Infectious Diseases Approaching

1
Infectious Diseases Approaching

• Infections of the skin, muscle, and soft tissue
  in emergency department

2
Objectives

• Lesions history, characteristic
• Pathogens
• Treatment

3
Anatomic Relationships

• Protection mechanism stratum corneum
• Disruption by burns, bites, abrasions, or foreign
  bodies
• Intracellular infection

4
Infections Associated with Vesicles

• Proliferation within the epidermis
• Characteristic common cause by virus
• Smallpox, Chickenpox, herpes zoster, cold sores,
  herpetic whitlow, Hand-foot-and mouth diseases...

5
Infections Associated with Bullae

• Bigger vesicles
• Disease SSSS( Staphylococcal scalded-skin
  syndrome), necrotizing fasciitis, gas gangrene,
  halophilic vibrio
• Infectious agents Staphylococcal aureus,
  Streptococcus pyogenes, Clostridium spp., vibrio
  vulnificus...

6
Infections Associated with Crusted lesions

• Early stage- bullous, then appear as thick crust
  with golden-brown color-- impetigo, infective by
  Staph. or Strept.
• Other causes ringworm, sporotrichosis,
  histoplasmosis, blastomycosis, cutaneous
  tuberculosis, nocardiosis...

7
Folliculitis

• Hair follicles serves as a portal of entry for a
  number of bacteria, S. aureus is the common cause
  of localized folliculitis
• Diffuse folliculitis hot-tub folliculitis is
  caused by Pseudomonas aeruginosa, free-swimming
  schistosomal cercariae
• Lesions Furunculosis, hot-tub folliculitis,
  swimmers itch, acne vulgaris

8
Ulcers with or without Eschars

• Different clinical manifestation
• Lesions anthrax, ulcerograndular tularemia,
  bulonic plague, buruli ulcer, leprosy, cutaneous
  tuberculosis

9
Erysipelas

• Characteristic abrupt onset, fiery-red,
  swelling, distinctive features as well-defined
  indurated margin, maybe associated with flaccid
  bullae, or pain
• lesions S. pyogenes
• Desquamation of involved skin maybe occurs 5 to
  10 days

10
Cellulitis

• Characteristic localized pain, swelling, and
  heat
• Cause indigenous flora colonizing the skin and
  appendages or by a wide variety of exogenous
  bacteria
• Something special animal bites, Pseudomonas
  aeruginosa infection presented with ecthyma
  gangrenosum, hot-tub folliculitis, and deep
  tissue infection on nail

11
Necrotizing Faciitis

• Formerly called streptococcal gangrene
• Early diagnosis is difficult when presented with
  pain or unexplained fever, then brawny edema and
  tenderness, dark red induration with bullae
  filled with blue or purple fluid, and then
  thrombosis of blood vessels
• Lesions streptococcal gangrene, Fourniers
  gangrene

12
Myositis and Pyomyositis

• Myositis can occur with viral , parasitic
  infection and so on
• Pyomyositis is usually due to S. aureus, is
  common in tropical area
• Lesions pyomyositis, streptococcsl necrotizing
  myositis, gas gangrene, nonclostridail myositis...

13
Treatment

• Early identify severe or aggressive infection
• 1. Visualized the deep structures
• 2. Remove necrotic tissue
• 3. Reduce compartment pressure
• 4. Obtain suitable material for Grams staining
  and for aerobic and anaerobic cultures
• Antibiotic clindamycin plus ampicillin/sulbactam
  plus gentamicin

14
Case Presentation

• 58 y/o female patient presented low grade fever
  and left arm erythmatous change
• History hot-spring and steaming in the recent
• How do you approach the patient?

15
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