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
Staphylococcal Infection • Staphylococci—G+ • beta hemolysins • Suppuration and Characteristic pus • thick, yellow, without foul smelling • S. aureus – furuncle & carbuncle • S. epidermidis – after surgery with foreign material
High Risk Factors • Obesity • Diabetes • Poor hygiene condition • Intravenous drugs
Infection involving an entire hair follicle and the underlying skin tissue Furuncle：Characteristic • Face • Buttocks • Thighs • Groin • Breast • Axil area
Furuncle：Signs & Symptoms • <2cm • raised, tender, shiny, bright red • intense, throbbing pain • yellow or white creamy discharge (matured)
Carbuncle：Characteristic • A confluent infection • involving multiple contiguous follicles • limited to the subcutaneous tissue • thick overlying skin and dense subcutaneous fascia
Carbuncle：Signs & Symptoms • Back of Neck or Torso • Pain, swelling, induration of the surrounding skin • Multiple small abscess with yellow thick pas • Fever, fatigued, leukocytosis, even sepsis
Management： • Leision care • help to “mature” • Surgical incision drainage • Large & deep enough incision for carbuncle • Antibiotics • Penicillin • Erythromycin • Clindamycin
Management： Surgical drainage
Prevention： • good hygiene condition • avoiding intravenous drug • loose clothing
Cellulitis：Characteristic • Connective tissue • dermis and subcutaneous tissues • acute spreading • pain, erythema, edema, and warmth
Cellulitis：History • trauma or surgery • causing a lesion in the skin • may have no discernible dermal injury • develops over a period of several days
Cellulitis：Signs & Symptoms The affected area • Warmth • Erythema • Edema • Tenderness The proximal to the area • Ascending lymphangitis • lymphadenopathy
Severe Cellulitis： • 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
Etiology： Microorganism • normal • group A streptococci & Staphylococcus aureus • Infants • group B streptococci • Immunocompromised • Pneumococcus gram-negative rods or fungi • Wounds • Aeromonas hydrophila, gram-negative rod
High Risk Factors • Obesity • Diabetes • Poor hygiene condition • Intravenous drugs • Immunodeficiency
Cellulitis：Complications • Bacteremia • Local abscess • Superinfection with gram-negative organisms • Lymphangitis • Thrombophlebitis • Facial cellulitis in children (meningitis in 8%) • Gas gangrene(amputation & mortality in 25%)
Cellulitis：Special Concerns • Escherichia coli in nephrotic syndrome • Cellulitis of the lower extremities in geriatric patients (thrombophlebitis) • Pseudomonads in immunocompromised children
Management： Antibiotics: • penicillinase-resistant synthetic penicillin • first-generation cephalosporin • clindamycin • metronidazole
Erysipelas：Characteristic • 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 70-80% in lower extremities
Erysipelas：Characteristic 5-20% in face
Erysipelas：History • 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：Signs & Symptoms • 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 Sharply-raised border with abrupt demarcation from healthy adjacent skin
Erysipelas：Signs & Symptoms rash • Painful • Erythematous • Edematous
Etiology： Microorganism • Group A streptococci (the most) • Group G, C, B streptococci (less) • Staphylococci (rarely)
Management： • Antibiotics (as soon as possible) • Penicillin • Erythromycin • Cephalexin • Symptomatic treatment • Antipyretic • Analgesics • Hydration (oral intake if possible) • Cold compresses
Complications： • Gangrene & Amputation • Bacteremia & Sepsis • Scarlet fever • Pneumonia • Abscess • Embolism • Meningitis • Death
Lymphadenitis：Characteristic • 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：Signs & Symptoms • 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
Lymphangitis：Characteristic • 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：Signs & Symptoms • 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
Diagnosis： • Physical examination • Biopsy (LN) • Blood culture Lymphadenitis and lymphangitis may spread within hours, spreading to the bloodstream may be fatal.
Management： Treatment should begin promptly • Specific antibiotics • Surgical drainage • Hot moist compresses
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