Bacterial Infection - Adrien Brooks

Bacterial Infection

Adrien Brooks

Impetigo

Prevention

·       Keeping the skin clean is the best way to keep it healthy. Treat cuts, scrapes, insect bites, and other wounds right away by washing the affected area.

If someone in your family already has impetigo, take these measures to help keep the infection from spreading to others:

·       Gently wash the affected areas with mild soap and running water and then cover lightly with gauze.

·       Wash an infected person’s clothes, linens and towels everyday and don’t share them with anyone else in your family.

·       Wear gloves when applying antibiotic ointment and wash your hands thoroughly afterward.

·       Cut an infected child’s nails short to prevent damage from scratching.

·       Wash hands frequently.

·       Keep your child home until your doctor says he or she isn’t contagious.

Diagnosis

·       Classic signs and symptoms of impetigo involve red sores that quickly rupture, ooze for a few days and then form a yellowish-brown crust. The sores usually occur around the nose and mouth but can be spread to other areas of the body by fingers, clothing, and towels.

·       Doctors usually diagnosis impetigo by looking at distinctive sores. Usually, lab tests are not necessary. But if the sores don’t clear, even with antibiotic treatment, your doctor may take a sample of the liquid produced by a sore and test it to see what types of antibiotics might work best on it. Some types of the bacteria that cause impetigo have become resistant to certain antibiotic drugs.

Treatment

·       Antibiotics are the mainstay of impetigo treatments. These drugs can be delivered by an ointment or cream that you can apply directly to the sores. You may need to first soak the affected area in warm water or use wet compresses to help remove the overlying scabs.

·       If you have more than just a few impetigo sores, your doctor might recommend antibiotic drugs that can be taken by mouth. Be sure to finish the entire course of medication even if the sores are healed. This helps prevent the infection from recurring and makes antibiotic resistance less likely.

MRSA Infection (Methicillin-Resistant Staphylococcus Aureus)

Prevention

·       Wash your hands. Careful hand washing remains your best defense against germs. Scrub hands briskly for at least 15 seconds, then dry them with a disposable towel and use another towel to turn off the faucet. Carry a small bottle of hand sanitizer containing at least 62 percent alcohol for times when you don't have access to soap and water.

·       Keep wounds covered. Keep cuts and abrasions clean and covered with sterile, dry bandages until they heal. The pus from infected sores may contain MRSA, and keeping wounds covered will help prevent the bacteria from spreading.

·       Keep personal items personal. Avoid sharing personal items such as towels, sheets, razors, clothing and athletic equipment. MRSA spreads on contaminated objects as well as through direct contact.

·       Shower after athletic games or practices. Shower immediately after each game or practice. Use soap and water. Don't share towels.

·       Sanitize linens. If you have a cut or sore, wash towels and bed linens in a washing machine set to the hottest water setting (with added bleach, if possible) and dry them in a hot dryer. Wash gym and athletic clothes after each wearing.

Diagnosis

·       Doctors diagnose MRSA by checking a tissue sample or nasal secretions for signs of drug-resistant bacteria. The sample is sent to a lab where it's placed in a dish of nutrients that encourage bacterial growth. But because it takes about 48 hours for the bacteria to grow, newer tests that can detect staph DNA in a matter of hours are now becoming more widely available.

Treatment

·       Both health care-associated and community-associated strains of MRSA still respond to certain antibiotics. In some cases, antibiotics may not be necessary. For example, doctors may drain a superficial abscess caused by MRSA rather than treat the infection with drugs.

Ungual Trauma

To help prevent an ingrown toenail:

•   Trim your toenails straight across. Don't curve your nails to match the shape of the front of your toe. If you have your toenails done at a salon, be sure to tell your pedicurist to trim your nails straight across. If you have a condition that causes poor blood flow to your feet and you can't trim your nails, see a podiatrist regularly to have your nails trimmed.

•   Keep toenails at a moderate length. Trim toenails so they're even with the tips of your toes. If you trim your toenails too short, the pressure from your shoes on your toes may direct a nail to grow into the tissue.

•   Wear shoes that fit properly. Shoes that place too much pressure on your toes or pinch them may cause a nail to grow into surrounding tissue. If you have nerve damage to your feet, you may not be able to sense if your shoes fit too tightly. Take care to buy and wear properly fitted shoes, preferably from a shoe store specializing in fitting shoes for people with foot problems.

•   Wear protective footwear. If your work puts you at risk of injuring your toes, wear protective footwear, such as steel-toed shoes.

Check your feet. If you have diabetes, check your feet daily for signs of ingrown toenails or other foot problems.

Diagnosis

·       Your doctor can diagnose an ingrown toenail based on your symptoms and a physical examination of your nail and the surrounding skin.

·       Left untreated or undetected, an ingrown toenail can infect the underlying bone and lead to a serious bone infection.

·       Complications can be especially severe if you have diabetes, which can cause poor blood flow and damage nerves in your feet. So a minor foot injury — a cut, scrape, corn, callus or ingrown toenail — may not heal properly and become infected. A difficult-to-heal open sore (foot ulcer) may require surgery to prevent the decay and death of tissue (gangrene). Gangrene results from an interruption in blood flow to an area of your body.

Treatment

•   Lifting the nail. For a slightly ingrown nail (redness and pain but no pus), your doctor may carefully lift the ingrowing nail edge and place cotton, dental floss or a splint under it. This separates the nail from the overlying skin and helps the nail grow above the skin edge. At home, you'll need to soak the toe and replace the material daily.

•   Partially removing the nail. For a more severe ingrown toenail (redness, pain and pus), your doctor may trim or remove the ingrown portion of the nail. Before this procedure, your doctor may temporarily numb your toe by injecting it with an anesthetic.

•   Removing the nail and tissue. If you have the problem repeatedly on the same toe, your doctor may suggest removing a portion of the nail along with the underlying tissue (nail bed). This procedure may prevent that part of your nail from growing back. Your doctor will use a chemical, a laser or other methods.

Your doctor may also recommend using topical or oral antibiotics, especially if the toe is infected or at risk of becoming infected.

Folliculitis

You can try to prevent folliculitis from coming back with these tips:

•   Avoid tight clothes. It helps to reduce friction between your skin and clothing.

•   Dry out your rubber gloves between uses. If you wear rubber gloves regularly, after each use turn them inside out, rinse with soap and water, and dry thoroughly.

•   Avoid shaving, if possible. For men with barber's itch, growing a beard may be a good option if you don't need a clean-shaven face.

•   Shave with care. Use an electric razor or a clean, sharp blade every time you shave. Adopt habits such as:

·       Washing your skin with warm water and a mild facial cleanser before shaving

·       Using a wash cloth or cleansing pad in a gentle circular motion

·       Applying lubricating shaving cream or gel for five to 10 minutes before shaving to soften the hair

·       Applying moisturizing lotion after you shave

·       Generally, men with barber's itch have been advised to shave in the direction of hair growth. But a study found that men who shaved against the grain saw their rash improve. Experiment to see what works for you. You may even want to consider hair-removing products (depilatories) or other methods of hair removal.

Use only clean hot tubs and heated pools. And if you own a hot tub or a heated pool, clean it regularly and add chlorine as recommended.

Diagnosis

·       Your doctor is likely to diagnose folliculitis by looking at your skin and reviewing your clinical history. If the usual treatments don't clear up your infection, he or she may use a swab to take a sample of your infected skin. This is sent to a laboratory to help determine what's causing the infection. Rarely, a skin biopsy may be done to rule out other conditions.

Possible complications of folliculitis include:

•       Recurrent or spreading infection

•       Large, itchy patches of infected skin (plaques)

•       Boils under the skin (furunculosis)

•       Permanent skin damage, such as scarring or dark spots

•       Destruction of hair follicles and permanent hair loss

Treatment

•       Creams or pills to control infection. For mild infections, your doctor may recommend the antibiotic cream mupirocin (Bactroban). Oral antibiotics aren't routinely used for folliculitis. But for a severe or recurrent infection, your doctor may prescribe them.

•       Creams, shampoos or pills to fight fungal infections. Antifungals are for infections caused by yeast rather than bacteria, such as pityrosporum folliculitis. Antibiotics aren't helpful in treating this type.

•       Creams or pills to reduce inflammation. If you have mild eosinophilic folliculitis, your doctor may suggest you try a steroid cream. If your condition is severe, he or she may prescribe oral corticosteroids. Such drugs can have serious side effects and should be used for as brief a time as possible.

Reference

The Mayo Clinic. Bacterial Infections. 2015. Accessed October 18, 2015.

Fungal and Parasitic Infections

This post is an overview of some of the main fungal or parasitic infections that could be seen in an athletic population. There are pictures to indicate the look of the infections in the event an athlete is suspected to have one.

Fungal: superficial fungal infections are the most common type for athletes. Tinea capitis (scalp), tinea barbae (beard area), tinea pedis (feet), tinea manum (hands), tinea cruris (groin area), tinea unguium (fingernails and toenails), and tinea corporis (skin area). Warm moist environment serves as the primary predisposing factor for all of these infections.

·         Tinea Pedis (feet, athlete’s foot)

o   Most common: interdigital tinea pedis (web space of toes = scaly, peeling)

o   Third hyperkeratotic scale on the plantar surface of the foot.

§ All types, the patient will complain of itching, especially after removing their socks

o   Treatment: mild localized infections respond with topical antifungal powder (Tinactin). Moderate respond to topical creams (Monistat) twice a day for 2-4 weeks. Extensive cases may require oral antifungal medications (Lamisil) in addition to a topical cream.

o   Prevention: wearing shower shoes in locker rooms and shower areas. Keep feet dry with breathable socks and using tolnaftate powder (Tinactin).

·         Tinea Corporis (ringworm)

o   Highly prevalent in wrestlers, also referred to tinea gladiatorum

o   Presents with a circular, erythematous, pruritic (itchy) plaque, with a raised edge, scaling, and central clearing.

o   Early lesions can look like dermatitis and later lesions look like psoriasis or eczema.

o   It is spread through skin-to-skin contact and occurs more often on the head, neck, and arms.

o   Treatment: athletes should be treated with antifungal medications for at least 2-4 weeks whereas the normal population may only need 1-2 weeks. Topical treatments such as clotimazole (Lortimin) are effective for noninflammatory cases. 

o   NCAA rules state that an athlete presenting with tinea corporis are to be withheld from practice for a minimum of 72 hours of topical antifungal treatments. When the athlete returns, the lesion must be covered.

o   Pretension: athletes should take a shower right after practice and wash workout clothes daily. 

·         Tinea Versicolor

o   This is a change in the pigment of the skin from white, to red, to brown.

o   This is more common in areas that are hot, humid climates.

o   Treatment: antifungal medications (oral or topical). The topical medications are cream or lotion to be left on for 10 minutes or overnight.

o   This has a high rate of recurrence, so oral medications maybe taken prophylactic.

·         Tinea Unguium (finger nails and toenails)

o   Nails will appear white, thickened, and discolored. The nail will eventually spate from the nailbed

o   Treatment: topical antifungals do not work. Systemic antifungals such as terbinafine (Lamidil) are commonly prescribed.

·         Tinea Crutis (Jock Itch)

o   Typically involves proximal medical thighs, inguinal folds of groin and buttocks.

o   Large, round, scaly plaques that have pustules, papules at the edge.

o   Tight clothing, obesity, and chronic corticoid steroid use are at risk.

o   Treatment: topical OTC antifungal meds are usually effective. If not responding, then refer to physician for potassium hydroxide (KOH) stain or fungal culture.

Parasitic Infections

·         Pediculosis (parasite infestation with lice)

o   Three common areas are head, body, and genital area.

o   Passed with direct skin contact.

o   Once infested could take up to 10 days for the eggs to hatch

o   Diagnosis: diagnosed through microscopic examinations of skin scraping.

o   Treatment: using a louse comb to remove lice in addition to a 7 day treatment of permethrin (Nix) lotion and lindane shampoo.

o   Prevention: all individuals in contact should be treated.

o   NCAA guidelines require infected individuals to complete treatment and show no signs of lice in order to compete.

·      

      Scabies

o   Spread by direct skin contact. Commonly affected sites are finger and toe webs, flexor surfaces of the wrist, elbow, axillae, buttocks, breasts, and male genitalia.

o   Common symptom is sever itching.

o   Diagnosis: positive detection is from a skin scraping of the lesion looking for the presence of mites, eggs, and feces.

o   Treatment: prescription-strength lotions or creams such as lindane (Kwell) applied to the body for 8-14 hours.

o   Prevention: highly contagious, if someone has been exposed to scabies, everyone around them should be treated.

o   NCAA guidelines require wrestlers to have negative scabies test at the tournament to compete.