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Superficial Infection Dr. Weiguo Hu 胡伟国 Dr. Weihua Qiu 邱伟华 Department of Surgery Rui Jin Hospital Shanghai Jiao Tong University School of Medicine.

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Presentation on theme: "Superficial Infection Dr. Weiguo Hu 胡伟国 Dr. Weihua Qiu 邱伟华 Department of Surgery Rui Jin Hospital Shanghai Jiao Tong University School of Medicine."— Presentation transcript:

1 Superficial Infection Dr. Weiguo Hu 胡伟国 Dr. Weihua Qiu 邱伟华 Department of Surgery Rui Jin Hospital Shanghai Jiao Tong University School of Medicine

2 Staphylococci—G+ beta hemolysins Suppuration and Characteristic pus thick, yellow, without foul smelling S. aureus – furuncle & carbuncle S. epidermidis – after surgery with foreign material Staphylococcal Infection

3 Obesity Diabetes Poor hygiene condition Intravenous drugs High Risk Factors

4 Infection involving an entire hair follicle and the underlying skin tissue Face Buttocks Thighs Groin Breast Axil area Furuncle : Characteristic

5 <2cm raised, tender, shiny, bright red intense, throbbing pain yellow or white creamy discharge (matured) Furuncle : Signs & Symptoms

6 A confluent infection involving multiple contiguous follicles limited to the subcutaneous tissue thick overlying skin and dense subcutaneous fascia Carbuncle : Characteristic

7

8 Back of Neck or Torso Pain, swelling, induration of the surrounding skin Multiple small abscess with yellow thick pas Fever, fatigued, leukocytosis, even sepsis Carbuncle : Signs & Symptoms

9 Leision care help to “mature” Surgical incision drainage Large & deep enough incision for carbuncle Antibiotics Penicillin Erythromycin Clindamycin Management :

10 Management : Surgical drainage

11 good hygiene condition avoiding intravenous drug loose clothing Prevention :

12 Connective tissue dermis and subcutaneous tissues acute spreading pain, erythema, edema, and warmth Cellulitis : Characteristic

13 trauma or surgery causing a lesion in the skin may have no discernible dermal injury develops over a period of several days Cellulitis : History

14 The affected area Warmth Erythema Edema Tenderness The proximal to the area Ascending lymphangitis lymphadenopathy Cellulitis : Signs & Symptoms

15 Significant erythema An eroded area near the center Irregular margins but not raised An ulcerated area in the center Painful and warm to the touch Severe Cellulitis :

16 normal group A streptococci & Staphylococcus aureus Infants group B streptococci Immunocompromised Pneumococcus gram-negative rods or fungi Wounds Aeromonas hydrophila, gram-negative rod Etiology : Microorganism

17 Obesity Diabetes Poor hygiene condition Intravenous drugs Immunodeficiency High Risk Factors

18 Bacteremia Local abscess Superinfection with gram-negative organisms Lymphangitis Thrombophlebitis Facial cellulitis in children (meningitis in 8%) Gas gangrene(amputation & mortality in 25%) Cellulitis : Complications

19 Escherichia coli in nephrotic syndrome Cellulitis of the lower extremities in geriatric patients (thrombophlebitis) Pseudomonads in immunocompromised children Cellulitis : Special Concerns

20 Antibiotics: penicillinase-resistant synthetic penicillin first-generation cephalosporin clindamycin metronidazole Management :

21 caused by group A beta-hemolytic streptococci Involving dermis and lymphatics more superficial subcutaneous infection than cellulitis characterized by intense erythema, induration, and a sharply demarcated border, Erysipelas : Characteristic

22 70-80% in lower extremities Erysipelas : Characteristic

23 5-20% in face Erysipelas : Characteristic

24 Abrupt onset of illness (Painful rash) Initial fever and chills (1-2 days later) Muscle and joint pain Nausea Headache Systemic infectious manifestations Skin discomfort Erysipelas : History

25 Fever Dermatologic signs Painful, erythematous, and edematous rash Sharply-raised border with abrupt demarcation from healthy adjacent skin Lymphangitis Erythema (irregular extensions) Desquamation Vesicles Lymphadenopathy Erysipelas : Signs & Symptoms

26 Sharply-raised border with abrupt demarcation from healthy adjacent skin Erysipelas : Signs & Symptoms

27 Painful Erythematous Edematous rash Erysipelas : Signs & Symptoms

28 Group A streptococci (the most) Group G, C, B streptococci (less) Staphylococci (rarely) Etiology : Microorganism

29 Antibiotics (as soon as possible) Penicillin Erythromycin Cephalexin Symptomatic treatment Antipyretic Analgesics Hydration (oral intake if possible) Cold compresses Management :

30 Gangrene & Amputation Bacteremia & Sepsis Scarlet fever Pneumonia Abscess Embolism Meningitis Death Complications :

31 The infection of lymph nodes (glands) usually associated with the site of the underlying infection, tumor, inflammation common result of a cellulitis or other bacteria infection Lymphadenitis : Characteristic

32 swollen, tender, hard nodes smooth or irregular to touch or soft and "rubbery" (fluctuant) if an abscess has formed the skin over a node may be reddened and hot Lymphadenitis : Signs & Symptoms

33 Infection of lymph vessels/channels Commonly results from cellulitis or abscess in the skin or soft tissues A progressing infection raising spread of bacteria to the bloodstream life-threatening infections Be confused with a clot in a vein (thrombophlebitis) Lymphangitis : Characteristic

34 red streaks from infected area to the armpit or groin throbbing pain along the affected area lymph nodes fever and chills malaise,loss of appetite, headache, muscle aches Lymphangitis : Signs & Symptoms

35 Physical examination Biopsy (LN) Blood culture Lymphadenitis and lymphangitis may spread within hours, spreading to the bloodstream may be fatal. Diagnosis :

36 Treatment should begin promptly Specific antibiotics Surgical drainage Hot moist compresses Management :

37 Many Thanks !


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