{"id":5167,"date":"2011-07-14T20:24:04","date_gmt":"2011-07-14T20:24:04","guid":{"rendered":"http:\/\/crashtext.org\/misc\/5167.htm\/"},"modified":"2023-10-14T16:36:27","modified_gmt":"2023-10-14T20:36:27","slug":"soft-tissue-infections","status":"publish","type":"post","link":"https:\/\/crashingpatient.com\/medical-surgical\/infectious-disease\/soft-tissue-infections.htm\/","title":{"rendered":"Soft Tissue Infections"},"content":{"rendered":"

<\/span>Skin Infections<\/span><\/h2>\n

<\/span>Historical Risk Factors<\/span><\/h3>\n

In patients with liver disease, vibrio vinificulis is a risk if eating or working with shellfish or sea water.\u00a0 Similiar syndrome caused by aeromonas hydrophilia is caused by freshwater<\/p>\n

Abx<\/strong><\/p>\n

HIV<\/p>\n

IVDA<\/strong><\/p>\n

Splenomegaly<\/p>\n

ETOH<\/strong><\/p>\n

heart murmur or any prosthetics<\/p>\n

Steroids<\/strong><\/p>\n

Chemotherapy<\/p>\n

Diabetes<\/p>\n

\"\"<\/a>\"\"<\/a><\/p>\n

(from EM Reports)<\/p>\n

<\/span>Cellulitis<\/span><\/h3>\n

Staph and strep pyogenes<\/p>\n

Periorbital\/orbital usually secondary to sinus infection<\/p>\n

Mild is <2cm in adults<\/p>\n

Mod\/Severe systemic signs or symptoms, labs abnormal, >2cm<\/p>\n

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Need blood cultures only if signs of systemic toxicity.\u00a0 Blood cultures are usually useless as isolates rarely correlate with actual bug.<\/p>\n

Wound cultures if patient is failing to improve on the current antibiotic regimen.\u00a0 If you do sample, take deep tissue from ulcer base.<\/p>\n

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Treatment<\/p>\n

augment c probenicid (inhibits tubular pcn secretion)?<\/p>\n

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Fake nails give pseudomonal infections, Also the pads in any shoes. Rx with Diclox\/Bactrim?<\/p>\n

Infection in bursa vs. joint, have patient pronate\/supinate arm to differentiate<\/p>\n

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Always admit cellulitis overlying a weight bearing joint.<\/p>\n

PCN resistant bugs skyrocket if you have a child in daycare<\/p>\n

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Outbreaks of persistent furunculosis on the lower extremities have been reported in patrons of nail salons. The causative organism has been identified as Mycobacterium fortuitum<\/em><\/p>\n

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<\/span>Enterobacter cloacae<\/em><\/span><\/h3>\n

think wooden foreign bodies<\/p>\n

<\/span>Impetigo<\/span><\/h3>\n

bullous=staph, otherwise strep.\u00a0 Thick amber\/honey crust<\/p>\n

<\/span>Erisypilas<\/span><\/h3>\n

raised<\/strong> lesions, painful and demarcated<\/p>\n

group A strep<\/p>\n

Lower ext 70%, Face 20%<\/p>\n

<\/span>Abscesses<\/span><\/h2>\n

I\/D<\/p>\n

If surrounding cellulitis, needs broad antibiotics<\/p>\n

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<\/span>Loop Drainage<\/span><\/h3>\n

J Ped Surgery Volume 45, Issue 3, Pages 606-609 (March 2010)The use of loop drains proved safe and effective in the treatment of subcutaneous abscesses in children. Eliminating the need for repetitive and cumbersome wound packing simplifies postoperative wound care. Furthermore, there is an expected cost savings with this technique given the decreased need for wound care materials and professional postoperative home health services. We recommend this minimally invasive technique as the treatment of choice for subcutaneous abscesses in children and consider it the standard of care in our facility.<\/p>\n

\u200bloop drainage of abscesses using the cuff of a sterile glove (<\/span><\/span>Journal of Emergency Medicine, 2014-08-01, Volume 47, Issue 2, Pages 188-191)<\/p>\n

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<\/span>Leishmaniasis<\/span><\/h3>\n

Chronic Non-Healing Ulcers:\u00a0 if traveler, consider leishmaniasis.\u00a0 From Sandfly bite.\u00a0 Cutaneous leishmania is also endemic to SW United States.\u00a0 Skin is dry, gray and scaly.\u00a0 Especially seen in immunocompromised players<\/p>\n

<\/span>Erythrasma<\/span><\/h3>\n

intensely pruritic<\/p>\n

seen in diabetic males<\/p>\n

genitocrural distribution<\/p>\n

Looks like candida, but there are no satellite lesions<\/p>\n

Under Wood’s lamp, it turns bright red<\/p>\n

Treat with Erythromycin<\/p>\n

<\/span>Clostridial Myonecrosis (Gas Gangrene)<\/span><\/h3>\n

Clostridium perfringens is the classic organism responsible for “gas gangrene” or clostridial myonecrosis, although any Clostridial species can produce such infections. Clostridium perfringens is especially likely in wounds contaminated with soil. Clinically, Clostridium infections begin within hours of an inciting trauma, or surgery, with the sudden onset of pain that rapidly extends beyond the wound. A thin, watery discharge may develop, and large hemorrhagic bullae appear. A Gram\u0092s stain of the discharge often reveals gram-positive bacilli with a paucity of white blood cells.<\/p>\n

Clostridium septicum can cause spontaneous, nontraumatic necrotizing infections. A colonic lesion, such as carcinoma, will predispose to this highly lethal disease.<\/p>\n

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<\/span>Toxic Shock Syndrome<\/a><\/span><\/h3>\n

<\/h3>\n

<\/span>Staphylococcal Scalded Skin Syndrome<\/span><\/h3>\n

Scalded skin syndrome often starts in a child with a bullous impetigo. The lesion begins as a vesicle, and then gradually enlarges into flaccid bullae that rupture. New bullae typically appear over the next 2-3 days, during which time hair and nails may also shed. Fever, skin tenderness, and a scarlatiniform rash are common. The exfoliation toxin can be also secreted by localized infection in the nasopharynx, umbilicus, or urinary tract. In some children, exposed dermal surfaces will weep, while fluid and electrolyte losses may lead to hypovolemia. Exposed surfaces may also serve as a portal for other infections. Most children recover in about 10 days if appropriately treated.<\/p>\n

Scalded skin syndrome should be treated with parenteral antibiotics. In a community-acquired infection, beta-lactamase-resistant antibiotics are appropriate. When the infection appears to have been acquired in a hospital or extended care facility, methicillin-resistant Staphylococcus aureus <\/em>should be considered and vancomycin is the drug of choice. Intranasal mupirocin may provide benefits by eliminating intranasal colonization.<\/p>\n

Staph Scalded Skin-Nikolsky\u0092s Sign-<\/em>easy separation of outer skin<\/p>\n

<\/span>Necrotizing Fasciitis (NSTI)<\/span><\/h2>\n

Group A streptococcus, known as the “flesh-eating bacteria” in the lay press, causes a wide spectrum of soft-tissue infections. They range from the mild and superficial, such as impetigo, to a rapidly progressive and deadly necrotizing contagion.<\/p>\n

Many of these patients develop hypotension, renal dysfunction, and coagulopathies resembling staphylococcal toxic shock syndrome. The mortality rate remains higher than 30% but with\u00a0 appropriate antibiotics and supportive care, can be reduced to 12%.<\/p>\n

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Recognition-suspect if pain is out of proportion to clinical findings, then progression to anesthesia.<\/p>\n

All present with hypotension, initially or soon afterwards.\u00a0 Progressing to multiorgan dysfunction.<\/p>\n

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\"\"<\/a>\"\"<\/a><\/p>\n

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Will at first look just like a cellulitis with\/without abcess.\u00a0 One clue is that area will become anesthetic as infection progresses.\u00a0 May not see bubbles of air on radiography b\/c only some organisms will produce.\u00a0 Not necessarily clostridium if you do see bubbles, e. coli and others can produce as well.\u00a0 Broad spectrum abx and surgical consult.\u00a0 Unasyn\/Genta or Amp\/Genta\/Flagyl or Imipenem\/Flagyl\u00a0 Unasyn plus clindamycin<\/p>\n

Stat surgical consult<\/p>\n

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