| What are the clinical features of non-bullous impetigo? | Wet yellow brown crusts overlying red inflamed skin | OR CONFIRMED MRSA INFECTION • Cotrimoxazole 2 DS tablets BD • Doxycycline 100 mg BD • Minocycline 100 mg BD • Linezolid 600 mg BD IV ANTIBIOTICS FOR MRSA • Vancomycin: 15 mg/kg BD • Linezolid: 600 mg BD • Clindamycin: 600-900 mg TDS 1. IMPETIGO CLINICAL FEATURES Wet yellow brown crusts overlying red inflamed skin • Types Non bullous (NBI; commoner), bullous (BI) • Affected age group usually children • Common sites Face (perinasal, perioral) > extremities; extensive with scabies/ atopic eczema MANAGEMENT • Topical antibiotics for 5 days • Oral antibiotics for extensive involvement or numerous lesions, lymphadenopathy or in outbreaks to prevent transmission 2. | 263 | definition | 1.000 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967368_bacterial_skin_infections.pdf | IMPETIGO CLINICAL FEATURES Wet yellow brown crusts overlying red inflamed skin • Types Non bullous (NBI; commoner), bullous (BI) • Affected age group usually children • Common sites Face (perinasal, perioral) > extremities; extensive with scabies/ atopic eczema MANAGEMENT • Topical antibiotics for 5 days • Oral antibiotics for extensive involvement or numerous lesions, lymphadenopathy or in outbreaks to prevent transmission 2. | 1 | page=1,block=35 | 0.700 | valid |
| What are the clinical features of ecthyma? | Black thick crust (eschar) with underlying ulcer & surrounding redness & edema | ECTHYMA CLINICAL FEATURES • Black thick crust (eschar) with underlying ulcer & surrounding redness & edema MANAGEMENT • Treat with oral antibiotics for 7 days • Gentle crust removal may be attempted after soakage with sterile saline; topical antibiotics over the exposed ulcer • Superficial peeling of skin due to toxin producing strains of staphylococcus • Starts as tender and warm erythema and progresses to localised or generalised exfoliation with fever, malaise +/- dehydration and electrolyte disturbances • Follows a local staphylococcal infection of either skin, throat, nose, umbilicus, or gut • Bacteria cannot be demonstrated from blisters (cultures from original site may be positive) • Treatment: preferably in-patient • Mild cases: oral anti-staphylococcal antibiotics; severe cases: IV antibiotic • Consider methicillin resistant Staphylococcus aureus (MRSA) coverage • Usually remits within a week in children, high mortality in adults | 28 | definition | 0.980 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967368_bacterial_skin_infections.pdf | ECTHYMA CLINICAL FEATURES • Black thick crust (eschar) with underlying ulcer & surrounding redness & edema MANAGEMENT • Treat with oral antibiotics for 7 days • Gentle crust removal may be attempted after soakage with sterile saline; topical antibiotics over the exposed ulcer • Superficial peeling of skin due to toxin producing strains of staphylococcus • Starts as tender and warm erythema and progresses to localised or generalised exfoliation with fever, malaise +/- dehydration and electrolyte disturbances • Follows a local staphylococcal infection of either skin, throat, nose, umbilicus, or |
| What is cellulitis characterized by? | Acute spreading infection of skin involving subcutaneous tissue; Painful, red, tender, diffuse swelling mostly involving the limbs | 7. CELLULITIS CLINICAL FEATURES Acute spreading infection of skin involving subcutaneous tissue; Painful, red, tender, diffuse swelling mostly involving the limbs 8. ERYSIPELAS CLINICAL FEATURES A more superficial, bright red, edematous, painful area with a clear demarcated edge; common sites: lower extremities>face. Often associated with lymphangitis and lymphadenopathy; broken skin/ portal of entry may be visualised ECTHYMA FOLLICULITIS IMPETIGO FURUNCLE CARBUNCLE Standard Treatment Workflow (STW) BACTERIAL SKIN INFECTIONS ICD-10-L01, L73. L08, L02, L03, A46, L00 | 32 | definition | 0.980 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967368_bacterial_skin_infections.pdf | CELLULITIS CLINICAL FEATURES Acute spreading infection of skin involving subcutaneous tissue; Painful, red, tender, diffuse swelling mostly involving the limbs 8. | 1 | page=1,block=47 | 0.700 | valid |
| What conditions make blood cultures and biopsies useful despite not being routinely recommended? | co-morbid conditions (malignancy on chemotherapy, immunocompromised states, animal bites etc.) | INVESTIGATIONS 1. Swabs for gram staining and pus culture are desirable 2.Blood cultures and biopsies are not routinely recommended, but useful with co-morbid conditions (malignancy on chemotherapy, immunocompromised states, animal bites etc.) IN ALL PATIENTS SUSPECT THE NEED FOR MRSA COVERAGE IF: • Poor immune status • Severe systemic signs • MRSA infection elsewhere • If no improvement in 48-72 hours • Penetrating trauma COMPLICATIONS Subcutaneous abscesses, blistering (often haemorrhagic), ulceration, tissue necrosis, myositis, septicemia RED FLAGS • Temperature >100.4 ºF, WBC>12,000 or < 4000/μL, heart rate > 90 bpm, or respiratory rate > 24/min may indicate sepsis • Severe pain followed by deceptive absence may indicate necrotising fasciitis • Dark discoloration of overlying skin | 149 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967368_bacterial_skin_infections.pdf | Swabs for gram staining and pus culture are desirable 2.Blood cultures and biopsies are not routinely recommended, but useful with co-morbid conditions (malignancy on chemotherapy, immunocompromised states, animal bites etc.) IN ALL PATIENTS SUSPECT THE NEED FOR MRSA COVERAGE IF: • Poor immune status • Severe systemic signs • MRSA infection elsewhere • If no improvement in 48-72 hours • Penetrating trauma COMPLICATIONS Subcutaneous abscesses, blistering (often haemorrhagic), ulceration, tissue necrosis, myositis, septicemia RED FLAGS • Temperature >100.4 ºF, WBC>12,000 or < 4000/μL, heart |
| What might recurrent folliculitis in multiple family members indicate? | nasal Staphylococcus aureus carriage or human-pet transmission | Skin hygiene, advise on handwashing/ local hygiene, avoidance of oil application, adequate nutrition In immunocompromised/ diabetics: consider the need for gram negative coverage 3. FOLLICULITIS CLINICAL FEATURES Hair follicle centred pustule/ papule Rule out non bacterial causes: oils, chemicals, waxing, epilation, occlusive dressing RECURRENT FOLLICULITIS Recurrent infection or outbreak in multiple members of family may indicate nasal Staphylococcus aureus carriage or human-pet transmission MANAGEMENT • Topical antibiotics for 5 days • Oral antibiotics for multiple lesions • Anti-inflammatory: Paracetamol 500mg/ Ibuprofen 400mg SOS for pain relief 4. FURUNCLE CLINICAL FEATURES Painful follicle centric nodule/ pus point/ impending bulla/ ulcer with marked surrounding erythema, edema and induration 5. | 435 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967368_bacterial_skin_infections.pdf | FOLLICULITIS CLINICAL FEATURES Hair follicle centred pustule/ papule Rule out non bacterial causes: oils, chemicals, waxing, epilation, occlusive dressing RECURRENT FOLLICULITIS Recurrent infection or outbreak in multiple members of family may indicate nasal Staphylococcus aureus carriage or human-pet transmission MANAGEMENT • Topical antibiotics for 5 days • Oral antibiotics for multiple lesions • Anti-inflammatory: Paracetamol 500mg/ Ibuprofen 400mg SOS for pain relief 4. |
| When are ancillary antibiotics recommended in incision and drainage management? | if systemic inflammatory signs, associated septic phlebitis, multiple/ large abscesses, prominent cellulitis & immunocompromised state | SEVERELY ILL PATIENTS • Inj Ceftriaxone 2g BD OR Inj Amoxicillin-clavulanate 1.2gm TDS • Alternatively - Inj Clindamycin 600-900mg TDS INCISION AND DRAINAGE • Incision and drainage/ debridement • Ancillary antibiotics if systemic inflammatory signs, associated septic phlebitis, multiple/ large abscesses, prominent cellulitis & immunocompromised state MANAGEMENT MANAGEMENT • Oral antibiotics + • Topical antibiotics: to reduce contamination of surrounding skin | 218 | relationship | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967368_bacterial_skin_infections.pdf | SEVERELY ILL PATIENTS • Inj Ceftriaxone 2g BD OR Inj Amoxicillin-clavulanate 1.2gm TDS • Alternatively - Inj Clindamycin 600-900mg TDS INCISION AND DRAINAGE • Incision and drainage/ debridement • Ancillary antibiotics if systemic inflammatory signs, associated septic phlebitis, multiple/ large abscesses, prominent cellulitis & immunocompromised state MANAGEMENT MANAGEMENT • Oral antibiotics + • Topical antibiotics: to reduce contamination of surrounding skin | 1 |
| What is the management for mild cellulitis or erysipelas with no focus of purulence? | Outpatient treatment with oral antibiotics | MILD • Typical cellulitis/ erysipelas with no focus of purulence MANAGEMENT • Outpatient treatment with oral antibiotics • Elevation of affected area (to allow for dependent drainage); treatment of predisposing factors • Anti-inflammatory (Ibuprofen 400mg BD, Indomethacin 75mg BD) MODERATE • Typical cellulitis/ erysipelas with systemic signs of infection MANAGEMENT Hospitalization and parenteral antibiotics: • Inj Ceftriaxone 2g BD OR Inj Amoxicillin-clavulanate 1.2gm TDS • Alternatively (allergic to penicillins) Inj Clindamycin 600-900mg IV TDS SEVERE With poor response to oral antibiotics, immunocompromised, signs of deeper infection like bullae, skin sloughing or systemic signs of infection like hypotension, or with organ dysfunction MANAGEMENT Empiric broad spectrum IV antibiotic coverage • Vancomycin + Piperacillin/ tazobactum • Surgical debridement • Sensitivity profile based modification of antibiotics | 78 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967368_bacterial_skin_infections.pdf | MILD • Typical cellulitis/ erysipelas with no focus of purulence MANAGEMENT • Outpatient treatment with oral antibiotics • Elevation of affected area (to allow for dependent drainage); treatment of predisposing factors • Anti-inflammatory (Ibuprofen 400mg BD, Indomethacin 75mg BD) MODERATE • Typical cellulitis/ erysipelas with systemic signs of infection MANAGEMENT Hospitalization and parenteral antibiotics: • Inj Ceftriaxone 2g BD OR Inj Amoxicillin-clavulanate 1.2gm TDS • Alternatively (allergic to penicillins) Inj Clindamycin 600-900mg IV TDS SEVERE With poor response to oral antibiotics, |
| What is the suggested method for removing the crust in ecthyma management? | Gentle crust removal may be attempted after soakage with sterile saline | ECTHYMA CLINICAL FEATURES • Black thick crust (eschar) with underlying ulcer & surrounding redness & edema MANAGEMENT • Treat with oral antibiotics for 7 days • Gentle crust removal may be attempted after soakage with sterile saline; topical antibiotics over the exposed ulcer • Superficial peeling of skin due to toxin producing strains of staphylococcus • Starts as tender and warm erythema and progresses to localised or generalised exfoliation with fever, malaise +/- dehydration and electrolyte disturbances • Follows a local staphylococcal infection of either skin, throat, nose, umbilicus, or gut • Bacteria cannot be demonstrated from blisters (cultures from original site may be positive) • Treatment: preferably in-patient • Mild cases: oral anti-staphylococcal antibiotics; severe cases: IV antibiotic • Consider methicillin resistant Staphylococcus aureus (MRSA) coverage • Usually remits within a week in children, high mortality in adults | 161 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967368_bacterial_skin_infections.pdf | ECTHYMA CLINICAL FEATURES • Black thick crust (eschar) with underlying ulcer & surrounding redness & edema MANAGEMENT • Treat with oral antibiotics for 7 days • Gentle crust removal may be attempted after soakage with sterile saline; topical antibiotics over the exposed ulcer • Superficial peeling of skin due to toxin producing strains of staphylococcus • Starts as tender and warm erythema and progresses to localised or generalised exfoliation with fever, malaise +/- dehydration and electrolyte disturbances • Follows a local staphylococcal infection of either skin, throat, nose, umbilicus, or |
| What is the typical progression of skin symptoms caused by toxin-producing strains of staphylococcus? | Starts as tender and warm erythema and progresses to localised or generalised exfoliation with fever, malaise +/- dehydration and electrolyte disturbances | ECTHYMA CLINICAL FEATURES • Black thick crust (eschar) with underlying ulcer & surrounding redness & edema MANAGEMENT • Treat with oral antibiotics for 7 days • Gentle crust removal may be attempted after soakage with sterile saline; topical antibiotics over the exposed ulcer • Superficial peeling of skin due to toxin producing strains of staphylococcus • Starts as tender and warm erythema and progresses to localised or generalised exfoliation with fever, malaise +/- dehydration and electrolyte disturbances • Follows a local staphylococcal infection of either skin, throat, nose, umbilicus, or gut • Bacteria cannot be demonstrated from blisters (cultures from original site may be positive) • Treatment: preferably in-patient • Mild cases: oral anti-staphylococcal antibiotics; severe cases: IV antibiotic • Consider methicillin resistant Staphylococcus aureus (MRSA) coverage • Usually remits within a week in children, high mortality in adults | 358 | summary | 0.970 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967368_bacterial_skin_infections.pdf |
| What is the management for moderate cellulitis or erysipelas with systemic signs of infection? | Hospitalization and parenteral antibiotics | MILD • Typical cellulitis/ erysipelas with no focus of purulence MANAGEMENT • Outpatient treatment with oral antibiotics • Elevation of affected area (to allow for dependent drainage); treatment of predisposing factors • Anti-inflammatory (Ibuprofen 400mg BD, Indomethacin 75mg BD) MODERATE • Typical cellulitis/ erysipelas with systemic signs of infection MANAGEMENT Hospitalization and parenteral antibiotics: • Inj Ceftriaxone 2g BD OR Inj Amoxicillin-clavulanate 1.2gm TDS • Alternatively (allergic to penicillins) Inj Clindamycin 600-900mg IV TDS SEVERE With poor response to oral antibiotics, immunocompromised, signs of deeper infection like bullae, skin sloughing or systemic signs of infection like hypotension, or with organ dysfunction MANAGEMENT Empiric broad spectrum IV antibiotic coverage • Vancomycin + Piperacillin/ tazobactum • Surgical debridement • Sensitivity profile based modification of antibiotics | 368 | summary | 0.890 | https://www.icmr.gov.in/icmrobject/uploads/STWs/1725967368_bacterial_skin_infections.pdf | MILD • Typical cellulitis/ erysipelas with no focus of purulence MANAGEMENT • Outpatient treatment with oral antibiotics • Elevation of affected area (to allow for dependent drainage); treatment of predisposing factors • Anti-inflammatory (Ibuprofen 400mg BD, Indomethacin 75mg BD) MODERATE • Typical cellulitis/ erysipelas with systemic signs of infection MANAGEMENT Hospitalization and parenteral antibiotics: • Inj Ceftriaxone 2g BD OR Inj Amoxicillin-clavulanate 1.2gm TDS • Alternatively (allergic to penicillins) Inj Clindamycin 600-900mg IV TDS SEVERE With poor response to oral antibiotics, |