Infections

Infections

Skin and soft-tissue infections can be localised or spreading, necrotising or non-necrotising. Localised or spreading non-necrotising infections usually respond to broad-spectrum antibiotics. Localised necrotising infections need surgical debridement as well as antibiotic therapy . Spreading necrotis ing soft-tissue infection constitutes a life-threatening surgical emergency , requiring immediate resuscitation, intravenous antibiotic therapy and urgent surgical intervention with radical debridement. Impetigo Impetigo is a superficial infection of skin with staphylococci, streptococci or both ( Figure 45.6 ). It is highly infectious and is characterised by blisters that rupture and coalesce to form a honey-coloured crust; it usually a ff ects children. Treatment is directed at washing the a ff ected areas and applying topical antistaphylococcal treatments; broad-spectrum oral antibiotics are required if streptococcal infection is also implicated. Erysipelas Erysipelas is a sharply demarcated streptococcal infection of the superficial lymphatics, usually associated with broken skin on the face ( Figure 45.7 ). The area a ff ected is erythematous and oedematous. The patient may be febrile and have a leuko cytosis. Prompt administration of broad-spectrum antibiotics after swabbing the area for culture and sensitivity is usually all that is necessary . Cellulitis/lymphangitis This is a bacterial infection of the skin and subcutaneous tissue that is more generalised than erysipelas. It is usually associated with broken skin or pre-existing ulceration. It is characterised by an expanding area of erythematous, oedematous tissue that is painful, in association with fever, malaise and leukocytosis. Erythema tracking along lymphatics may be visible (lymphangitis) ( Figure 45.8 ). The commonest causative Thomas Hodgkin , 1798–1866, curator of the museum and demonstrator of morbid anatomy , Guy’s Hospital, London, UK. - - - Streptococcus pyogenes and S. aureus . Blood and organisms are skin cultures for sensitivity should be taken before prompt administration of broad-spectrum intravenous antibiotics and elevation of the a ff ected extremity .

(b) Figure 45.5 Pyoderma gangrenosum affecting the legs (a) and the breasts (b) (courtesy of St John’s Institute for Dermatology, London, UK). Figure 45.6 Impetigo. Note the honey-coloured crust (courtesy of St John’s Institute for Dermatology, London, UK).

Figure 45.7 Erysipelas (courtesy of St John’s Institute for Dermatol ogy, London, UK).

Infections

Skin and soft-tissue infections can be localised or spreading, necrotising or non-necrotising. Localised or spreading non-necrotising infections usually respond to broad-spectrum antibiotics. Localised necrotising infections need surgical debridement as well as antibiotic therapy . Spreading necrotis ing soft-tissue infection constitutes a life-threatening surgical emergency , requiring immediate resuscitation, intravenous antibiotic therapy and urgent surgical intervention with radical debridement. Impetigo Impetigo is a superficial infection of skin with staphylococci, streptococci or both ( Figure 45.6 ). It is highly infectious and is characterised by blisters that rupture and coalesce to form a honey-coloured crust; it usually a ff ects children. Treatment is directed at washing the a ff ected areas and applying topical antistaphylococcal treatments; broad-spectrum oral antibiotics are required if streptococcal infection is also implicated. Erysipelas Erysipelas is a sharply demarcated streptococcal infection of the superficial lymphatics, usually associated with broken skin on the face ( Figure 45.7 ). The area a ff ected is erythematous and oedematous. The patient may be febrile and have a leuko cytosis. Prompt administration of broad-spectrum antibiotics after swabbing the area for culture and sensitivity is usually all that is necessary . Cellulitis/lymphangitis This is a bacterial infection of the skin and subcutaneous tissue that is more generalised than erysipelas. It is usually associated with broken skin or pre-existing ulceration. It is characterised by an expanding area of erythematous, oedematous tissue that is painful, in association with fever, malaise and leukocytosis. Erythema tracking along lymphatics may be visible (lymphangitis) ( Figure 45.8 ). The commonest causative Thomas Hodgkin , 1798–1866, curator of the museum and demonstrator of morbid anatomy , Guy’s Hospital, London, UK. - - - Streptococcus pyogenes and S. aureus . Blood and organisms are skin cultures for sensitivity should be taken before prompt administration of broad-spectrum intravenous antibiotics and elevation of the a ff ected extremity .

(b) Figure 45.5 Pyoderma gangrenosum affecting the legs (a) and the breasts (b) (courtesy of St John’s Institute for Dermatology, London, UK). Figure 45.6 Impetigo. Note the honey-coloured crust (courtesy of St John’s Institute for Dermatology, London, UK).

Figure 45.7 Erysipelas (courtesy of St John’s Institute for Dermatol ogy, London, UK).

Infections

Skin and soft-tissue infections can be localised or spreading, necrotising or non-necrotising. Localised or spreading non-necrotising infections usually respond to broad-spectrum antibiotics. Localised necrotising infections need surgical debridement as well as antibiotic therapy . Spreading necrotis ing soft-tissue infection constitutes a life-threatening surgical emergency , requiring immediate resuscitation, intravenous antibiotic therapy and urgent surgical intervention with radical debridement. Impetigo Impetigo is a superficial infection of skin with staphylococci, streptococci or both ( Figure 45.6 ). It is highly infectious and is characterised by blisters that rupture and coalesce to form a honey-coloured crust; it usually a ff ects children. Treatment is directed at washing the a ff ected areas and applying topical antistaphylococcal treatments; broad-spectrum oral antibiotics are required if streptococcal infection is also implicated. Erysipelas Erysipelas is a sharply demarcated streptococcal infection of the superficial lymphatics, usually associated with broken skin on the face ( Figure 45.7 ). The area a ff ected is erythematous and oedematous. The patient may be febrile and have a leuko cytosis. Prompt administration of broad-spectrum antibiotics after swabbing the area for culture and sensitivity is usually all that is necessary . Cellulitis/lymphangitis This is a bacterial infection of the skin and subcutaneous tissue that is more generalised than erysipelas. It is usually associated with broken skin or pre-existing ulceration. It is characterised by an expanding area of erythematous, oedematous tissue that is painful, in association with fever, malaise and leukocytosis. Erythema tracking along lymphatics may be visible (lymphangitis) ( Figure 45.8 ). The commonest causative Thomas Hodgkin , 1798–1866, curator of the museum and demonstrator of morbid anatomy , Guy’s Hospital, London, UK. - - - Streptococcus pyogenes and S. aureus . Blood and organisms are skin cultures for sensitivity should be taken before prompt administration of broad-spectrum intravenous antibiotics and elevation of the a ff ected extremity .

(b) Figure 45.5 Pyoderma gangrenosum affecting the legs (a) and the breasts (b) (courtesy of St John’s Institute for Dermatology, London, UK). Figure 45.6 Impetigo. Note the honey-coloured crust (courtesy of St John’s Institute for Dermatology, London, UK).

Figure 45.7 Erysipelas (courtesy of St John’s Institute for Dermatol ogy, London, UK).