Transcript Myositis- (NSTI) - USF Health

The Skin and Beyond:
Skin and Soft Tissue Infections
Presentation to: Infectious Disease Update
for the Primary Care Physician
Methodist Healthcare
John Sinnott, MD, FACP
Associate Dean, International Affairs
Director, Signature Program in Allergy, Immunology and Infectious Disease
Director, Division of Infectious Disease
University of South Florida, College of Medicine
Pretentious Quote:
… [T]he skin has diseases, one of
those diseases is man.
Friedrich Nietzsche
In General: Skin Lesions


Tumors
Rashes
Melanoma:
•A symmetric
•B order — irregular
•C olor — pigment variable
•D iameter > 0.5 cm
Skin Infections:
LAYER
INFECTION
Epidermis
Impetigo
Dermis
Erysipelas
SubQ
Cellulitis
Fascia
Fasciitis- (NSTI)
Muscle
Myositis- (NSTI)
Pathogens:
•Impetigo contagiosum – GAS
•Impetigo bullosum – Staph
•Erysipelas – GAS
•Cellulitis – Staph, GAS
•Fasciitis – GAS, Mixed
•Myositis – Clostridia
CA-MRSA: NB
• CA – MRSA is increasing and
may become more like HAMRSA
DM, prisoners, contact sports are
old risk groups; now everyone
is at risk
Variant Cellulitis: Bites or Water !
Human Bite:
GAS
Dog Bite:
Anaerobes
C. canimorsus
P. multocida
Cat Bite:
Saltwater:
Fresh water:
P. multocida
V. vulnificus
M. marinum
E. tarda
A. hydrophila
Edwardsiella: Treatment
• All edwardsiella naturally sensitive to:
• Tetracyclis, aminoglycosides, most B-Lactams,
quinolones, antifolates, chloramphenicol,
nitrofurantoin, and fosfomycin
• All edwardsiella naturally resistant to:
• Macrolides, lincosamides, streptogramins, glycopeptides,
rifampin, fusidic acid, and oxacillin
Stock I, Wiedemann B. Natural Antibiotic Susceptibilities of Edwardsiella tarda, E. ictaluri, and E.
hoshinae. Antimicrob Agents Chemother, 2001 August; 45 (8): 2245-2255.
Harrison's Principles of Internal Medicine, 16th Edition. Kasper D, Braunwald E, Fauci A, et al, Eds. 134: 6.
2006
Necrotizing Soft Tissue Infections: “NSTI’S”
•Meleney's synergistic gangrene
•Clostridial anaerobic cellutis
•Clostridial gas gangrene
•Necrotizing fasciitis
•Type 1 NF- polymicrobial (Fournier’s)
•Type 2 NF- Grp A Strep (IVIG, HB O2)
Gas in Soft Tissue:
•Non-bacterial Causes
•Trauma / Surgery
•Air Injection
•H2O2 Irrigation
•Bacterial
•Glucose Fermenting
Diagnosis NSTI’s:
•Serial exams!
•Serial exams!
•Soft tissue X- ray, MRI, CT
•Low threshold for surgery
•Full thickness frozen-section Bx
•Direct visualization
•Gram stain
Management and Therapy:
•Hemodynamic stabilization, nutrition,
lytes, fluid resuscitation, oxygenation
•Early, aggressive and repetitive
debridement
•Early, aggressive and repetitive
debridement
•Hyperbaric tx
•A-B’s
37 y/o male with alcoholic cirrhosis admitted for RLE cellulitis; DX necrotizing
fasciitis, BCX grew Group Strep A
37 y/o male with alcoholic cirrhosis admitted for RLE cellulitis; DX necrotizing
fasciitis, BCX grew Group Strep A
37 y/o male with alcoholic cirrhosis admitted for RLE cellulitis; DX necrotizing
fasciitis, BCX grew Group Strep A
Miscellaneous Dermatologic Manifestations of Disease:
• Pseudomonas folliculitis
• Herpetic Whitlow
• Herpes Gladiatorum
• Molluscum Contagium
• Seborrheic Dermatitis
• Secondary Syphilis
“We know too much and believe
too little.”
T. S. Elliot