ABSTRACT
A 62-year-old man developed a scalp rash 2 months ago, followed by bilateral eyelid swelling. The nonpruritic rash then spread to involve most of his skin. He also had fatigue, muscle weakness, mild muscle soreness with activity, and dysphagia for solid foods for the last 3 weeks. He had no other symptoms. He had a 50 pack-year history of smoking and drank two to three shots of alcohol daily.
Subject(s)
Dermatomyositis/complications , Exanthema/etiology , Lung Neoplasms/complications , Radiography, Thoracic , Small Cell Lung Carcinoma/complications , Adrenal Cortex Hormones/therapeutic use , Bronchoscopy , Dermatomyositis/diagnosis , Dermatomyositis/drug therapy , Drug Therapy , Exanthema/diagnosis , Exanthema/drug therapy , Humans , Lung Neoplasms/diagnosis , Lung Neoplasms/drug therapy , Magnetic Resonance Imaging , Male , Middle Aged , Small Cell Lung Carcinoma/diagnosis , Small Cell Lung Carcinoma/drug therapy , Treatment OutcomeABSTRACT
A panel of national experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2005 guidelines for the treatment of skin and soft tissue infections (SSTIs). The panel's recommendations were developed to be concordant with the recently published IDSA guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections. The focus of this guideline is the diagnosis and appropriate treatment of diverse SSTIs ranging from minor superficial infections to life-threatening infections such as necrotizing fasciitis. In addition, because of an increasing number of immunocompromised hosts worldwide, the guideline addresses the wide array of SSTIs that occur in this population. These guidelines emphasize the importance of clinical skills in promptly diagnosing SSTIs, identifying the pathogen, and administering effective treatments in a timely fashion.
Subject(s)
Skin Diseases, Bacterial/diagnosis , Skin Diseases, Bacterial/therapy , Soft Tissue Infections/diagnosis , Soft Tissue Infections/therapy , Humans , United StatesABSTRACT
A panel of national experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2005 guidelines for the treatment of skin and soft tissue infections (SSTIs). The panel's recommendations were developed to be concordant with the recently published IDSA guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections. The focus of this guideline is the diagnosis and appropriate treatment of diverse SSTIs ranging from minor superficial infections to life-threatening infections such as necrotizing fasciitis. In addition, because of an increasing number of immunocompromised hosts worldwide, the guideline addresses the wide array of SSTIs that occur in this population. These guidelines emphasize the importance of clinical skills in promptly diagnosing SSTIs, identifying the pathogen, and administering effective treatments in a timely fashion.
Subject(s)
Skin Diseases, Bacterial/diagnosis , Skin Diseases, Bacterial/therapy , Soft Tissue Infections/diagnosis , Soft Tissue Infections/therapy , Humans , United StatesSubject(s)
Bronchiolitis/diagnosis , Bronchiolitis/microbiology , Haemophilus Infections/diagnosis , Haemophilus Infections/microbiology , Haemophilus influenzae , Aged , Cough/etiology , Diagnosis, Differential , Dyspnea/etiology , Fever/etiology , Humans , Male , Pharyngitis/etiology , Radiography, Thoracic , Tomography, X-Ray ComputedABSTRACT
Several common conditions can mimic cellulitis, creating a potential for misdiagnosis and incorrect management. The most common disorders mistaken for lower limb cellulitis include venous eczema, lipodermatosclerosis, irritant dermatitis, and lymphedema. The dermatologist is often consulted when a patient has failed to respond to therapy, and a thorough knowledge of the differential diagnosis is essential. This article focuses on entities that can mimic cellulitis, with an emphasis of elements of the history and physical examination that can help to distinguish between lower limb cellulitis and its simulators.
Subject(s)
Cellulitis/diagnosis , Dermatitis/diagnosis , Dermatology , Leg , Skin Diseases/diagnosis , Diagnosis, Differential , Education, Medical, Continuing , HumansABSTRACT
An aging population and obesity have both contributed to a rising incidence of lower limb cellulitis; the most important predisposing factors include older age, obesity, venous insufficiency, saphenous venectomy, and edema. Streptococci are the most commonly implicated pathogen, and often reside in the interdigital toes spaces. Any disruption of the skin surface can allow the organism to invade. Effective management requires an appropriate antibiotic and attention to the predisposing factors. This article summarizes the epidemiology and treatment of this common infection.
Subject(s)
Bacterial Infections/diagnosis , Cellulitis , Cryptococcosis/diagnosis , Dermatology , Leg , Bacterial Infections/drug therapy , Bacterial Infections/epidemiology , Cellulitis/diagnosis , Cellulitis/epidemiology , Cellulitis/microbiology , Cryptococcosis/drug therapy , Cryptococcosis/epidemiology , Education, Medical, Continuing , HumansSubject(s)
Mohs Surgery/adverse effects , Skin Neoplasms/surgery , Surgical Wound Infection/classification , Wound Healing/physiology , Female , Humans , Male , Mohs Surgery/methods , Preoperative Care/methods , Primary Prevention/methods , Prognosis , Severity of Illness Index , Skin Neoplasms/pathology , Surgical Wound Infection/prevention & controlABSTRACT
Most cases of hypersensitivity pneumonitis develop only after many years of inhaling allergens, which include microbes, animal or plant proteins, and certain chemicals that form haptens. The initial clinical presentation is either episodes of acute illness with dyspnea and prominent constitutional symptoms, such as fever, or an insidious onset of dyspnea, coughing, and weight loss, sometimes with superimposed acute episodes. The histopathologic process consists of chronic inflammation of the bronchi and peribronchiolar tissue, often with poorly defined granulomas and giant cells in the interstitium or alveoli. Fibrosis and emphysema may develop. The radiologic findings include diffuse ground-glass opacification, centrilobular ground-glass opacities, air trapping, fibrosis, lung cysts, and emphysema. The histologic and radiologic features in some cases may resemble those of usual interstitial pneumonia or nonspecific interstitial pneumonia. The diagnosis usually rests on a variable combination of findings from history, serology, radiography, lung biopsy, and bronchoalveolar lavage, which characteristically reveals a lymphocyte content of more than 30%, often with an increased CD4-to-CD8 ratio of T cells. Treatment includes avoiding the allergen, if possible, and, in severe cases, systemic corticosteroids. The long-term prognosis is usually good, but some patients develop severe respiratory insufficiency, and a few die of the disease.
Subject(s)
Alveolitis, Extrinsic Allergic/diagnostic imaging , Lung/diagnostic imaging , Radiography, Thoracic/methods , Tomography, X-Ray Computed/methods , HumansABSTRACT
UNLABELLED: The blue (or purple) toe syndrome consists of the development of blue or violaceous discoloration of one or more toes in the absence of obvious trauma, serious cold-induced injury, or disorders producing generalized cyanosis. The major general categories are: (1) decreased arterial flow, (2) impaired venous outflow, and (3) abnormal circulating blood. Depending on its pathogenesis, the discoloration may be blanching or nonblanching. An accurate diagnosis is critical, because many of the causes threaten life and limb, but the patient's medical history, accompanying nondermatologic findings on physical examination, and a discriminating use of laboratory tests are usually more important than the nature of the cutaneous abnormalities in determining the cause. LEARNING OBJECTIVES: After completing this learning activity, participants should be able to define the blue (or purple) toe syndrome, categorize the causes, and recognize the important historical, clinical, and laboratory findings that differentiate the causes and lead to the correct diagnosis.
Subject(s)
Blue Toe Syndrome , Blood Coagulation Disorders/complications , Blue Toe Syndrome/diagnosis , Blue Toe Syndrome/etiology , Embolism/complications , Humans , Thrombosis/complications , Vascular Diseases/complicationsABSTRACT
Treating clinically uninfected venous leg ulcers or superficial diabetic foot ulcers with systemic antimicrobial agents does not accelerate healing, even when pathogens grow from cultures of the wounds. Topical antibiotics do not prevent infections following routine dermatologic surgical procedures or minor wounds in an emergency department, but they are effective in reducing infections following minor trauma in children.
Subject(s)
Anti-Infective Agents/therapeutic use , Wound Healing/drug effects , Wound Infection/drug therapy , Administration, Cutaneous , Administration, Oral , Anti-Infective Agents/administration & dosage , Anti-Infective Agents, Local/therapeutic use , Controlled Clinical Trials as Topic , Diabetic Foot/drug therapy , Diabetic Foot/microbiology , Humans , Varicose Ulcer/drug therapy , Varicose Ulcer/microbiology , Wound Infection/microbiologySubject(s)
Esophageal Perforation/diagnosis , Esophagus , Foreign Bodies/diagnosis , Acute Disease , Animals , Bone and Bones , Chest Pain/etiology , Diagnosis, Differential , Dyspnea/etiology , Esophageal Perforation/complications , Esophageal Perforation/therapy , Foreign Bodies/complications , Foreign Bodies/therapy , Humans , Male , Middle Aged , Seafood , Treatment OutcomeABSTRACT
The most common skin infections are caused by Staphylococcus aureus, group A streptococci (Streptococcus pyogenes), or the normal skin flora. An antistaphylococcal oral antibiotic is the preferred treatment for nonbullous and bullous impetigo, and a therapeutic agent that is effective against both S aureus and streptococci is appropriate for most cases of cellulitis. For furuncles, carbuncles, cutaneous abscesses, and inflamed epidermal cysts, the most important therapy is incision and drainage, and in most cases there is no need for antimicrobial therapy. Patients with venous ulcers and atopic eczema do not benefit from systemic antimicrobial therapy unless obvious infection is present, as indicated by clinical features such as fever, cellulitis, and lymphangitis.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Skin Diseases, Bacterial/therapy , Staphylococcal Skin Infections/therapy , Streptococcal Infections/therapy , Dermatitis, Atopic/drug therapy , Dermatitis, Atopic/microbiology , Drainage , Humans , Methicillin Resistance , Skin Diseases, Bacterial/microbiology , Staphylococcus aureus/isolation & purification , Streptococcus pyogenes/isolation & purification , Varicose Ulcer/drug therapy , Varicose Ulcer/microbiologyABSTRACT
Antimicrobial prophylaxis is rarely appropriate for dermatologic surgery. Dermatologic procedures seldom cause bacteremia, and they have been implicated as a cause in only an extremely small number of cases of endocarditis or infections of vascular grafts or orthopedic prostheses. Accordingly, systemic prophylactic antibiotics are not indicated in patients undergoing dermatologic surgery who have valvular heart disease, vascular grafts, or orthopedic prostheses. Because wound infections following dermatologic surgery are uncommon, usually mild, and generally easily treatable, systemic antimicrobial prophylaxis is not indicated to prevent postoperative wound infections either. Topical antibiotic ointments for that purpose are ineffective. Whether prophylactic antivirals are helpful in preventing herpes simplex infections after facial resurfacing is uncertain.
Subject(s)
Anti-Infective Agents/therapeutic use , Antibiotic Prophylaxis/methods , Endocarditis, Bacterial/prevention & control , Surgical Wound Infection/prevention & control , Dermatology , Endocarditis, Bacterial/microbiology , Herpes Simplex/prevention & control , Humans , Prosthesis-Related Infections/prevention & control , Risk Factors , Surgical Procedures, OperativeABSTRACT
Coccidioidomycosis was first discovered by a medical student in Argentina in 1892, and knowledge about the infection mostly arose from observations of clinicians and scientists in California, primarily at Stanford University Medical Center. Some discoveries came by chance. Many others arose from careful epidemiologic and clinical investigations in the San Joaquin Valley during the 1930s, when people migrated there from the "Dust Bowl" of the Midwest, and during the 1940s, when the events of World War II brought military recruits, prisoners of war, and persons of Japanese descent to camps and other areas of endemicity. Especially impressive were the contributions of Charles E. Smith, who tirelessly studied this disease throughout his professional career.
Subject(s)
Coccidioidomycosis/history , Mycology/history , Argentina , History, 19th Century , History, 20th Century , Humans , United StatesSubject(s)
Anti-Bacterial Agents/therapeutic use , Skin Diseases, Infectious/diagnosis , Skin Diseases, Infectious/drug therapy , Soft Tissue Infections/diagnosis , Soft Tissue Infections/drug therapy , Animals , Antifungal Agents/therapeutic use , Bacterial Infections/diagnosis , Bacterial Infections/drug therapy , Cats , Dogs , Humans , Immunocompromised Host , Mycoses/diagnosis , Mycoses/drug therapy , Skin Diseases, Infectious/microbiology , Soft Tissue Infections/microbiology , Wound Infection/diagnosis , Wound Infection/drug therapy , ZoonosesABSTRACT
A 69-year-old Judean man presents with chronic low-grade fever, pedal edema, and abdominal pain. His condition deteriorates over several weeks with the appearance of shortness and foulness of breath, pruritus, convulsions of every limb, and gangrene of the genitalia. Just before he dies, he orders dozens of the leading men of his kingdom imprisoned and instructs his sister to kill them all after he is gone. Who is he and what is the likely cause of his death?
Subject(s)
Famous Persons , Fournier Gangrene/history , Kidney Failure, Chronic/history , Fournier Gangrene/diagnosis , History, Ancient , Humans , Israel , Jews/history , Kidney Failure, Chronic/diagnosis , MaleABSTRACT
The literature on diffuse alveolar hemorrhage heavily emphasizes the causal role of vasculitides. We present a patient with diffuse alveolar hemorrhage caused by leptospirosis. Although the pathology in leptospirosis occurs secondary to a vasculitic process, this disease is not listed as a cause of diffuse alveolar hemorrhage in the review literature. In the right clinical scenario, the disease should be considered in a patient presenting with diffuse alveolar hemorrhage.