Bacterial skin and softBacterial skin and softtissue infectiontissue infection

Dr Nasser MostafaviDepartement of Pediatric Infectious Disease

Isfahan University of Medical Sciences

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Skin and soft tissue infectionSkin and soft tissue infection

� Non necrotizing:◦ Nonpurulent:� Cellulitis� Erysipelas

◦ Purulent:� Impetigo, echtyma� Folliculitis, furuncle, carbuncles, skin abscesses

� Necrotizing :� Necrotizing fasciitis

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CellulitisCellulitis� Infection of the deep dermis and

subcutaneous fat: indistinct margins� Break to the skin ( trauma, stasis, eczema)� Streptococcus pyogene, S. aureus, Rarely

gram-negative aerobic bacilli� Indolent course of edema, warmth,

erythema, and tenderness of the skin� Commonly fever, and regional adenopathy� Sometimes lymphangitis, suppuration

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CCellulitis of the legellulitis of the leg

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Cellulitis of footCellulitis of foot

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Treatment of cellulitisTreatment of cellulitis

� Admission and parenteral cloxacillin /naficillin(+ clindamycin or vancomycin if systemic toxicity)◦ Systemic toxicity◦ Fever

WBC> 15 000◦ WBC> 15 000◦ Lymphadenopathy◦ Rapid progression◦ Progression of symptoms 24-48 hours of oral therapy◦ Persistence of symptoms 48-72 hours of oral therapy

� Oral dicloxacillin, cephalexin or clindamycin 5-10days: other cellulitis

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Persistence ofPersistence of symptoms aftersymptoms after 4848--7272 h.h.� Underlying infection( OM, abscess, ..) :

imaging� Resistant organism: Culture, coverage for

resistant organisms and gram-negativeg g gbacilli

� Slow response to therapy: Extension ofthe duration (up to 14 days)

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ErysipelasErysipelas� Infection of the upper dermis and superficial

lymphatics: sharply defined, slightly elevatedborder

� Skin abrasion� Group A streptococcus, sometimes H.inf type

b and S pneumoniab, and S. pneumonia� Mostly in face, ear and lower extremities� Usually abrupt onset+ high fever and rapid

progress� IV penicillin+ clindamycin until improvement

and culture results( blood, margin) then oralpenicillin, amoxicillin, cephalexin, or clindamycinfor 5-10 days

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Erysipelas of the lower legErysipelas of the lower leg

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Erysipelas of theErysipelas of the faceface

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Specific forms of cellulitisSpecific forms of cellulitis

� Neonatal� Buccal( facial) cellulitis: Streptococcus

pneumoniae, Haemophilus influenzae typebb

� Periorbital cellulitis� Perianal cellulitis:� Lymphangitis

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NeonatalNeonatal CellulitisCellulitis

� Usually requires hospitalization except forthe mildest of cases

� Coverage for GBS, MRSA, and BHstreptococcip

� Vancomycin plus either cefotaxime orgentamicin for 7-10 d

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Neonatal cellulitisNeonatal cellulitis

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PerianalPerianal (vaginal) dermatitis(vaginal) dermatitis

� Marked well demarcated perirectalerythema with swelling, pruritus, andtenderness, no fever, no progressivedisease

� Group A beta hemolytic streptococcus� Oral penicillins +/- topical mupirocin

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Perianal dermatitisPerianal dermatitis

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Buccal( facial) cellulitisBuccal( facial) cellulitis

� Violaceous hue of the cellulitic area in theface of infants with no clear skin abrasion

� Nearly always hematogenous seeding byH. influenzae type byp

� Meningitis in 15-20%� Treatment:◦ LP◦ Ceftriaxone + clindamycin/ vancomycin

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Facial cellulitisFacial cellulitis

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