis, Localized inflammation •Muscle pain • Predisposing factors- Immunodeficiency, IVDAs, Trauma and malnutrition • Complications- Abscess, sepsis • Rx- Drain surgically and antibiotics
- 41. Gangren e • Clinical situationwhere extensive tissue necrosis is complicated by bacterial infection Dry gangrene Wet gangrene Gas gangrene
- 42. Dry Gangre ne • The resultof ischaemic coagulative necrosis. • Black, dry, sharply demarcated • Secondary bacterial infection is insignificant E.g. Gangrene of extremities in thrombo-embolic
- 43. Wet Gangre ne • Tissuenecrosisis complicatedbysevere infection. • Swollen,reddish-black foul smelling tissue. • Extensive liquefaction of dead tissue occurs due to invasion of organisms & acute inflammation. • No clear demarcationbetween dead and viable tissue. • Occursin extremities and internal organs E.g.Diabetic gangreneof foot
- 45. GasGangrene (Clostridial myonecrosis) • Clostridium perfringen s • Extensive tissu edestruction • gas production by fermentative action of bacteria. • Swollenreddish-
- 46. Treatmen t • usually surgicaldebridement • amputation (if necessary) • Antibiotics alone are not effective