Skin and soft tissues
•
Cause: staphylococcal or streptococcal
skin infection.
•
Age group: infants and young children.
•
Features: erythematous macules (later
vesicular/bullous) on the face, neck
and hands—often associated with pre-existing skin lesions such as eczema.
•
Infectivity: nasal carriage is often the source
of infection. Auto-inoculation occurs and lesions are infectious until dry.
•
Antibiotics: topical antimicrobials are often
not useful in younger children due to
scratching causing further spread of bacteria; if treatment required, use oral
antibiotic, taking taste and formulation into account prior to prescription
(oral flucloxacillin and erythromycin are often poorly tolerated).
•
Cause: Staphylococcus aureus.
•
Age group: any age.
•
Features: infecton of hair follicles or
sweat glands.
•
Infectivity: nasal carriage is often the source
of infection in recurrent boils.
•
Antibiotics: systemic.
•
Cause: group A streptococcus, Staphylococcus aureus, Streptococccus pneumoniae, rarely Haemophilus influenzae type b in
unimmunized children.
•
Age group: any age.
•
Features: fever with unilateral erythema,
tenderness, and oedema of the eyelid,
often following local trauma to the skin. Complications include local abscess,
meningitis, and cavernous sinus thrombosis.
•
Investigations: if severe (eye movements are not
visible or complete ptosis) refer to
ENT or ophthalmology and perform cranial CT scan.
•
Antibiotics: IV ceftriaxone 80 mg/kg/od where
eye movements are visible. Add IV
metronidazole if eye movements not visible or not improved at 24hr.
•
Cause: exfoliative staphylococcal toxin.
•
Age group: infants and young children.
•
Features: fever and malaise with a purulent,
crusting, localized infection around
the eyes, nose, and mouth. Later diffuse erythema and skin tenderness leading
to separation of the epidermis through the granular cell layer. Nikolsky’s sign
is epidermal separation on light pressure with no subsequent scarring after
healing.
Antibiotics:
IV flucloxacillin 50mg/kg/qds.
•
Cause: group A streptococcus, less
commonly Staphylococcus aureus
•
Age group: any age.
•
Features: SC infection of tissue down to
fascia and muscle. Symptoms may be
due to shock, systemic illness, and severe pain.
•
Antibiotics: IV, and surgical debridement.
•
Toxin-producing
staphylococci or streptococci
•
Multisystem
disease due to staphylococcal toxin-1 in 75%
•
Systemic
illness with high fever
•
GI: vomiting, watery diarrhoea
•
Shock
and hypotension, altered conscious level
•
Neuromuscular: occasional severe myalgia
•
Skin rash: red mucous membranes and diffuse
macular rash; 10 days after infection
desquamation of the palms, soles, fingers, and toes
•
Haematology: thrombocytopenia, coagulopathy
•
Biochemistry: abnormal liver and kidney function
•
Temperature 39*C
•
Systolic
blood pressure <90mmHg
•
Rash
(may or may not include desquamation)
•
Involvement
of three or more of gastrointestinal, musculoskeletal, renal, hepatic, CNS,
blood, and mucous membranes
•
Isolation
of group A streptococcus
•
Hypotension
•
Involvement
of two or more of coagulopathy, adult respiratory distress syndrome, soft
tissue necrosis, rash with desquamation, or renal or hepatic involvement
•
IV
fluids and resuscitation
•
Antibiotics
against staphylococci and streptococci. Clindamycin often added to
flucloxacillin regime due to anti-toxin activity in vitro
· IV immunoglobulin
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