PANCE Blueprint Dermatology (5%)

Bacterial Infections (PEARLS)

The NCCPA™ PANCE Dermatology Content Blueprint covers three dermatologic bacterial infections

Cellulitis (ReelDx)
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

Cellulitis with erythematous tender swelling of the left lower extremity

Erysipelas
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

TX:

  • 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.

Erysipelas. This patient has large, confluent erythematous plaques. A bulla is present near the angle of her jaw.

Impetigo
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.

Impetigo with crusted patches around the mouth.

Dermatologic Infectious diseases (PEARLS) (Prev Lesson)
(Next Lesson) Cellulitis (ReelDx)
Back to PANCE Blueprint Dermatology (5%)

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