Download Free Medical Dermatological infections in children PowerPoint Presentation

Dermatological infections in children PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Check out this medical presentation on Staphylococcal Scalded Skin Syndrome, which is titled "Dermatological infections in children", to know about the Dermatological infections in children including bacterial, fungal, and viral.

Tags : Staphylococcal Scalded Skin Syndrome, Dermatological infections, children, bacterial, fungal, viral

Published on : Jul 05, 2021 | Views : 1540 | Downloads : 4

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

DERMATOLOGIC INFECTIONS IN CHILDREN ROBERTA C. ROMERO, M.D., F.P.D.S. TROPICAL DISEASE FOUNDATION
Slide 2-

DERMATOLOGICAL INFECTIONS BACTERIAL IMPETIGO/SSS FOLLICULITIS, FURUNCULOSIS FUNGAL TINEA VERSICOLOR DERMATOPHYTOSIS CANDIDA VIRAL HAND FOOT AND MOUTH DISEASE MOLLUSCUM CONTAGIOSUM
Slide 3-

6 YEAR OLD BOY -SKIN LESIONS OF 4 DAYS DURATION GOLDEN YELLOW CRUSTS ON SHALLOW EROSIONS ON FACE NOT TENDER, NOT ITCHY, SLIGHT FEVER DIAGNOSIS?????
Slide 4-

DIAGNOSIS: Impetigo Contagiosa Recognition Rapid evolution: Erythematous macule  papulovesicle  pustule  superficial erosions with honey-colored crusts (“mamaso”) Not tender, not painful, +/- fever Areas: face, extremities, buttocks Etiologic agents: Mainly Staph aureus, sometimes GABHS
Slide 5-

Typical clinical presentation of Impetigo Contagiosa (Mamaso) Starts with a single 2-4 mm erythematous macule Form “honey- colored” crusts Vesicles easily rupture Direct extension rapidly follows Several individual or coalesced macules/patches Courtesy of Dr. B.Bince Vesicles form
Slide 6-

Courtesy of Dr. R. Romero-Francisco
Slide 7-

Courtesy of Dr. R. Romero-Francisco
Slide 8-

3 year old girl Skin lesions of 3 days duration See superficial blister on left underarm Diagnosis????
Slide 9-

IMPETIGO CONTAGIOSA BULLOUS IMPETIGO Staph aureus produces epidermolysin (exfoliatoxin) Cleavage of superficial layer of epidermis formation of a superficial blister Bullous impetigo or erosion of epidermis (mamaso)
Slide 10-

Blister has been unroofed erosion Courtesy of Dr. R. Romero-Francisco
Slide 11-

Impetigo Contagiosa: Management Topical antibiotics: 1. few, localized lesions 2. superficial lesions 3. asymptomatic child Meds: Mupirocin, Fusidic acid 3x a day Oral antibiotics if multiple and widespread: Cloxacillin, Erythromycin
Slide 12-

13 month old baby girl 1 day duration of whole body erythema with superficial erosions Baby is very irritable Diagnosis??????
Slide 13-

ppt slide no 13 content not found
Slide 14-

Staphylococcal Scalded Skin Syndrome or SSSS A child less than 5 y/o with diffuse tender erythema  scarlatiniform eruption accentuated in flexures and periorificial areas  “wrinkled” appearance and superficial desquamation Severe cases with diffuse sterile flaccid blisters and erosions
Slide 15-

Characteristic facies: peri-orificial erythema and scaling  distinctive radial crusting and fissuring May have pharyngitis, conjunctivitis and superficial erosions of the lips with sparing of oral mucosa SSSS: Recognition
Slide 16-

Courtesy of Dr. R. Romero-Francisco
Slide 17-

Courtesy of Dr. R. Romero-Francisco
Slide 18-

Staphylococcal Scalded Skin Syndrome (SSSS) A toxin mediated infection Due to exfoliative toxins A, B released by Staphylococcus aureus phage Type II
Slide 19-

SSSS: Management: Remember that this is a Systemic Staph infection Anti-Staph antibiotics for 7-10 days Aggressive fluid and electrolyte management Denuded phase: NSS compresses Desquamation phase: emollients Heals without scarring in 10-14 days
Slide 20-

ppt slide no 20 content not found
Slide 21-

2 year old boy with pustules over the upper lip of 4 days duration Painful Diagnosis??
Slide 22-

C A R B U N C L E S Folliculitis Fu-run-cles
Slide 23-

Major Bacterial Infections of the Skin
Slide 24-

Furuncles and Carbuncles If single and not involving the dangerous triangle of the face: simple incision and drainage may suffice. May apply topical mupirocin on surrounding skin to avoid inoculation with pathogen
Slide 25-

Historical perspective Comparison of Bacterial Isolates: *1995 **2005 Staphylococcus aureus 84.5% = 85.5% Sensitivity to Oxacillin 97.7% 55.4% *Romero R, et. al. Bacterial Isolates among primary and secondary skin infections in the community. Research paper in fulfillment of fellowship. Phil Children’s Medical Center ** Romero, R., et al.Efficacy and safety of mupirocin in superficial bacterial infection. Phil J Int Med. 2006
Slide 26-

Why the sudden change? Possibilities: (Philippine scenario) Incomplete intake of prescribed antibiotics Self medication – availability of antibiotics from local drugstores w/o prescription Application of “penicillin” powder on infected wounds
Slide 27-

Community Acquired Methicillin Resistant Staph Aureus (CA-MRSA) What is MRSA (CDC Definition)? MRSA is, by definition, any strain of Staphylococcus aureus bacteria that has developed resistance to beta-lactam antibiotics which include the penicillins (methicillin, dicloxacillin, nafcillin, oxacillin, etc.) and the cephalosporins. Community acquired MRSA is a hybrid strain from a previously hospitalized patient who developed MRSA and the strain normally found in the community.
Slide 28-

Community Acquired Methicillin Resistant Staph Aureus (CA-MRSA) The resistance of MRSA to beta-lactam antibiotics is due to the presence of the mecA gene sequence. The mecA gene produces transpeptidase PBP2a (penicillin-binding peptide) that decreases the bacterial affinity of the beta-lactam antibiotics. Most CA-MRSA hybrid strains may acquire a virulence factor not seen with HA-MRSA
Slide 29-

Management of CA-MRSA Most cases do not need hospitalization For furuncles and carbuncles: Incision and drainage Get culture and sensitivity Initiate antibiotic therapy Trimethoprim 160 mgs, Sulfamethoxazole 800mgs: 1 tablet 2 x a day or Clindamycin HCl 450 mgs 3x a day Frei, C.R. TMP or Clindamycin for CA-MRSA Skin Infections. J AM Board of Fam Med 2010:23(6):714=719
Slide 30-

No improvement or worsening after 2 days of antibiotics. Severe pain. Fever, nausea, vomiting, other constitutional signs and symptoms Recognition of Severe MRSA infection
Slide 31-

Management of CA-MRSA Most cases do not need hospitalization For furuncles and carbuncles: Incision and drainage Get culture and sensitivity Initiate antibiotic therapy Trimethoprim 160 mgs, Sulfamethoxazole 800mgs: 1 tablet 2 x a day or Clindamycin HCl 450 mgs 3x a day Note: in severe cases: HOSPITALIZE Frei, C.R. TMP or Clindamycin for CA-MRSA Skin Infections. J AM Board of Fam Med 2010:23(6):714=719
Slide 32-

2 year old boy with recurrent crops of carbuncles and furuncles responsive to oral cloxacillin. Problem: Why recurrent?
Slide 33-

Recurrent Furunculosis Frequent attacks of furuncles/carbuncles: (1 or more episodes per month despite oral antibiotics) Look for source of staphylococcus! May have to do culture of anterior nares of patient or caregiver(s) If +: Apply mupirocin 4x a day for 5 days to anterior nares Or Rifampicin plus Cloxacillin for 7 days
Slide 34-

Recurrent Staph infections Look for the source of infection (auto-inoculation? Personal contact?) “Reservoirs” of Staph aureus: 1. anterior nares 2. ears 3. throat 4. hands 5. axillae 6. perineum/anus
Slide 35-

Algorythm for recurrence Mupirocin BID-QID x 5 days applied on the internal nares Culture other sites (perineum, fingernails, Toe webs, axilla) Add rifampicin Or Rifampicin plus minocycline Rifampicin plus co-trimoxazole **MRSA Guay D. Treatment of bacterial skin and skin structure infections. Expert Opin Pharmacother 2003; 4(8): 1259-75.
Slide 36-

Fungal Infections Candida Pityriasis versicolor Tinea capitis
Slide 37-

Diaper Candidiasis Infant with “diaper rash” of one week duration No response to cortisone cream Diagnosis?
Slide 38-

Diaper Candidiasis Note: Satellite pustules Glazed, beefy red shiny skin Diagnosis: Candidal Diaper Dermatitis
Slide 39-

Other signs of candidal infection: fine scaling on border of erythematous lesions White cheesy material Courtesy of Dr. R. Romero-Francisco
Slide 40-

Diaper Candidiasis: Recognition usually presents as well demarcated erythema with peripheral scale and satellite papules/pustules inguinal creases are involved in some instances, erythema has been described as “beefy red”
Slide 41-

White plaque difficult to scrape Courtesy of Dr. R. Romero-Francisco
Slide 42-

Oral Thrush: Recognition “Thrush”: pseudomembranous Candidiasis white to gray, “cheesy” looking colonies that form pseudomembranes gentle removal reveals a raw red base
Slide 43-

Candidiasis: Management Topical anti-candidal agent (nystatin or an azole preparation) +/- topical steroid NOTE: after the eruption has cleared, continue the anti-candidal agent for three more days Oral mycostatin or fluconazole if recurrent and extensive
Slide 44-

16 year old male Increasing number of hypopigmented patches Asymptomatic Other lesions on upper chest Diagnosis????
Slide 45-

KOH Smear
Slide 46-

ppt slide no 46 content not found
Slide 47-

Pityriasis Versicolor: Recognition Small round to oval macules or minimally elevated plaques with “wrinkling” and superficial scale (“fingernail sign”) Lesions may be erythematous to brownish to hypopigmented (“an-an”)
Slide 48-

Most common on the chest, back and proximal arms Face involved in younger children May be mildly pruritic Etiologic agent: Pityrosporum ovale or Malassezia furfur Pityriasis Versicolor: Recognition
Slide 49-

Pityriasis versicolor: Management Selenium sulfide or Zinc pyrithione 10-15 mins/day for 1-2 weeks Ketoconazole shampoo 5 mins/day for 3 days Ketoconazole cream Oral ketoconazole discouraged Advise on residual pigmentation
Slide 50-

12 year old girl with a mass on L parietal area, asymptomatic Several weeks duration + cerviical lymph nodes but appears to worsen with anti-biotics Diagnosis????
Slide 51-

Note the mass: Boggy and soggy erythe-matous mass (Kerion) Presence of alopecia Diagnosis: Tinea Capitis
Slide 52-

Courtesy of Dr. R. Romero-Francisco
Slide 53-

Another presentation of Tinea capitis: Suspect in a prepubertal child with scaly alopecia Courtesy of Dr. R. Romero-Francisco
Slide 54-

KOH smear
Slide 55-

Tinea Capitis”Management Oral anti-fungals: 1. Griseofulvin: 15-25 mkd (max: 1 g/d) 6-12 weeks 2. Terbinafine: 3-6 mkd face/body/scalp: 2-4 weeks Ketoconazole shampoo
Slide 56-

4 year old boy with shallow small ulcers on tongue Has difficulty eating and with low grade fever Similar lesions on hands, feet and buttocks Diagnosis?????
Slide 57-

Courtesy of Dr. R. Romero-Francisco
Slide 58-

Coxsackie A16 virus: Recognition: HFM Distinct pattern: Hand, Foot and Mouth distribution Lesions vary: maculopapular, roseola-like, urticarial, but most common is vesicular Usual evolution: erythematous small macules and papules  superficial gray vesicles on an erythematous base  some may ulcerate, leaving superficial scabs
Slide 59-

Shallow grayish ulcer on erythematous base
Slide 60-

Coxsackie A16 virus: Recognition Hand, Foot and Mouth disease > areas involved: mouth, hands and feet, buttocks; may also be seen on face and extremities > rash usually lasts for 2-7 days > (+/-) fever, sore mouth, anorexia, malaise, abdominal pain
Slide 61-

5 year old child with multiple flesh colored papules on trunk Asymptomatic but increasing in number Diagnosis????
Slide 62-

Molluscum Contagiosum Note: Flesh colored papules Central umbilication Not inflamed as a rule
Slide 63-

ppt slide no 63 content not found
Slide 64-

Flesh colored papules Central umbilication
Slide 65-

Molluscum contagious: Recognition Flesh colored to pinkish to pearly white discrete papules with central umbilication Most common areas: axillae, lateral trunk, lower abdomen, thighs, face May have a dermatitis in 10% of cases Etiologic agent: Molluscipox virus
Slide 66-

Molluscum contagiosum: Management “Benign neglect”: spontaneous resolution in 6-9 months May have a more persistent, progressive course **Tx options: 1. Curettage 2. topical Cantharidin 3. Tretinoin cream 4. Imiquimod cream
Slide 67-

Molluscum contagiosum: What can the Pediatrician do? Recognize Refer Please do not give topical steroids May try: 1. Tretinoin or Imiquimod 2. nail polish??!!
Slide 68-

DERMATOLOGICAL INFECTIONS BACTERIAL IMPETIGO/SSS FOLLICULITIS, FURUNCULOSIS FUNGAL TINEA VERSICOLOR DERMATOPHYTOSIS CANDIDA VIRAL HAND FOOT and MOUTH DISEASE MOLLUSCUM CONTAGIOSUM
Slide 69-

THANK YOU FOR YOUR KIND ATTENTION