Main skin infections pyogenic germs

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introducedon :

  • skin manifestations in relation to the presence of pyogenic germs in the body
  • Normal skin is colonized by bacterial flora (un million/cm2)

Flora resident (permanent) : includes :

  • Cocci Gram (+) : Staphylococcus epidermis, capture, man
  • bacilli Gram (+) : corynebacteria
  • bacteria Gram (-) : cocci (Neisseria) and bacilli (Acinetobacter, Proteus ...)

Flora transient (pollutant) : resulting from external contamination or mucous porting. The most frequent infections are pyogenic bacteria, Staphylococcus aureus and Streptococcus (Aureus and Pyogenic)

  • There are several levels of defense of the skin against pathogenic bacteria :

Protection mechanical : thanks to the continuity of the corneocytes

Protection  chemical :  related skin pH (neighbor 5.5),  sebum (covering the corneocytes enhancing keratinocyte barrier)

Protection organic : by the constant presence of a protective bacterial flora

Activity immune : highly developed (epidermal Langerhans cells)

  • The alteration of one or more of these defense mechanisms is responsible for the occurrence of the following skin infections

Impétigo

introducedon :

  • Impetigo is a superficial bacterial skin infection (epidermidis), non-follicular, self-inoculated and non-immunizing
  • Favored by promiscuity, poor hygiene and burglary skin

Épidémiologie :

  • Age : especially children (5-6 years), sometimes newborns and infants, sex-ratio = 1

Adult : as a impetiginisation (on a pre-existing skin disease)

  • I contagiosité : highly contagious, small family epidemics or communities
  • seeds : Staphylococcus pathogen gold (70%), Streptococcus β-hemolytic (25%), Α-hemolytic streptococcus (10%)

CLinique :

Type from description : Vesiculobullous impetigo child

  • Lesion elementary :

Vesicular-bubble  superficial :  a few millimeters to 3 cm,  sub-stratum,  content quickly disorder (pustule), and fragile flange, rapidly progressing to training :

Erosion : erythematous, suintante, superficial, covered :

crusts : yellowish, mélicériques (color of honey), centrifugal extension ± areola peripheral inflammatory

➢ It coexists of different ages lesions (vesicular-bubble, erosion, crusts)

  • Group : either isolated, be grouped into crusted plaques peripheral extension with the central tendency healing, aspect circiné
  • Topography : often peri-orificial from, then spread to the face (+++) then the rest of the body by manual porting
  • Sign functional : moderate pruritus
  • signs Related : Regional lymphadenopathy common, general signs absent (no fever)

shapes clinics :

  • impetigo giant phlycténulaire (bullous impetigo) : characteristic shape of the newborn and infant, as small sporadic outbreaks (crèches, maternity), by manual porting caregivers (staphylococcique +++)

Clinique : large bubbles (1-2 cm) with a peripheral erythema

  • impetigo ecthyma : impetigo digging, affecting the epidermis and dermis (ulcerous)

factors Contributing : venous stasis, poor hygiene, diabetes, alcohol, HIV

Germ : staphylococcus +++, Streptococcus β-hemolytic group A, mixed

Clinique : necrotic ulceration covered with black crusts

Seat : legs

  • impetiginisation (Impetigo in adults) : secondary infection in a preexisting dermatosis by Staphylococcus or Streptococcus, dermatosis becomes oozing and festering. Always remove pruritic dermatosis (gale, contact dermatitis)

Diagnostic positive :

  • Examination : age, epidemic, preexisting dermatosis
  • Clinique : polymorphic nature, seat (peri-orificiel)
  • Bactériologie : rarely requested, useless in practice
  • histology : rarely requested

Evolution / Complications :

  • Under treatment : lesions regress within days, without scarring (except ecthyma)
  • Without treatment :

Complications septic :

  • Locales : abscess, pyodermite, lymphangite, rarely osteomyelitis
  • general : bacteraemia, septicémies, pneumonia

immunological :  acute glomerulonephritis due to Group A Streptococcus (we automatically look proteinuria, 3 weeks after)

Toxiniques :

  • epidermolysis Staphylococcique acute : syndrome SSSS (Staphylococcal Scalded Skin Syndrome)
  • scarlatine  Staphylococcique :  diffuse erythema,  predominant in the folds and accompanied no bubbles, progressing to desquamation 10-20 days

recurrences : take a sample of houses in Staphylococcus (nasal cavity +++) in the patient and family as there is a chronic carrier in a healthy subject

Traitement :

  • Measures General : School ouster few days, examine the entourage including community, possible treatment of houses in Staphylococcus if recurrences, hygiene (wearing clean underwear,   nails cut short),   etiological treatment of pruritic dermatoses underlying
  • Treatment local : it is systematic and often enough in low-extended forms

Lavage : twice daily, with water and soap

antiseptics (Chlorhexidine,   povidone iodée,   Potassium permanganate)   and or antibiotics topical (fusidic acid, Mupirocine) : en application bi- or tri-daily

duration : 8 at 10 days

  • Treatment general :

Indications : extensive lesions, extensive, major general signs

➢ Choose a broad-spectrum antibiotic action (act on the Staphylococcus and Streptococcus) : penicillin M (Oxacilline, cloxacillin : 30-50 mg/kg/j), amoxicillin + clavulanic acid or first generation cephalosporin, Synergistine (Pristinamycine : 30-50 mg/kg/j) or fusidic acid (1-1.5 g / day in adults, 30-50 mg / kg / day in children)

duration : 10 days

Infections folliculaires :

Infections of the pilosebaceous follicle, most often caused by Staphylococcus aureus

  • Folliculites :

Folliculites superficial :

  • Clinique : papulo-pustules centered by a flexible base coat and
  • Seat : face (beard, front), trunk (From, anterior trunk), buttocks and legs
  • Evolution : acute, in spurts
  • Treatment : essentially local, 2x / day for 8-10 days, local antiseptics (Hexamidine or iodinated derivatives), general hygiene rules

Folliculites deep :

  • Clinique : red nodule, closed, painful, topped with a pustule and centered by a hair
  • Evolution : subaigüe, without discharge of pus
  • Treatment : pendant 8-10 days, local treatment (at a rate of 2x / day, antiseptic and topical antibiotic), sometimes treating general anti-Staph (Oxacilline)
  • Furoncles : deep folliculitis, necrotizing (necrosis of the entire pilosebaceous unit)

Clinique :

  • Boil  isolated :  begins with deep folliculitis and appears necrotic area, yellowish called "bourbillon" that will eliminate leaving an ulcerated area, crateriform, with final scar healing
  • Anthrax :  is an agglomerate of boils,  performing an inflammatory closet hyperalgic, dotted with pustules

signs general : fever and lymphadenopathy regional

  • Staphylococcie malignant from the face : rare, it complicates the manipulation of a boil medio facial

Clinique : deep dermal-hypodermitis face + marked constitutional symptoms

Evolution : to thrombophlebitis cavernous sinus extremely serious

  • Boil  recurrent  (furonculose) :  evolves in spurts every few weeks to months, in adults younger male sex more often

factors Contributing : diabetes, seborrhea, hypersudation, poor hygiene, obesity, immune deficiency

✓ The concept of healthy carrier of Staphylococcus is essential (in the patient or those around), dont 60% cases are intermittent carriers

Gîtes of staphylococcus : nasal cavity (50%), intestinal environment (20%, especially infants), perineum and folds (25% : umbilicus, armpits, postauricular, external auditory meatus)

Treatment :

  • Boil or anthrax isolated :

antibiotic General Anti-Staph : indicated if isolated but large boil, mid-facial furoncle, anthrax, furonculose, existence of general signs, terrain (diabetic, immunodépression). The molecules are then Penicillin M, les synergistines, fusidic acid, pendant 10 days

Treatment local : antiseptic + local antibiotics, 2x / day for 10 days (may suffice)

Measures hygiene locale and General : thorough washing of hands before and after care, establishment of a protection by a dressing

  • Furonculose :  recommendations are :  Loose clothing,  strict hygiene (daily shower with chlorhexidine), washing at 90 ° C laundry

Sample : at sites in Staphylococcus (patient and family environment) and treatment if positive, fusidic acid or Mupirocin, 2x/j, 10 days / months, pendant 6-12 month

antibiotic : systemically + local treatment

Stop working : in case of occupation with a risk of food contamination

ISrysipèle :

Fromfinish :

  • It's a skin-hypodermitis, bacterial, acute, non-necrotizing, most often linked (85%) a β-hemolytic Streptococcus group A
  • Different seeds are sometimes associated

Épidémiologie :

  • common condition, sex-ratio = 1
  • Age : adult (55-65 years), Sometimes young adults, rarely the child
  • Topography : legs (80%), face
  • factors Contributing :

Door input locoregional : chronic wound (leg ulcer, operative wound), Inter-toe cracking (mechanical or mycotic), Single trauma of the lower extremities

insufficiency venous or lymphatic of the members lower

factors general : diabetes, immunodépression, advanced age

Diagnostic :

  • Diagnostic positive : clinique (+++), the germ is rarely highlighted (gateway or blood cultures)

Aspects clinics : common form of adult : swollen leg unilateral acute febrile red

  • beginning : is brutal, high fever (39-40°C) or chills, then :

Sfires  cutaneous :  inflammatory skin closet erythematous, edematous, bright red,  warm and painful to palpation,  very limited,  extending progressively,  a peripheral bead is rare on the leg but often face,  superficial bullous detachment (mechanics of dermal edema result) or of purpuric lesions

  • signs Related : inguinal adenopathy inflammatoire ± signes digestifs (diarrhea), there is frequently a door of locoregional entry

exams  Additional :  often leukocytosis with neutrophilia, inflammatory syndrome (CRP early high,   VS),   serology Streptococci (ASLO, ASD, ASK) not specific, frank increased levels 2-3 weeks apart (retrospective diagnosis). In the typical form, no bacteriological examination is necessary

shapes clinics :

  • symptomatic : bullous forms, purpuric, pustules and abscesses
  • topographical :

Face (5-10%  cases) :  often unilateral and very edematous, marked with a peripheral bead. More rarely : upper limb, abdomen, thorax…

  • scalable (subacute) : fever and leukocytosis are moderate, or absent, the diagnosis is based entirely on clinical and regression antibiotics
  • Diagnostic differential :

At face : acute eczema, malignant staphylococcal infection of the face, ophthalmic zoster

At member : phlebitis (sometimes associated), inflammatory thrust venous lipodermatosclerosis, acute edematous syndrome of the lower limbs, envenimations

Fasciite   necrotizing :   the importance of general toxic signs,   no improvement on antibiotics, local extension of necrosis, crepitus èimposent surgical exploration that provides diagnosis

Traitement :

  • Hospitalization : if diagnostic doubt,  marked constitutional symptoms,  complications,  significant comorbidity, unfavorable social context, lack of improvement at 72 hours
  • Means :

antibiotic : systemic, antistreptococcique

b-lactamines (+++) :

Penicillin  G :  injectable,  Reference treatment,  10-20  MUI / JA 4-6 perfusions

Penicillin V : oral, 4-6 MUI / JA 3 daily catch

Penicillin A : oral, amoxicillin (3-4.5  g / d 3 daily catch) first line in the event of residence or relay treatment of penicillin G after obtaining apyrexia

  • Synergistines : Pristinamycine : 2-3 g / d 3 daily catch
  • Clindamycine : 600-1200 mg / d 3-4 taken (gastrointestinal adverse reactions)
  • Glycopeptides, Augmentin® or Cephalosporins

Treatment adjuvant : strict rest in bed (necessary until the regression of inflammation), preventive anticoagulant therapy (a Érysipèle + venous insufficiency of the lower limb), NSAIDs and corticosteroids are formally discouraged (risk of progression to necrotizing fasciitis), analgesic treatment (for pain) and appropriate treatment of the front door, elastic support (if edema)

  • Indications :

And  hospitalization :  Penicillin G IV (at least until the apyrexia)  then orally relay (penicillin V, amoxicillin). Total duration : 10-20 days

And at domicile : Misoprostol by mouth hang 15 days about

  • Pristinamycine (or clindamycine) in β-lactam allergy or 2nd line,

especially if staphylococcal etiology is suspected

  • Prévention of the recurrences : treatment of persistent door entrance and veno-lymphatic insufficiency, Careful skin hygiene

➢ In case of multiple recurrences : discuss a long-term penicillin (Extencilline® : 2.4 MIU IM all 2-3 weeks)