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INFECTIOUS INFLAMMATORY DISEASES: BACTERIAL DISEASES

SUPERFICIAL PYODERMA

KEY CLINICAL
CLINICAL DIFFERENTIAL
DISEASE ETIOLOGY DIAGNOSTIC DIAGNOSTICS MANAGMENT
MANIFESTATIONS DIAGNOSIS
PROCESURES
Impetigo S. aureus Transient vesicle or The diagnosis of Seborrhis dermatitis Culture Local treatment with
Contagiosa Group A pustule that quickly nonbullous impetigo is Atopic dermatitis mupirocin ointment or
Streptococcus evolves into a honey- nearly always clinical. Allergic contact cream, removal of
colored crusted plaque dermatitis crusts, and good
that can enlarge to Culture Tinea capitis hygiene is sufficient to
greater than 2 cm in Herpes simplex cure most mild to
diameter Varicella
moderate cases.
Scabies
Burns Retapamulin 1%
Insect bites
ointment
Erythema multiforme
Pediculosis capitis
Fusidic acid

Systemic antibiotics may


be required in extensive
cases.

Folliculitis S. Aureus Infection of hair, follicle Gram staining & culture Painful dermal / Gram staining & Incision and drainage +
+/- pus in the ostium of subcutaneous nodule culture systemic antimicrobial
follicle Ruptured epidermoid therapy
Slightly tender or pilar cyst ,
hydradenitis
suppurativa (axilla,
groin, vulva)

Furuncle S. Aureus Firm, tender, nodule Gram staining & culture Painful dermal / Gram staining & Incision and drainage +
1-2 cm diameter subcutaneous nodule culture systemic antimicrobial
Nodules become Ruptured epidermoid therapy
fluctulant with abcess or pilar cyst ,
formation +/- pustule hydradenitis
Nodule with cavitation suppurativa (axilla,
remains after drainage groin, vulva)
of abcess
Distribution : any hair
bearing region , beard
area , posterior neck
and occipital scalp ,
axillae buttocks
solitary or multiple
lesions

© FAAS, 2A 2018
Carbuncle S. aureus Red and indurated, and Diagnosis is made on the A carbuncle will need to
multiple pustules soon basis of the clinical be drained of fluid which
appear on the surface, appearance. speeds up the healing
draining externally process.
around multiple hair Leukocytosis may be
follicles present in an extensive Local application of a
carbuncle warm cloth may aid
carbuncles. This should
Histologic exam shows be done several times a
multiple abscesses, day.
separated by connective-
tissue trabeculae, infiltrate A carbuncle with
the dermis and pass along surrounding cellulitis, or
the edges of the hair one with associated
follicles, reaching the fever, should be treated
surface through openings with a systemic
in the undermined antibiotic.
epidermis
For severe infections or
Gram stain of pus, clusters infections in a
of Gram-positive cocci, or dangerous area,
isolation of S. aureus on maximal antibiotic
culture confirms the dosage should be
diagnosis. employed by the
parenteral route.

If MRSA is implicated or
suspected in serious
infections, Vancomycin 1
to 2g intravenously daily
in divided doses) is
indicated.

Antibiotic treatment is
continued for atleast 1
week.

For large, painful


carbuncles, incision and
drainage is critical

© FAAS, 2A 2018
Eryththrasma Coryne The most common site Diagnosis is strongly Tinea Vesicolor Culture of the For localized
bacterium of involvement is the suggested by the location Tinea curis specific erythrasma, especially of
minutissimum web spaces of the feet, and superficial character Psoriasis Corynebacterium in the web spaces of the
where erythrasma of the process, but must abundance from the feet, benzoyl peroxide
presents as a be confirmed by lesion corroborates wash and 5% gel are
hyperkeratotic white demonstration of the the diagnosis. Gram- effective in most cases.
macerated plaque. characteristic “coral-red” stained imprints of
In the genitocrural, fluorescence with Wood’s the horny layer of the Clindamycin or
axillary, and lamp illumination skin show rod-like, erythromycin (2%
inframammary regions, Gram-positive solution) or azole
the lesions present as organisms in large creams are several of
well-demarcated, numbers. the many effective
reddish-brown, topical agents
superficial, finely scaly,
and finely wrinkled
patches.
Uniform appearance as
compared with tinea
corporis or cruris, which
often have central
clearing

DEEP DERMIS SUBCUTANEOUS PYODERMA

Cellulitis S.aureus Erythema, pain, firm and Stains and cultures. Non-infectious Blood cultures Severe, hospitalized
Group A tender induration, and Culture of surface swabs, Infectious : Mri or ultrasound patient :
Streptococcus less commonly, needle aspirates, and Lupus erythematosus, Clinical diagnosis Ampicillin/sulbactam
fluctuance punch biopsies. Dermatomyositis Ticarcillin/clavulanate/
Scleroderma Piperacillin/tazobactam
Some cause bulla Relapsing Imipenem/cilastatin,
formation or necrosis, polychondritis. meropenem.
resulting in extensive Vascular/Circulatory Alternative drugs
areas of epidermal disorders (Vancomycin
sloughing and superficial Deep venous Clindamycin Linezolid)
erosion thrombosis
Superficial Simple, outpatient
Lymphadenopathy thrombophlebitis (Cephalexin
Infectious: Dicloxacillin)
Systemic symptoms, Bacterial ( Erysipeloid Alternative drugs
such as fever, chills, and Erythema migrans) (Clindamycin
malaise. Viral ( Early herpes Azithromycin,
zoster Parvovirus Clarithromycin)
Abscess formation, B19)
fasciitis, and Mycobacterial Refractory, high
myonecrosis (Tuberculosis cutis likelihood of MRSA
verrucosa Atypical infection
mycobacterial (Vancomycin Linezolid)
infections) Alternative drugs
Fungal (Fungal (Daptomycin
Dermatophytoses Quinupristin-dalfopristin
Cutaneous Tigecycline)
candidiasis Deep
fungal infections)
Parasitic
(Leishmaniasis
Onchocerciasis)

© FAAS, 2A 2018
Erysipelas Facial Prodromal Symptoms: Leukocytosis and Acute compartment ESR Symptomatic
infections : malaise, chills, high elevations in erythrocyte syndrome CRP treatment of aches and
group A fever sedimentation rate (ESR) angioedema Bacterial Cultures fever
streptococci and C-reactive protein Allergic contact
Typical Complaints: (CRP) dermatitis Hydration (oral intake if
Lower Pruritus, burning, Cellulitis possible)
extremity tenderness, swelling Histologic hallmarks : Angioneurotic edema
infections : dermal edema, vascular Cold compresses
non - group A Other Symptoms: dilatation,and Elevation and rest of
streptococci Muscle and joint pain, streptococcal invasion of the affected limb:
nausea, headache and lymphatics and tissues. reduce local swelling,
Erysipelas other systemic inflammation, and pain
(newborns) : manifestations of an Bacterial invasion : a
group B infectious process dermal inflammatory Saline wet dressings:
streptococci infiltrate (neutrophils and Should be applied to
mononuclear cells). ulcerated and necrotic
Streptococcal lesions and changed
toxins : brisk Rarely to see bacterial every 2-12 hours,
inflammation invasion of local blood depending on the
(typical) vessels severity of the infection

The epidermis is often Antibiotics: Penicillin,


secondarily involved. Cephalosporin,
Roxithromycin,
Pristinamycin

Lymphangitis Acute: Pain over the area of Complete Blood Count Upper Extremities: Clinical diagnosis Penicillin G (GAS
Group A redness proximal to the Peripheral white blood cell Subacute or Chronic infection)
Streptococci original break in the count elevated sporotrichoid Nafcillin or Oxacillin
(most common) skin. Marked increase in syndrome caused by (Staph aureus)
Staphylococcus polymorphonuclear cells organism such as
aureus Infection in the thumb Sporothrix schenckii
(occasionally) or medial surface of
Pasteurella index finger. Lower Extremities:
multicida; HSV Superficial
(rare) Early occurrence of Thrombophlebitis

Subacute- Axillary pain


Chronic
Nodular: Systemic symptoms
Mycobacterium are often prominent
marinum than local pain and
Sporothrix erythema.
schenckii a. Subpectoral
Nippostrongylu abscess/infection
s brasiliensis b. Pleural effusion

Cutaneous Lesions:
Red linear streaks, few
to several centimeters
in width, extend from the
local lesion toward the
regional lymph node,
usally enlarged and
tender.

© FAAS, 2A 2018
Echthyma Impaired Erythematous or Skin biopsy shows a Pyoderma Gram stain Antipseudomonal
Gangrenosum immunity leads purpuric macule and necrotizing hemorrhagic gangrenosum Skin biopsy penicillin (piperacillin)
to increased develops rapidly into a vasculitis with few Necrotizing vasculitis Blood cultures Aminoglycosides
susceptibility to hemorrhagic bulla that inflammatory cells but Polyarteritis nodosa Tissue cultures Fluoroquinolones
infections with ruptures many surrounding bacilli. Cyroglobulinemia Third-generation
pseudomonas cephalosphorin
or other Becomes a gunmetal Gram Stain: gram (-) rods Aztreonam
pathogens. gray, infarcted lesion are numerous in the media
with surrounding and adventitia of the
Damage to the erythema and evolves necrotic vessels, but
vessels will into a necrotic black or typically spare the intima.
interrupt local gray–black eschar and Extravasation of blood,
blood supply surrounding erythema. edema and necrosis are
that leads to seen around the involved
redness, Frequently, in the vessels.
edema, pustule anogenital or axillary
formation and region.
hemorrhage
then necrosis of
skin with scab
and ulcer
formation.

BACTERIAL SKIN DISEASES OTHER THAN THE PYODERMAS

KEY CLINICAL
CLINICAL DIFFERENTIAL
DISEASE ETIOLOGY DIAGNOSTIC DIAGNOSTICS MANAGMENT
MANIFESTATIONS DIAGNOSIS
PROCESURES
Hansen’s disease Mycobacterium Painless skin patch Skin biopsy Tinea vesicolor Skin biopsy, nasal Antibiotics:
(Lerosy) leprae accompanied by loss samples stained Vitiligo smears, or both are Paubacillary: Dapsone,
of sensation but not with hematoxylin- Psoriasis used to assess for Rifampicin
itchiness. eosin and Fite- Scabies acid-fast bacilli using
Faraco are the Contact dermatitis Fite stain. Multibacillary:
Loss of sensation is a primary basis for Insect bites Dapsone, Clofazamine,
feature of tuberculoid laboratory Syphilis Serologic assays can Rifampicin
leprosy diagnosis and Drug eruption be used to detect
While in lepromatous categorization. Leishamaniasis phenolic glycolipid-1 Single-lesion
leprosy, sensation is (specific for M. leprae) paubacillary:
preserved. and Rifampicin, Ofloxacin,
lipoarabinomannan Minocycline
Foot drop or clawed (commonly seen in
hands (may result mycobacteria). Pediatric: Dapsone,
from neuritic pain and Clofazamine
rapid peripheral nerve Other Immunologic
damage tests include the Surgery
Skin lesions that may following:
be faded/discolored Polymerase chain
Eye problems that reaction (PCR)
may lead to blindness Phenolic glycolipid-1
Growths on the skin Lymphocyte migration
Enlarged nerves, inhibition test (LMIT)
Muscle weakness, Lepromin skin test
Wasting,Stuffy nose,
Nosebleeds

© FAAS, 2A 2018
Cutaneous tuberculosis
Primary Tubercle Bacilli Chancre appears 2-4 Clinical Syphilis Bacterial Culture- Consists of a 4-drug
inoculation (minor wounds) weeks after presentation is Sporotrichosis confirmatory regimen, isoniazid,
tuberculosis Bovine Bacilli (oral inoculation still the main key PPD Reaction pyrazinamide,
lesions) in the process of Tularemia rifampicin, and
Papule, crust, erosion CTB diagnosis - Bartonellosis ethambutol or
Any ulcer with streptomycin.
Face, conjunctivae, little or no
oral cavity hands, tendency to heal
lower extremities and unilateral
regional
Painless ulcer (>5cm) lymphadenopath
or fungating y in a child
granuloma should arouse
suspicion.

Tuberculosis Paucibacillary Hands, lower Clinical Warts or keratoses Histopathologic Consists of a 4-drug
verrucosa cutis Disorder extremities presentation is Hyperkeratotic lupus Features: regimen isoniazid,
(warty Exogenous still the main key vulgaris Pseudoepitheliomatou pyrazinamide,
tuberculosis, Reinfection (minor Papule in the process of Blastomycosis s hyperplasia rifampicin, and
prosector’s Wounds) (asymptomatic) vs. CTB diagnosis Hypertrophic lichen with marked ethambutol or
wart, lupus Risk Groups: Papulopustule with planus hyperkeratosis streptomycin.
verrucosus) professionals purple inflammatory Chromomycosis Dense inflammatory
handling infectious halo Bromoderma infiltrate
material and Tertiary syphilis Abscesses in the
children Hyperkeratotic, superficial dermis or
verrucous plaque with within the
irregular border pseudoepitheliomatou
s rete pegs
Usually solitary but
can be multiple
Fissures discharging
pus extend into the
underlying brownish-
red to purplish
infiltrated base

Lupus vulgaris Postprimary, Bbrownish-red, soft or Clinical Sarcoidosis Diascopy- typical Combination therapy of
(Tuberculosis paucibacillary form friable macule or presentation is Discoid lupus apple jelly color; highly drugs used for
Luposa) papule with a smooth still the main key erythematosus characteristic tuberculosis, such as
or hyperkeratotic in the process of Lymphocytoma Histopathologic- isoniazid,
surface CTB diagnosis - Tertiary syphilis typical tubercles pyrazinamide,
Progression: Typical LV Leprosy Positive Tuberculin rifampicin, and
Elevation, deeper plaques may be Lupoid leishmaniasis test except early ethambutol or
brownish color and recognized by phases streptomycin.
plaque formation the softness of Positve PCR
Usually solitary the lesions,
Head and neck (90%) brownish-red
Starts on the nose, color, and slow
cheek, earlobe, or evolution
scalp and slowly
extends onto adjacent
regions; Gyrate
outline border;
Ulceration may occur
Hypertrophic forms:
soft nodule or plaque,
hyperkeratotic surface

© FAAS, 2A 2018
Scrofuloderma Multibacillary or Most often - parotidal, Clinical Sporotrichosis Histopathologic- Full anti-tuberculous
(Tuberculosis Paucibacillary submandibular, and presentation is Hidradenitis tuberculoid therapy and surgical
Colliquativa Cutis) supraclavicular still the main key suppurativa granulomas on the excision are required.
regions and may be in the process of Mycobacterium periphery of the
bilateral CTB diagnosis scrofulaceum infection abscesses or the
Initial: firm, Syphilitic gummas margins of the sinuses
subcutaneous nodule, Actinomycosis Underlying
usually well defined, Severe forms of acne tuberculous
freely movable, and conglobata lymphadenitis or bone
asymptomatic. and joint disease
As the lesion Positive results on
enlarges, it softens. culture - confirmatory
After months,
liquefaction with
perforation occurs,
causing ulcers and
sinuses
Ulcers are linear or
serpiginous with
undermined, inverted,
bluish edges and soft,
granulating floors.
Sinusoidal tracts
undermine the skin
Clefts alternate with
soft nodules
Scar tracts develop
and bridge ulcerative
areas or even
stretches of normal
skin.

Orificial Autoinoculation of Small yellowish or Clinical Sporotrichosis Histopathologic- Full anti-tuberculous


Tuberculosis Mycobacteria from reddish nodule presentation is Hidradenitis massive nonspecifc therapy
(Tuberculosis progressive Breaks down to form still the main key suppurativa inflammatory infltrate
Ulcerosa Cutis Et tuberculosis of a soft ulcer in the process of Mycobacterium and necrosis
Mucosae, Acute internal organs with a typical CTB diagnosis scrofulaceum infection Tubercles with
Tuberculous Ulcer) (pulmonary/intestina punched-out Syphilitic gummas caseation
l TB) appearance, Actinomycosis
undermined edges, Severe forms of acne
and circular or conglobata
irregular border
Tongue (most
common)
Ulcer floor exhibits
multiple yellowish
tubercles and bleeds
easily
Single or multiple
lesions and are
extremely painful,
resulting in dysphagia

© FAAS, 2A 2018
Lichen Hematogenous Lichenoid Eruption Clinical Lichen planus Histopathologic- Full anti-tuberculous
Scrofulosorum spread of Asymptomatic, firm, presentation is Lichen nitidus Superfcial tuberculoid therapy
Mycobacteria in an follicular or still the main key Lichenoid secondary granulomas develop
individual strongly perifollicular flat in the process of syphilis around hair follicles or
sensitive to M. topped yellowish or CTB diagnosis Micropapular forms of independent of the
tuberculosis pink papules sarcoidosis adnexa
Trunk
Children and
adolescents with
active TB

Papulonecrotic Associated Extensor aspects of Clinical Pityriasis lichenoides Positive tuberculin test Full anti-tuberculous
Tuberculid pulmonary or extremities, buttocks, presentation is et varioliformis acuta Skin Biopsy- M. therapy
extrapulmonary and lower trunk still the main key Prurigo tuberculosis DNA
tuberculosis Symmetric distribution in the process of Lichen urticatus (50%)
evolve with Disseminated crops CTB diagnosis Secondary syphilis Wedge shaped
papulonecrotic of livid or dusky red necrotic area in the
tuberculid papules with a central upper dermis extends
depression and crust into epidermis
over a crater-like ulcer Blood vessel
Involvement (cardinal
feature) - obliterative
and granulomatous
vasculitis
Nodular Vasculitis/ Bacterial Erythematous Positive MTB Histopathology- Full anti-tuberculous
Erythema (Mycobacterium subcutaneous cultures lobular or mixed therapy
Induratum Of tuberculosis), nodules and Positive skin test lobular and septal
Bazin fungal, protozoal, plaques of lower legs or Quantiferon panniculitis with
and viral Calves, anterolateral gold test for MTB vasculitis (90%)
legs, feet, and thighs Extensive necrosis of
Venous insufficiency the adipocytes
Middle-aged women Variable inflammatory
Ulceration and infiltrate in the fat
scarring lobule: neutrophils in
Chronic course early lesions and
epithelioid histiocytes
and multinucleated
giant cells
Vasculitis of the small
veins and venules of
fat lobule
Erythema Streptococcal upper Symmetric, tender, A positive PPD Cellulitis High ESR Full anti-tuberculous
Nodosum respiratory erythematous, warm infection-induced Positive throat culture, therapy
infections nodules, and plaques panniculitis or high ASO titer in
on the anterior acute those with a
aspects of the lower lipodermatosclerosis streptococcal etiology
extremities (LDS) and leukocytosis
Acute onset EI/NV Histopathology:
More common in Mostly septal
women panniculitis without
Fever, fatigue, vasculitis
arthralgias, arthritis, Thickened septa with
headache inflammatory cells
Lasts from 3–6 weeks Neutrophils in early
lesions and histiocytes
and Miescher
granulomas in late-
stage lesions

© FAAS, 2A 2018
Nontuberculous mycobacteriosis
Buruli Ulcer Mycobacterium Subcutaneous nodule EARLY LESIONS
Disease ulcerans gradually enlarges Foreign body
then ulcerates granuloma,
Painless due to nerve Sebaceous cyst
damage and tissue Phycomycosis,
destruction Nodular fasciitis,
Lesions – usually Appendageal tumor
extremities in adults Always rule out:
Ulceration can persist Panniculitis, Nodular
for months and years vasculitis
LATE LESIONS
Blastomycosis or other
deep fungus infection,
Pyoderma
gangrenosum
Suppurative
panniculitis
Always rule out:
Necrotizing cellulitis

Fishtank/Swimmin Mycobacterium Occurs in freshwater Blastomycosis


g Pool Granuloma marinum and saltwater, Coccidioidomycosis
including swimming Sporotrichosis
pools and fish tanks Histoplasmosis
Nocardiosis
Disease begins as a Tertiary syphilis
violaceous papule at Yaws
the site of a trauma 2-
3 weeks after
inoculation
May have a nodule or
a psoriasiform or
verrucous plaque at
the site of inoculation
usually at the hands,
feet, elbows, or knees
The lesions may
ulcerate, they’re
usually solitary but
occasional
lymphocutaneous
spread occurs. They
may heal
spontaneously within
1-2 years with
residual scarring
Lesions are
suppurative, rather
than granulomatous
and may be multiple
in normal or
immunosuppressed
hosts

© FAAS, 2A 2018
Mycobacterium Mycobacterium Papules in Sporotrichosis
kansasii kansasii sporotrichoid Tuberculosis
distribution;
sometimes,
subcutaneous
nodules extend to
deeper structures and
may result in a carpal
tunnel syndrome or
joint disease
Ulcerated plaques
may also develop as a
metastatic lesion.
Disseminated disease
occurs in
immunosuppressed
individuals and such
patients have cellulitis
and abscesses rather
than granulomatous
lesions
Most commonly
affected organ is the
lung, usually in
patients with other
conditions. There are
nasopharyngeal
secretions that can
lead to periorifical
cutaneous infections

Mycobacterium Mycobacterium Cervical Other forms of


scrofulaceum scrofulaceum lymphadenitis bacterial
(typically lymphadenitis; viral
submandibular and infections, including
submaxillary nodes), mumps and
frequently unilateral mononucleosis; and
malignancy, including
solid tumors,
lymphoma, and
leukemia

Mycobacterium M. avrium- Single or multiple


Avium- intracellulare painless, scaly
Intracellulare yellowish plaques, or
as subcutaneous
nodules with a
tendency to ulceration
Lesions have included
generalized
cutaneous
ulcerations,
granulomas, infiltrated
erhthematous lesions
on the extremities,
pustules, and soft-
tissue swelling

© FAAS, 2A 2018
Mycobacterium Rarely found to
szulgai, cause human
Mycobacterium disease in cases of
haemophilm, otherwise
Mycobacterium unexplained
genavense cervical
lymphadenitis,
cellulitis, draining
nodules and
plaques, bursitis,
pneumonia, and
subcutaneous
granulomatous
eruptions

Myobacterium Myobacterium Lesion is a dark red Organisms may Histopathology


fortuitum, fortuitum, nodule, often with be indentified by Simultaneous
Mycobacterium Mycobacterium abscess formation special occurrence of
chelonae, chelonae, and clear fluid laboratories to polymorphonuclear
Mycobacterium Mycobacterium drainage. Healthy permit a rational leukocyte
abscessus abscessus individuals can be treatment microabscesses and
affected but granuloma formation
disseminated disease with foreign-body-type
usually occurs in giant cells. There is
hemodialysis patients usually necrosis but no
or other caseation. Acid-fast
immunocompromised bacilli may
individuals. Multiple occasionally be found
episodes of within microabscesses
abscesses on the
extremities or a
generalized macular
and papular eruption
Meningococcemia
Neisseria ACUTE Culture: ACUTE CBC CHEMOTHERAPY
rd
meningitidis MENINGOCOCCEMI isolation of N. MENINGOCOCCEMIA Gram staining Primary therapy: 3
A meningitidis from : Culture generation
History a normally sterile Acute bacteremias and All meningococcal cephalosporin
Follows a mild URTI body fluid such endocarditis isolates from blood, (ceftriaxone or
associated with as blood, CSF, Cutaneous necrotizing CSF, or other normally cefotaxime)
headache, influenza- or synovial fluid vasculitis sterile body cavities Alternatives (if strain is
like complaints, Enteroviral infections should be tested for susceptible): Penicillin
nausea, and muscle Rocky Mountain penicillin susceptibility. G, Ampicillin,
soreness (short-lived) spotted fever Meningococcal PCR Fluoroquinolone or
Initial findings: fever, Toxic Shock aztreonam
obtundation, and Syndrome Usual adult dosage
other manifestations Purpura fulminans Ceftriaxone= 2 g q12h
of meningitis Weil disease Cefotazime= 2-3q q6h
Fulminant (Leptospirosis) Penicillin G= 4MU q4h
meningococcemia= Ampicillin= 2g q4h [if
vomiting, stupor, CHRONIC penicillin MIC <0.1
precipitous MENINGOCOCCEMIA ug/mL]
development of a Subacute bacterial
hemorrhagic rash, endocarditis SUPPORTIVE
and hypotension may Acute Rheumatic fever THERAPY
be evident within a Henoch-Schonlein Shock in sepsis
few hours of the onset purpura Antibiotic selection
of symptoms. Rat-bite fever Draining procedures for

© FAAS, 2A 2018
Milder cases= slower Erythema multiforme abscesses
pace. Gonococcemia Appropriate use of
(chronic) volume expanders
Cutaneous lesions Administration of B-
Petechial, transient adrenergic stimulation
macular or papular drugs (dopamine,
lesions isoproterenol)
Petechiae = small and Correction of severe
irregular with a acidosis
“smudged” Use of peripheral
appearance; vasodilators
(+) most often located
on the extremities and CHEMOPROPHYLAXI
trunk; S
(+) in head, palms, Adults= rifampin,
soles, and mucous ceftriaxone,
membranes. ciprofloxacin,
azithromycin
Extensive DOC children=
hemorrhagic lesions rifampin; >1 mo= 10
with central necrosis mg/kg, max. 600mg PO
(suggillations) and q12h for 2d
bullae can develop.
Gangrenous IMMUNIZATION
hemorrhagic areas= MCV4 (A,C,Y, W-135)
(+)severe preferred for children,
meningococcemia w/ adolescents, adults <55
DIC yp
Skin lesions and Indicated for 2-10 yo w/
bacteremia =rarely: persistent C’
meningococcal component def,
pneumonia anatomic or functional
Cellulitis= children asplenia, high risk px
with meningococcal All 11/12 yo (catch
conjunctivitis. period, 13-18yo)
Polysaccharide vaccine
Other Physical (A,C,Y, W-135)
Findings Safe, effective for
Signs of meningeal adults >56yo
irritation and altered
consciousness
Cranial nerve palsies,
long-tract signs,
seizures, and
alterations in vital
signs associated with
changes in
intracranial pressure
may be present
Obtundation and
hypotension without
meningeal signs,
associated with the
syndrome of DIC=
characteristic features
of fulminant
meningococcemia.

© FAAS, 2A 2018
CHRONIC
meningococcemia
History
Initially= acute febrile
illness, but it wanes
and leaves the patient
with intermittent
muscle aches, joint
soreness, mild
headache, and
anorexia with weight
loss
Simultaneous
emergence of a
localized rash with
several days of fever
and joint soreness is
characteristic
As fever recedes
the rash fades 
totally free of skin
manifestations
(weeks)
This pattern of
recurring fever and
rash may last from a
few weeks to 6 or 8
months.
Untreated cases may
eventually evolve into
acute
meningococcemia,
meningitis, or
endocarditis.

Cutaneous Lesions
Distributed about one
or more painful joints
or on pressure areas
in contrast to the acral
distribution in
gonococcemia
Vary in appearance
and size (1–20 mm)
from one crop of
lesions to the next
and include:
(1) pale to rose-
colored macular and
papular lesions (the
most common type)
(2) slightly indurated
and tender erythema
nodosum-like nodules
(3) petechiae of
variable size
(4) petechiae with
vesicular or pustular

© FAAS, 2A 2018
centers
(5) hemorrhage
(minute) with an
areola of paler
erythema
(6) grossly
hemorrhagic areas
with pale blue–gray
centers.

© FAAS, 2A 2018

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