Superficial Infection

Dr. Weiguo Hu
Dr. Weihua Qiu

Department of Surgery
Rui Jin Hospital
Shanghai Jiao Tong University School
of Medicine

Staphylococcal Infection

StaphylococciG+

Suppuration and Characteristic pus

beta hemolysins
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

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

Surgical incision drainage

help to mature
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

normal

group B streptococci

Immunocompromised

group A streptococci & Staphylococcus aureus

Infants

Microorganism

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)

Symptomatic treatment

Penicillin
Erythromycin
Cephalexin
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

throbbing pain

from infected area to the armpit or groin

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

Many
Thanks