Bacterial Infections (PEARLS)
The NCCPA™ PANCE Dermatology Content Blueprint covers three dermatologic bacterial infections
Patient will present as → a 64-year-old female with a 4 cm × 7 cm edematous, red, hot tender area on the left thigh. The lesion has gotten larger over the past 6 hours. She tells you she has also had a low-grade fever and some chills. On physical exam, there is a poorly demarcated 12cm red and tender plaque on her right calf. Some parts resemble an orange peel. There is a superficial cut in the middle of the plaque.
Acute bacterial skin and skin structure infection of the dermis and subcutaneous tissue; characterized by pain, erythema, warmth, and swelling. Margins are flat and not well demarcated.
- Caused by Staphylococcus and Streptococcus in adults
- H. influenzae or strep pneumonia in children
DX: culture taken of all purulent wounds and follow up in 48 hours
Treat mild cellulitis (MSSA) with Cephalexin or Dicloxacillin
- Cat bite with augmentin or doxycycline if PCN allergic
- Puncture wound with Cipro (cover pseudomonas)
Treat methicillin-resistant Staphylococcus aureus infection (MRSA) with
- Trimethoprim-sulfamethoxazole (TMP-SMZ) 1 DS tab PO BID
- Clindamycin 300–450 mg PO
- Doxycycline 100 mg PO BID
- Intravenous Vancomycin or Linezolid
Cellulitis with erythematous tender swelling of the left lower extremity
Patient will present as → a 19-year-old female with a painful rash on her left leg. She has a small bug bite in the same area about three weeks ago. Since then, the area has become red, painful, and hot. On physical exam, you not a shiny, raised, indurated, and tender plaque-like lesions on the left leg. The redness is well-demarcated and hot to the touch. You send her home on penicillin.
A distinct form of cellulitis notable for acute, well-demarcated, raised superficial bacterial skin infection with lymphatic involvement almost always caused by Group A strep (strep pyogenes)
- Symptoms may include redness and pain at the affected site, fevers, and chills
DX: culture and sensitivity
- Mild disease can be treated with Penicillin G (erythromycin/clindamycin for PCN allergy)
- Moderate: Bactrim and penicillin/cephalexin
- severe IMP or MER IV and linezolid BID or Vanco IV/Dapto IV
Erysipelas. This patient has large, confluent erythematous plaques. A bulla is present near the angle of her jaw.
Patient will present as → a 5-year-old girl with crusting facial lesions present for 3 days. The mother reports that prior to the development of the facial lesions her daughter was scratching at insect bites. Examination reveals a red facial rash with a golden “honey-colored crust” and pruritus.
Child < 6 y/o complaining of non-painful, pruritic lesions on the face
- The main symptom is red sores that form around the nose and mouth. The sores rupture, ooze for a few days, then form a yellow-brown crust
- “honey-colored” and weeping
- Most commonly caused by S. aureus
Treatment is topical mupirocin, dicloxacillin, cephalexin for more severe illness
- Complications: poststreptococcal glomerulonephritis
Impetigo with crusted patches around the mouth.
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