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BACTERIAL INFECTION DESCRIPTION ETIOLOGY
STAPHYLOCOCCUS - Normal inhabitant of anterior nares
- Also resides on hands & perineum
IMPETIGO - “mamaso” - Staphylococci
- Heals without scarring - Streptococci
- Cuts, burns, excoriation - Combination of both
- Eczemas, atopic dermatitis, bullous diseases bacteria
- Tinea, candidiasis - S. aureus – epidermolytic
toxin which lyses
desmosomes and splits
epidermis  blister
formation
ECTHYMA - “bakokang” - Group A beta-hemolytic
- Ulcerative impetigo streptococci (GABHS)
- Lesion of neglect - Staphylococci
- Excoriations, insect bites, minor trauma - Both
- Heals with scarring
- Lower extremities
FOLLICULITIS - Inflammation of hair follicles - Bacterial infection (Staph
- Hair shaft breaks due to friction / Strep)
- Heals without scarring - Chemical irritation
- Physical injury (wearing of
tight jeans)
- Face: Staphylococcus (F.
barbae)
- Scalp/Legs: F. impetigo
- Trunk: P. aeroginosa
(folliculitis)
- Back: Candida albicans
(periporitis suppurative)
CLINICAL
- Usually pustules,
furuncles and erosions
with honey colored
pustules
- Bullae
- widespread
erythema (redness)
- desquamation
(scaling & crusting)
- vegetating
pyodermas
(confluences of
pustules)
Bullous Impetigo
Primarily staphylococcal
disease
Infants (sometimes adults)
Vesicles ( <5 mm)
Bullae (>5 mm)
Dried collapsed roofs of
vesicles cover the
superficial erosion
Diagnosis:
- Gram Stain
- Cocci in clusters: Staphylococcus
- Pair / chains: Streptococcus
- Disrete / scattered
- Round / oval: 0.5 – 3.0
cm
- Indurated ulcer
- Dirty yellowish-gray
crust
- Pruritus & tenderness
- Lasts for weeks
- Painless / tender
pustule heals without
scarring
- Dirty yellow or gray
with erythema
- Pustule confined to
ostium of hair follicle
- Scattered, discrete or
grouped
- Red brown crust on
tip of pustule
- Halo  inflammation
DIAGNOSIS
Non-bullous Impetigo
Staphyloccoal (previously
a streptococcal disease)
Face, intertriginous area
Chin, nose, above the
mouth
Oozing erosion or transient
thin roofed vesicles which
increase size rapidly
Honey-colored granular
crust
DDX:
- Millaria: inflammation of
sebaceous glands
without involvement of
hair follicles
MANAGEMENT
- Proper handwashing
- Topical antibacterial
agents with anti-
inflammatory
- Corticosteroids
- Anti-fungal agents
- Keep injured area clean
- Antibacterial soap
(germicidal)
- Soak or compresses
 PNSS 10-15
mins
 1 tsp salt +
85mL boiled
BACTERIAL INFECTIONS - BUDJOY.MD
water fro 10-
15 mins
- Gentle debridement
with fingers or gauze
after soak
- Topical antibiotic:
Bactroban
- Systemic anti-
staphylococcal:
Cloxacillin
- Systemic treatment:
 Cloxacillin
 Dicloxacillin
 Erythromycin
(sensitive S. aureus)
-
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SUPERFICIAL - Impetigo of Bockhart - Staphylococcus aureus - Fragile, yellow or -

PUSTULA - Extremities and scalp white domed pustules
FOLLICULITIS - Face especially perioral area - Develops in crops
- Scratches, insect bites, abrasions, post - Heals in few days
surgical incisions - Yellowish, purulent
discharge

SYCOSIS VULGARIS - Sycosis barbae - Staphylococcus - Perifollicular, chronic,
- Barber’s itch (prior to shaving / washing) pustular
- Upper lip or nose Staphylococcal
infection of beard
- Inflammatory papules
& pustules
- Tendency to recur
- Begins with erythema
& burning itching
- Erythematous crop
which is a later site of
fresh crop of pustules
- Severe sycosis:
Marginal blepharitis
with conjunctivitis
STAPHYLOCOCCUS - Eyelashes - Staphylococcus aureus - -
FOLLICULITIS - Axilla - C. albicans
- Thigh - P. aeroginosa
- Pubic area
DDX: - Oral and topical
- Tinea Barbae antibiotics
 Dermatophytes - Corticosteroids
 Rarely upper lip
 Affects beard
- Acne vulgaris
- Pseudofolliculitis barbae
 Torpid papules
 Papules on side of
ingrown beards
 Blacks
- Herpetic sycosis
 HSV 1
 Self limiting
Gram Stain - Removal of exciting
 Cocci in clusters agents
within PMN  3x/day with antibac
- Culture soaps
 Drain deep lesions
- Topical antibiotics
 Mupirocin

BACTERIAL INFECTIONS - BUDJOY.MD

(bactroban)
 Retapamulin
(nonresponsive to
Mupirocin)
 Fusiidic acid
- Systemic antibiotic (if
drainage & topical fail)
 1st gen
cephalosporin
 Cloxacillin
 Dicloxacillin
(penicillinase
resistant)
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FURUNCLE - “pigsa” - Evolves from - Carbuncle: two or
- Acute deep-seated, erythematous, hot, very staphylococcal folliculitis more confluence of
tender inflammatory nodule furuncles with
- Undergo central necrosis separate heads
- Chronic staphylococcal carrier states in nares - Hard nodule 
or perineum fluctuant abscess with
- Friction of collar or belts central necrotic plug
- Obesity  rupture  ulcer
- Bactericidal defects - Bright red, indurated
- Complication of scabies, pediculosis or round plaque
abrasions - Isolated single lesions
- Impaired integrity of skin surface or few multiple lesions
- Scattered, discrete
- Occurs only where
there are hair follicles
& in areas of friction &
sweating (nose, neck,
face axilla, buttocks)
- Incision & Drainage
 Gram stain
 Culture
 Antibiotic sensitivity
- Blood culture
 With fever or
constitutional
symptoms
- Simple furunculosis
 Local application of
heat (15-20 mins)
 I & D (if antibiotics
failed)
 No systemic
antibiotics needed
except for patients
at risk of
bacteremia
- Furunculosis with
surrounding cellulitis or
fever
 Systemic
antibiotics (1-2
weeks)
 Cephalosporin
 Penicillinase-
resistant penicillins
- Recurrent folliculosis
 Difficult to treat
 Persistent Staph
 Frequent bathing
of germicidal soap
 Antibacterial
ointments inside of
the nares
 Oral antibiotic
treatment

BACTERIAL INFECTIONS - BUDJOY.MD

 Rifampicin +
Cloxacillin (7-10
days)
 Gentamycin
CELLULITIS - Acute spreading infection of dermis and - Erythematous, hot,
subcutaneous tissue edematous
- Very tender
- Vary in size
- Sharply defined
borders, irregular,
slightly elevated
- Can form on plaques
(vesicles, bullae,
erosions, abscess,
hemorrhage,
necrosis)
ERYSIPELAS - “kolebra” - Painful
- Acute superficial inflammatory form of - Margin of lesion is
cellulitis raised, sharply
- Involve lymphatics demarcated from
- Lower legs adjacent normal skin
- Face - Lymphatic involvement
- Ears “streaking” is prominent
- Umbilical stump - More superficial
- Areas of pre-existing lymphedema - Margins are more
demarcated
- Usually spread centrally
on lower extremities
- Skip areas
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H. INFLUENZA - Young children < 3 years old

CELLULITIS - Cheek
- Periorbital area
- Head and neck
ECTHYMA - Most common site: Extremities - P. aeruginosa
GANGRENOSUM - Rapidly becomes necrotic
- Leads to ulcer

INFECTIOUS - Rapidly progressive - Adults with no underlying - Oral antibiotics

GANGRENE - Associated with extensive necrosis of disease - Wound care
subcutaneous tissue and overlying skin  Group A beta-  Removal of
- Transmission: Break in the skin (puncture, hemolytic Strep. necrotic tissues
abrasion, laceration, surgical site) pyogenes  debridement
- Underlying dermatosis (Tinea pedis, statis  Staph. Aureus
dermatitis/ulcer)  Culture yields are
- Nasal fissures low
- Adults with underlying
disease
 DM, chemotherapy,
hematologic
malignancies, HIV, IV
drug abuse
 Productive culture
yields
 Clostridium speticum
 P. aeruginosa
 E. coli
 Acinetobacter
 Pasteurella

BACTERIAL INFECTIONS - BUDJOY.MD

multocida
 H. influenza
 Enterobacter
 Proteus mirabilis
- Children
 Successful
identification of
infectious agents
 H. influenza
 Group A strep
 S. aureus