Bacterial Nail Infections

Bacterial nail infections are caused by microorganisms such as Staphylococcus aureus (S. aureus). It is an infection of the nail fold which may involve the nail plate.

Structure of the Nail

The nail is actually a plate of keratin formed by the germinal tissue called the nail matrix, under the proximal part of the nail (where it starts growing from the underlying finger tissue). The nail matrix is part of the nail bed which adds thickness to the nail plate. The nail protects the tip of the finger from accidental trauma.

The nail joins the finger at the proximal and lateral nail folds. This tissue actually splits to enclose the nail at its boundaries. The upper part of the proximal nail plate forms the cuticle which joins the nail plate to the skin behind it. This is a tight seal which keeps the nail free of infection.

The nail fold is infected in cases of paronychia. This may be the result of injury, infections or allergic reactions.

Types of Bacterial Paronychia

Acute paronychia is usually preceded by finger trauma in the form of biting the nails, manicuring too deep, a hangnail or sucking the fingers. The most common organism involved is S. aureus. Other causative microorganisms include streptococcus and pseudomonas species.

Chronic paronychia is caused by many factors acting together, including infective and inflammatory agents. It occurs mostly in people who have their hands constantly exposed to agents which are chemically or immunologically irritant, or in a wet environment.

Symptoms

Acute paronychia presents with localized pain and tenderness of the skin around the nail. The skin appears reddened and swollen, and the infection may discolor the nail or lead to distortion of its shape.

In more severe cases, pus may collect and form an abscess at the base or sides of the nail. In such cases the skin feels fluctuant and looks whitish. In more severe infections, the nail is lifted off the nail bed by the extension of the infection beneath the margin of the nail.

Chronic paronychia is usually not very red, but the nail folds are puffy and painful. The characteristic boggy look and feel gives away the diagnosis. In such cases the symptoms will have been present for at least 6 weeks, either constantly or from time to time.

These episodes may be triggered by exposure to wet surroundings. Fluctuance is not usually seen in these cases. However, the nail plates become chronically thickened and the color may change. The cuticles appear to be widely separated from the underlying nail plate, leaving a gap through which microbes may penetrate and cause infection.

Diagnosis and Management

With early paronychia, the finger should be fomented in hot water 3-4 times a day. This relieves pain and swelling while the infection resolves. With persistent infection, oral antibiotics should be started. The finger may be splinted to alleviate the symptoms and prevent further trauma.

Antibiotics are usually selected to treat staphylococci. In cases which follow finger-sucking or nail biting, anerobes may be present, and thus appropriately general antibiotics should be prescribed.

The commonly used antibiotics are penicillin and ampicillin. If resistant staphylococci are present, amoxicillin with clavulanic acid may be used, as may clindamycin. Another option is to take specimens for cultures before starting antibiotic therapy.

If a collection of pus has formed, surgical drainage should be considered. Otherwise the pus may form a run-around abscess by extending under the nail fold to reach the other side.

Other routes of extension are under the nail plate to the nail bed, elevating the nail. In such cases incisions may have to be made, and the nail may require to be removed, for proper drainage to occur.

When the skin is yellow or white over the abscess, it is dead and direct incision is all that is necessary.

The wound should be pressed gently to drain the pus and packed for open drainage, along with an appropriate oral antibiotic. Dressings should be removed after 48 hours, and warm soaks will help continue drainage and promote healing.

In chronic bacterial paronychia, it is necessary to keep the hands clean and dry, and to protect them from chemicals and trauma. Cotton-lined gloves are useful for this.

Topical steroids, antibiotics and antifungals are effective in treating the infection which is often complicated by fungal infection. Acetic acid soaks are also used. Oral antibiotics may be started if required. Surgical management involves removing the nail, or marsupialization of the eponychium.

References

Further Reading

Finger Infection

If you believe you are experiencing signs of a hand or finger infection, including swelling and redness, drainage or pus, severe pain, or stiffness and fever, contact Hand to Shoulder Center of Wisconsin in Appleton or Green Bay, WI. Our team of orthopedic specialists have experience diagnosing finger and hand infections, and are here to provide you with treatment options.

Finger Infections (Felon, Paronychial and Tendon Sheath Infections)

An infection is caused when another organism (bacteria) gets inside the body and reproduces. The organism is often referred to as a parasitic organism or an infectious agent. Most organisms enter into the body through open wounds. Since the hand can easily be injured during everyday activities, any trauma involving an open wound allows damaging organisms to enter. The anatomy of the hand also may aid in the development of an infection with its compartmentalized structure.

Hand and/or finger infection (Fig.1) can cause mild to severe problems even after the infection has been resolved. Stiffness, loss of strength and tissue can be affected by the infection. However, if treated early and effectively, most infections can be eliminated with antibiotics, rest, elevation, and other non-operative actions. Failure to properly treat infections may result in permanent disability or even loss of the digit.

Figure 1: Infected Finger

Symptoms of an Infection

Symptoms of an infection may include:

• Pain and/or severe throbbing pain
• Low to high grade fever
• Stiffness with movement that may produce excruciating pain
• Swelling and redness
• Drainage or pus

At Hand to Shoulder Center of Wisconsin, we provide comprehensive treatment for common infections of the upper extremity, including treatment of but not limited to:

• Paronychia – an infection of the finger that involves the tissue at the nail’s fold; primarily caused by a bacterial infection.
• Felon – an infection of the soft tissue in the fingertip pad.
• Cellulitis – this is a superficial infection that involves the skin and underlying tissue.
• Tendon sheath infection (Fig. 2) – an infection that involves the tendon sheaths that are responsible for flexing or closing the hand.
• Bite wound – harmful bacteria can be found in the mouth of an animal or human causing an infection to develop.
• Deep space infection – typically a severe infection of one or several deep structures of the hand or fingers that require surgical drainage.

Figure 2: Tendon sheath infection

Diagnosis and Treatment

At Hand to Shoulder Center of Wisconsin, our subspecialty-trained orthopedic surgeons conduct a thorough examination. Review of medical history is discussed along with a physical and visual evaluation.

In treating an infection (Fig. 3), it will depend on the degree of the infection; some early infections can be managed with oral antibiotics, while others may require intravenous antibiotics in a hospital setting.

Figure 3: Inflamed and infected finger

In treating an infection with drainage the physician may order an x-ray to determine if a foreign body is present. If a foreign body is present, steps to surgically remove it are often taken. A small incision is made, the wound is flushed out to remove debris and infected material. The material is often sent to a laboratory for testing to determine the type of bacteria causing the infection. Antibiotics are prescribed and postoperative monitoring is conducted by the physician. In some cases, the infection may spread to other areas of the body, which can ultimately result in amputation of the body part, or death, if not treated by a physician in a timely manner. It is highly important that wound infections are treated with proper care. In some cases of severe infection, intravenous antibiotics may be given to combat severe blood infection (sepsis).

Rehabilitation

A physical or occupational therapist will perform hands-on techniques to aid in decreasing and relieving pain while focusing on restoring pain-free range of motion. Muscle strengthening and decreasing stress on the joints by using braces and splints may be applied. Modalities such as ultrasound and heat/ice are often used to help control pain, facilitate motion and control swelling. Early rehabilitation treatment protocols include a home exercise program to encourage range of motion and restoring functional use of the hand.

Full Medical Disclaimer

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Paronychia | DermNet NZ

Author: Hon A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, 1997. Updated by Dr Jannet Gomez, August 2017. 

What is paronychia?

Paronychia is inflammation of the skin around a finger or toenail. It can be acute (< 6 weeks) or chronic (persisting > 6 weeks).

Paronychia is also called whitlow. It may be associated with felon (infection of the pulp of the fingertip).

Who gets paronychia?

Acute paronychia can affect anyone. However, it is more likely to follow a break in the skin, especially between the proximal nail fold/cuticle and the nail plate. For example:

Chronic paronychia mainly occurs in people with hand dermatitis, or who have constantly cold and wet hands, such as:

Acute and chronic skin infections tend to be more frequent and aggressive in patients with diabetes or chronic debility, or that are immune suppressed by drugs or disease.

What causes paronychia?

Acute paronychia is usually due to bacterial infection with Staphylococcus aureus (which may be multiresistant), Streptococcus pyogenes, Pseudomonas, or other bacterial pathogens. It can also be due to the cold sore virus, Herpes simplex, and the yeast, Candida albicans.

The cause or causes of chronic paronychia are not fully understood. In many cases, it is due to dermatitis of the nail fold. Often several different micro-organisms can be cultured, particularly Candida albicans and the Gram-negative bacilli, pseudomonas.

What are the clinical features of paronychia?

Acute paronychia

Acute paronychia develops rapidly over a few hours, and usually affects a single nail fold. Symptoms are pain, redness and swelling. 

If herpes simplex is the cause, multiple tender vesicles may be observed. Sometimes yellow pus appears under the cuticle and can evolve to abscess. The nail plate may lift up (onycholysis). Acute paronychia due to S. pyogenes may be accompanied by fever, lymphangitis and tender lymphadenopathy.

Acute candida more commonly infects the proximal nail fold.

Acute paronychia

Chronic paronychia

Chronic paronychia is a gradual process. It may start in one nail fold, particularly the proximal nail fold, but often spreads laterally and to several other fingers. Each affected nail fold is swollen and lifted off the nail plate. This allows the entry of organisms and irritants. The affected skin may be red and tender from time to time, and sometimes a little pus (white, yellow or green) can be expressed from under the cuticle.

The nail plate thickens and is distorted, often with transverse ridges.

Chronic paronychia

See more images of paronychia …

What are the complications of paronychia?

Acute paronychia can spread to cause a serious hand infection (cellulitis) and may involve underlying tendons (infectious tendonitis).

The main complication of chronic paronychia is nail dystrophy. It is often associated with distorted, ridged nail plates. They may become yellow or green/black and brittle. After recovery, it takes up to a year for the nails to grow back to normal.

How is paronychia diagnosed?

Paronychia is a clinical diagnosis, often supported by laboratory evidence of infection.

• Gram stain microscopy may reveal bacteria 
• Potassium hydroxide microscopy may reveal fungi
• Bacterial culture  
• Viral swabs
• Tzanck smears
• Nail clippings for culture (mycology).

What is the treatment for paronychia?

Acute paronychia

• Soak affected digit in warm water, several times daily.
• Topical antiseptic may be prescribed for a localised, minor infection.
• Oral antibiotics may be necessary for severe or prolonged bacterial infection; often a tetracycline, such as doxycycline, is prescribed.
• Consider early treatment with aciclovir in case of severe herpes simplex infection.
• Surgical incision and drainage may be required for abscess followed by irrigation and packing with gauze.
• Rarely, the nail must be removed to allow pus to drain.

Chronic paronychia

Attend to predisposing factors.

• Keep the hands dry and warm.
• Avoid wet work, or use totally waterproof gloves that are lined with cotton.
• Keep fingernails scrupulously clean.
• Wash after dirty work with soap and water, rinse off and dry carefully.
• Apply emollient hand cream frequently – dimethicone barrier creams may help.

Treatment should focus on dermatitis and any microbes grown on culture  [1].

Other management

• Patients with diabetes and vascular disease with toenail paronychia infections should be examined for signs of cellulitis.
• Surgical excision of the proximal nail fold may be necessary.
• Eponychial marsupialisation involves surgical removal of a narrow strip of skin next to the nail, to reduce the risk of infection [3].
• Swiss roll technique has the advantage of retaining the nail plate and quicker recovery [4].

What is the outlook for paronychia?

Acute paronychia usually clears completely in a few days, and rarely recurs in healthy individuals.

Chronic paronychia may persist for months or longer and can recur in predisposed individuals.

Paronychia: Practice Essentials, Background, Epidemiology

Author

Elizabeth M Billingsley, MD Professor of Dermatology, Pennsylvania State University College of Medicine; Director, Mohs Micrographic Surgery, Penn State Hershey Medical Center

Elizabeth M Billingsley, MD is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, Association of Professors of Dermatology, Council for Nail Disorders, Pennsylvania Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Allison T Vidimos, MD, RPh Chair, Department of Dermatology, Vice Chair, Dermatology and Plastic Surgery Institute, Staff Physician, Department of Dermatology and Dermatologic Surgery and Cutaneous Oncology, Cleveland Clinic; Professor of Dermatology, Department of Medicine, Case Western Reserve University School of Medicine

Allison T Vidimos, MD, RPh is a member of the following medical societies: American Academy of Dermatology, Association of Professors of Dermatology, International Transplant and Skin Cancer Collaborative, American College of Mohs Surgery, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery

Disclosure: Partner received grant/research funds from Genentech for none.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Acknowledgements

Yelena Bogdan Stony Brook University Health Sciences Center School of Medicine (SUNY)

Disclosure: Nothing to disclose.

David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

webmd.com”>David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Pamela L Dyne, MD Professor of Clinical Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Attending Physician, Department of Emergency Medicine, Olive View-UCLA Medical Center

Pamela L Dyne, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

webmd.com”>Noah Elise Gudel, DO Resident in Internal Medicine, University of Tennessee Medical Center at Knoxville

Disclosure: Nothing to disclose.

Micelle J Haydel, MD Associate Clinical Professor of Medicine, Residency Director, Section of Emergency Medicine, Louisiana State University Health Science Center

Micelle J Haydel, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Association, Sigma Theta Tau International, Society for Academic Emergency Medicine, and Southern Medical Association

Disclosure: Nothing to disclose.

Mark F Hendrickson, MD Chief, Section of Hand Surgery, Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation

webmd.com”>Disclosure: Nothing to disclose.

Steve Lee, MD Physician in Plastic, Reconstructive, and Hand Surgery, Plastic Surgery, PLLC

Steve Lee, MD is a member of the following medical societies: American College of Surgeons and American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Mohamad Marouf, MD Consulting Staff, Department of Emergency Medicine, University Hospitals Health System, Richmond Heights Medical Center

Disclosure: Nothing to disclose.

Heather Murphy-Lavoie, MD, FAAEM Assistant Professor, Assistant Residency Director, Emergency Medicine Residency, Associate Program Director, Hyperbaric Medicine Fellowship, Section of Emergency Medicine and Hyperbaric Medicine, Louisiana State University School of Medicine in New Orleans; Clinical Instructor, Department of Surgery, Tulane University School of Medicine

webmd.com”>Heather Murphy-Lavoie, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, and Undersea and Hyperbaric Medical Society

Disclosure: Nothing to disclose.

Jerome FX Naradzay, MD, FACEP Medical Director, Consulting Staff, Department of Emergency Medicine, Maria Parham Hospital; Medical Examiner, Vance County, North Carolina

Jerome FX Naradzay, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Julia R Nunley, MD Professor, Program Director, Dermatology Residency, Department of Dermatology, Virginia Commonwealth University Medical Center

webmd.com”>Julia R Nunley, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Nephrology, International Society of Nephrology, Medical Dermatology Society, Medical Society of Virginia, National Kidney Foundation, Phi Beta Kappa, and Women’s Dermatologic Society

Disclosure: Nothing to disclose.

Richard K Scher, MD Adjunct Professor of Dermatology, University of North Carolina; Professor Emeritus of Dermatology, Columbia University

Richard K Scher, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American Dermatological Association, American Medical Association, Association of Military Surgeons of the US, International Society for Dermatologic Surgery, Noah Worcester Dermatological Society, and Society for Investigative Dermatology

webmd.com”>Disclosure: Nothing to disclose.

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jeter (Jay) Pritchard Taylor III, MD Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina School of Medicine; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist

webmd.com”>Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Paronychia Nail Infection – American Osteopathic College of Dermatology (AOCD)

Paronychia is an often tender infection or inflammation around the base of the nail fold. It can start suddenly (acute paronychia) or gradually (chronic paronychia).

Acute paronychia

Acute paronychia develops over a few hours when a nail fold becomes painful, red and swollen. Yellow pus may appear under the cuticle. In some cases fever and painful glands under the arms accompany a particularly severe case of acute paronychia. It is usually due to “Staph” bacteria germs. Mild cases can be treated with soaks and antibiotic cream, but most cases are treated with oral antibiotics. Sometimes an abscess (a pocket of trapped pus) forms and has to be lanced. Acute paronychia usually clears completely in a few days, and it only rarely happens repeatedly.

Chronic paronychia

Chronic paronychia is a gradual process and much more difficult to get rid of. It may start in one nail fold but often spreads to several others. Each affected nail fold (the skin that lies next to the nail) becomes swollen and lifted above the nail. It may be red and tender from time to time, and sometimes a little thick pus (white, yellow or green) can be expressed from under the cuticle.

The nail itself becomes distorted and ridged as it grows. It may become yellow or green and brittle. After recovery, it may take up to a year for the nails to grow back to normal. Chronic paronychia is due to skin irritation that becomes infected. The infection may be from several different types of germs. Often a mixture of yeasts and bacteria are present, particularly candida species and Gram negative bacilli. The inflammation results in debris that builds up, encouraging more infection. It mainly occurs in people who have constantly wet hands, such as hairdressers, nurses, bartenders and housewives. It is more likely to occur, and more difficult to clear up, in those with poor circulation, especially during the winter months.

In order to successfully treat chronic paronychia the hands must be kept clean and dry. One should avoid wet work, or use totally waterproof gloves with a cotton liner. After dirty work, wash thoroughly with an antibacterial soap. If the hands tend to dry, follow every washing with an application of a hand cream.

Treatment of the infection is usually a topical cream or lotion. Frequently prescribed medications may include thymol, mupirocin, Loprox or Lotrisone. Apply these twice daily to the nail fold, and be prepared to use them regularly for some time. In addition an oral antifungal drug may be prescribed. It often takes months to clear paronychia, and it can recur in predisposed individuals.

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The medical information provided in this site is for educational purposes only and is the property of the American Osteopathic College of Dermatology. It is not intended nor implied to be a substitute for professional medical advice and shall not create a physician – patient relationship. If you have a specific question or concern about a skin lesion or disease, please consult a dermatologist. Any use, re-creation, dissemination, forwarding or copying of this information is strictly prohibited unless expressed written permission is given by the American Osteopathic College of Dermatology. 

Causes, Symptoms and Treatment Options

Medically reviewed by Drugs. com. Last updated on Nov 5, 2020.

What is a Felon?

An infection inside the tip of the finger can form an enclosed pocket of pus (or abscess) that is very painful as it expands. A felon is a fingertip abscess deep in the palm side of the finger. It usually is caused by bacterial infection, most often from growth of Staphylococcus aureus bacteria.

A painful bump on the end of a finger that is sometimes mistaken for a felon is a herpes virus infection that forms a herpetic whitlow.

It is important to get treatment quickly for felons when they are small. If the bacteria pocket continues to expand, it can compress blood vessels in the finger and cut off the fingertip’s circulation, causing in permanent damage to the finger. Also, an untreated felon can spread its infection to the bone within the finger. This can lead to a more serious infection, called osteomyelitis, which takes much longer to cure.

Like other types of infections, felons sometimes begin after the finger is punctured by a wood splinter or something else.

Symptoms

A felon causes extreme pain at the fingertip, especially when pressure is applied to the “fingerprint” surface. The end of the finger swells, is warm and turns red. There may be an accumulation of a white, thick discharge (pus). As the felon increases, the fingertip may feel numb, and bending the finger may be painful.

Diagnosis

Your doctor can usually diagnose a felon just by examining it. He or she will ask whether you have had an injury in the area. Tenderness, redness, firmness and enlargement of the fingertip are all signs of a felon. If you have small bubble-like cysts on the skin, called vesicles, and repeated episodes, it is likely the cause is herpetic whitlow.

Expected Duration

Because an enlarging abscess in the finger reduces blood supply into the area, it is hard for your body’s immune system to fight this type of infection. Felons almost always need to be opened and drained by a doctor before they can heal. Most clear up within days to weeks. Healing may be faster with aggressive treatment.

Prevention

If you are going to work with wood or other materials that could cause splinters, wear protective gloves. People with diabetes who prick their fingers for home blood tests should first wipe the fingertip with alcohol. Avoiding contact with others who have herpes may prevent herpetic infections, though there may be no way to know in advance who has the infection. Prompt diagnosis and treatment of a herpetic infection may prevent complications.

Treatment

Felons are usually treated with minor surgery to allow drainage. Typically, your doctor will make the whole finger numb by injecting an anesthetic once into each side of your finger, just beyond the knuckle of the hand. Then he or she will make one or more small cuts in the tip of your finger to allow the pus to drain out. A narrow gauze strip may be left in the wound to hold it open for continued drainage. The gauze may need to be replaced every day or two as it absorbs bacteria and debris from inside the wound.

A doctor usually will prescribe antibiotics that work against “staph” bacteria infections. Antibiotics may be changed if the infection does not clear up promptly or if testing of the pus indicates that the infection is caused by an unusual organism or one that is resistant to the usual antibiotics.  For severe cases, a more extensive operation may be necessary including making a small hole in the nail to allow additional drainage.

If the infection is actually a herpetic whitlow rather than a felon, drainage is not performed because it may delay healing or increase the risk of bacterial infection. Herpes infections in the finger tend to clear up on their own. Your doctor may prescribe an antiviral medication, such as acyclovir (Zovirax) or valacyclovir (Valtrex), which may help speed recovery.

If you have this or any skin or wound infection, make sure you are up-to-date with your tetanus vaccinations.

When To Call A Professional

Because of the complications that can occur from a felon, you should see your doctor and go to an emergency room for immediate care if you develop sudden or severe pain or swelling in a finger.

Prognosis

The prognosis is excellent. Felons caused by bacterial infections are curable with drainage and antibiotic treatment. Complications are rare and usually can be prevented with prompt diagnosis and treatment.

External resources

National Foundation for Infectious Diseases

http://www.nfid.org/

Infectious Diseases Society of America

http://www.idsociety.org/

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Secondary Bacterial Paronychia after Herpetic Whitlow

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Secondary Bacterial Paronychia after Herpetic Whitlow
Woosik Pae, MD
Gachon University, Incheon, Korea, Republic of (South)

Whitlow is an infection of the tip of the finger, generally caused by bacterium. It is often difficult to distinguish paronychia or felon. In rare cases, it may also be caused by herpes simplex virus. Herpes simplex virus can cause a skin & soft tissue infection through a break in the skin barrier after contact. This primary viral infection usually last 1 to 3 weeks. Also, skin lesion is healed completely without scars. Herpetic whitlow is reported to occur in 2.5 per 100,000 people each year. The cause is herpes simplex virus type 1 (60%) or type 2 (40%). And it is occured mainly in patients, such as medical healthcare workers, dental practitioners, beauty industry workers, or finger-sucking children. Because herpetic whitlow is not seen often, it may be mistaken for a different kind of infection of the finger. Delayed recognition and treatment can put patients at risk of complications following categories from superinfection to herpetic encephalitis. A 24-year-old woman was referred by her primary care physician because of erythema, swelling, multiple vesicles, and tenderness of the middle finger of her left hand. She was a nurse working in the intensive care unit and had contact with a patient with varicella a few days ago. Primary care physician had already treated her with the Augmentin (amoxicillin-clavulanic acid) for 1 week, but symptoms persisted and became worse. When she was transfer to us, there was mucoid discharge through primary wound near finger-nail. Also, there was spontaneously a clear secretion of serous fluid from vesicles, and increased tenderness near the finger-nail with swelling. On the basis of the clinical appearance and past history, we considered herpetic whitlow with superinfection. So incision was done near the finger-nail and we extracted the nail for decompression and drainage. After wound irrigation, we applied antiviral ointment & topical antibiotics at the same time. And we added antiviral medication. After treatment for 2 weeks, almost cutaneous wound disappeared. Whitlow is rarely caused by the herpes simplex virus, and it cures easily by antiviral medication without surgical intervention. It is important to differentiate between herpetic and bacterial whitlow, because these diseases require a different treatment. Often misdiagnosed and delayed treatment can cause secondary bacterial infections that are difficult to treat. For this reason, the most important medical procedure is the very careful listening of the patient’s past history, when treating a patient with vesicles on the finger.

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Gangrene

Gangrene is necrosis (death) of body tissues due to lack of blood flow or bacterial infection. Gangrene most often affects the limbs, including the fingers, feet, or the entire limb, but can also develop in muscles and internal organs.

The risk of developing gangrene is generally higher if you have a medical condition that can damage blood vessels and impair blood flow, such as diabetes and atherosclerosis.

Treatment of gangrene includes surgical excision of necrotic tissue, antibiotic therapy and other methods. The prognosis for recovery is better if gangrene is detected early and treatment is started quickly.

SYMPTOMS

Signs and symptoms of gangrene skin lesions are as follows:

• discoloration of the skin – from pale to blue, purple, black, bronze or red, depending on the type of gangrene;
• severe pain, followed by a feeling of numbness;
• Unpleasant odor from the affected part of the skin.

If you have a type of gangrene affecting tissues located under the skin, for example, gas gangrene or gangrene of the internal organs, then you will notice that:

1. The affected tissue becomes swollen and painful.
2. You feel hot and sick.

A condition called septic shock can develop if a bacterial infection in gangrenous tissue spreads throughout the body. Signs and symptoms of septic shock include:

• low blood pressure;
• body temperature is higher than 38 ° C or lower than 36 ° C;
• heart palpitations;
• dizziness;
• shortness of breath;
• confused consciousness.

REASONS

Gangrene can develop for one or more reasons:

• Lack of blood supply. Blood provides oxygen and nutrients to cells, as well as components of the immune system, antibodies that prevent infections. Without a proper blood supply, cells cannot survive and tissues are destroyed.
• Infection. If bacteria multiply unhindered for a long time, infection can itself lead to tissue necrosis, causing gangrene.

Types of gangrene

Dry gangrene. Dry gangrene is characterized by dry and wrinkled skin, ranging in color from brown to purplish blue to black. Dry gangrene usually develops slowly. This occurs most often in people with blood vessel disorders such as atherosclerosis.
Wet gangrene. Gangrene is called “wet” if there is a bacterial infection in the affected tissue. Swelling, blistering, and moist-looking tissues are common features of wet gangrene.It can develop after severe burns, frostbite, or injury. Common in people with diabetes who accidentally injure a toe or foot. Wet gangrene must be treated immediately because it spreads quickly and can be fatal.

Gas gangrene. Gas gangrene usually affects deep muscle tissue. In gas gangrene, the surface of the skin may be normal at first. As the condition progresses, the skin may turn pale and then gray or purplish red.The affected skin may produce a slight crackling sound due to the gas in the tissues. Gas gangrene is usually caused by the bacterium Clostridium perfringens, which develops in areas of trauma or surgical wound that have a poor blood supply. The bacterial infection produces toxins that release gas – hence the name “gas” gangrene – and the cause of tissue death. Like wet gangrene, gas gangrene is life-threatening.

Gangrene of internal organs. Gangrene affecting one or more organs, most often the intestines, gallbladder or appendix, is called internal gangrene.This type of gangrene occurs when blood flow to an internal organ is blocked, for example, when part of the intestine bulges out through a weakened area of ​​muscles in the abdomen (hernia) and twists. Gangrene of the internal organs often causes fever and severe pain. Internal gangrene can be fatal if left untreated.

Fournier gangrene. Fournier’s gangrene is a rare form of gangrene that affects the genitals. Men are affected more often, but women can also develop this type of gangrene.Fournier’s gangrene usually results from an infection in the genital area and urinary tract and causes genital pain, redness, and swelling.

Synergistic gangrene of Meleney. This rare type of gangrene usually develops 1–2 weeks after surgery, with painful skin lesions.

RISK FACTORS

Some factors that increase the risk of developing gangrene. These include:

• Age. Gangrene is much more common in older people.
• Diabetes. If you have diabetes, your body does not make enough of the hormone insulin (which helps the cell get sugar from the blood), or your cells are resistant to the effects of insulin. High blood sugar can eventually damage your blood vessels, interrupting blood flow to parts of your body.
• Diseases of the blood vessels. Narrowing and hardening of an artery (atherosclerosis) and blood clots can also block blood flow to a specific area of ​​the body.
• Serious injury or surgery. Any process that causes damage to the skin and underlying tissues, including trauma or frostbite, increases the risk of gangrene, especially if you have an underlying medical condition that reduces blood flow to the affected area.
• Obesity. Obesity is often associated with diabetes and vascular disease, but pressure from excess weight can also constrict arteries, resulting in decreased blood flow and increased risk of infection and poor wound healing.
• Immunosuppression. The body’s ability to fight infection is impaired by the human immunodeficiency virus (HIV) or after chemotherapy or radiation therapy.
• Medicines. In rare cases, the anticoagulant drug warfarin may be the cause of gangrene, especially when combined with heparin therapy.

COMPLICATIONS

Gangrene can lead to scarring and will require reconstructive surgery.Sometimes the amount of necrotic tissue is so large that a part of the body, such as the legs, has to be removed.

Gangrene infected with bacteria can quickly spread to other organs and can be fatal if left untreated

.

TESTS AND DIAGNOSTICS

Tests used to make the diagnosis of gangrene include:

• Blood tests. An abnormal increase in white blood cells often indicates infection.
• Instrumental methods. Radiography, computed tomography (CT), or magnetic resonance imaging (MRI) can be used to examine internal organs and assess the extent to which gangrene has spread.
• Arteriography is a test used to visualize arteries. During this test, a dye is injected into the blood and a series of X-rays are taken to determine how well the blood is moving through the arteries. An arteriogram can help your doctor figure out if any of your arteries are closed.
• Surgery. Surgery can be performed to determine how much gangrene has spread in your body.
• Crops of tissue or liquid. Plating fluid from the blister on the skin may indicate the bacteria Clostridium perfringens (a common cause of gas gangrene), or the doctor may look under a microscope at a tissue sample for signs of cell death.

TREATMENT AND PREPARATIONS

Gangrene-damaged tissue cannot be saved, but steps can be taken to prevent the progression of gangrene. These procedures include:

Surgery. The doctor’s removal of dead tissue helps stop the spread of gangrene and allows healthy tissue to heal. If possible, the doctor can repair damaged blood vessels to increase blood flow to the affected area.A skin graft is a type of reconstructive surgery that is used to repair skin damage caused by gangrene. During a skin graft, your doctor removes an area of ​​healthy skin from another part of your body – usually a place hidden under your clothing – and gently transfers it to the affected areas. Healthy skin can be held in place with a bandage or a few small stitches. A skin flap can only take root if an adequate blood supply has been restored in the damaged area of ​​the skin.

In severe cases of gangrene, the affected parts of the body, such as the foot, fingers, or limb, may need to be surgically removed (amputation). In some cases, a prosthesis may subsequently be used.

Antibiotics. Antibiotics given by vein (intravenous) can be used to treat gangrene caused by an infection.

Hyperbaric oxygen therapy. Hyperbaric oxygen therapy can be used to treat gas gangrene.With increased pressure and increased oxygen content, the blood is able to deliver more oxygen. Oxygen-rich blood inhibits the growth of bacteria that multiply in the absence of oxygen and helps infected wounds heal more easily.

With this type of therapy, you will be in a special chamber, which usually consists of a table that fits into a special tube chamber. The chamber contains pure oxygen, and the pressure inside the chamber will slowly increase, about two and a half times that of normal atmospheric pressure.During your treatment session, you may feel dizzy and tired.

Hyperbaric oxygen therapy for gas gangrene usually lasts about 90 minutes. You may need up to three sessions on the first day of hyperbaric oxygen therapy, and then twice a day for up to five days.

Other treatments for gangrene may include supportive care, including fluid, nutrient, and pain relievers to relieve pain.

FORECAST

In general, people with dry gangrene have a better prognosis because dry gangrene is not associated with a bacterial infection and spreads more slowly than other types of gangrene. However, when infected gangrene is diagnosed and treatment is promptly initiated, the likelihood of recovery is high.

Elderly people, people with weakened immune systems or comorbid conditions (for example, diabetes, atherosclerosis, or some types of cancer), and those who seek medical help for advanced cases of gangrene are more likely to have complications from gangrene.

PREVENTION

Here are some tips to help you reduce your risk of developing gangrene:

• Control your diabetes. If you have diabetes, check your hands and feet daily for cuts, sores, and signs of infection such as redness, swelling, or discharge. Ask your doctor to check your hands and feet at least once a year.
• Lose weight. Extra pounds not only increase your risk of diabetes but also put pressure on your arteries, decrease blood flow, and increase the chances of infection and slow wound healing.
• Do not smoke. Chronic tobacco use can damage blood vessels.
• Try to prevent infections. Wash open wounds with mild soap and water and try to keep them clean and dry while they heal.
• Watch the temperature drop. Frostbite of the skin can lead to gangrene, due to frostbite decreases blood circulation in the affected area.If you notice any area of ​​your skin that is pale, hard, cold, and numb after prolonged exposure to low temperatures, see your doctor.

The new test will distinguish any viral infection from a bacterial one and will save you from taking unnecessary antibiotics

Scientists have developed a test that detects genetic markers of any viral infection in the blood. This will distinguish it from bacterial and avoid unnecessary antibiotics.

A very useful test made by specialists at Duke University Medical Center . It allows you to distinguish any viral infection from a bacterial one. When a person falls ill with symptoms of acute respiratory infections, an acute respiratory disease, it is almost impossible to immediately recognize the source of the infection – whether it is a virus or a bacterium. Meanwhile, it is obvious that the treatment in these two cases should be completely different. Antibiotics, which our compatriots love to swallow at the first sign of malaise, are effective only for bacterial infections, and for viral infections they will not help, but only harm.

The test is based on a blood test, which detects a marker produced by the immune cells of a sick person only in response to a viral infection.

03 September 10:32

Authors published its description in Science Translational Medicine .They believe that their discovery can already be applied in practical medicine to save patients from unnecessary antibiotic use.

“It is also important to recognize the viral nature of the infection in case of infection with such serious pathogens as the avian influenza virus or the Middle East coronavirus,” emphasizes study co-author Jeffrey Ginsburg, professor of medicine at Duke University. – The currently used tests are designed for one type of virus, for their application you need to know what to look for.

But our test will detect any virus not even known to science yet. ”

It is also capable of detecting any potential viral bioterrorism threat.

The human immune system responds to a virus infection in a different way than to a bacterial infection.These differences can be seen at the genetic level, as certain genes are turned on in response to a viral attack. Thus, any viral infection leaves a genetic “fingerprint” that can be detected.

This fingerprint includes a reaction of the so-called reverse transcription – the synthesis of double-stranded DNA on a single-stranded RNA template, which occurs during the multiplication of RNA viruses.

The developed test system is based on the detection of reverse transcription.

In previous work, a team at Duke University approached the development of a test, finding about 30 genes involved in the immune system’s response to the virus. To do this, biologists conducted research on volunteers who, in the interests of science, were infected with non-dangerous respiratory viruses.

In the present study, the test was tested on 102 patients admitted to an emergency clinic.Some of them had a viral infection, others a bacterial, control volunteers were not infected with anything.

Using their test, the specialists identified patients with a viral infection with an accuracy of 90%.

Scientists were satisfied with this result, and they believe that the test opens up a new approach to the diagnosis of infectious diseases.

Currently, the test, which evaluates the activity of 30 genes, takes about 12 hours. Researchers plan to improve it in the direction of reducing the number of genes, shortening the time and improving the accuracy of diagnosis.In the future, they are going to conduct more extensive testing of the test.

According to co-inventor Christopher Woods, the test developed will solve a serious health problem.

“One of the biggest global threats is bacterial resistance to antibiotics, which arises as a result of the overuse of antibiotics.

A test that can quickly distinguish viral from bacterial infection will eliminate unnecessary antibiotic use and reduce the bacteria’s chances of developing resistance, ”Woods said.

90,000 Sepsis and septic shock: signs and diagnosis

Sepsis is a potentially life-threatening condition caused by the body’s response to infection. The body usually releases chemicals into the bloodstream to fight infection. Sepsis occurs when the body’s response to these chemicals is disrupted, causing changes that can disrupt the function of many organs.

If sepsis turns into septic shock, blood pressure drops sharply. This can lead to death.

Sepsis causes infections and can happen to anyone. Sepsis is most common and most dangerous for:

• Seniors
• Pregnant women
• Children under 1 year old
• People with chronic diseases such as diabetes, kidney, lung or cancer
• People with weakened immune systems

In the early stages, sepsis is treated with antibiotics and a large number of IVs to increase the chances of survival.

Signs and symptoms of sepsis

To be diagnosed with sepsis, you must have probable or confirmed infection and all of the following:

1. Change in mental status
2. The first (top) number in a blood pressure reading – also called systolic pressure – is less than or equal to 100 millimeters of mercury
3. Respiratory rate greater than or equal to 22 breaths per minute

Signs and symptoms of septic shock

Sepsis can progress to septic shock, when certain changes occur in the circulatory system and body cells, which disrupt the delivery of oxygen and other substances to tissues.Septic shock is more likely to cause death than sepsis. To be diagnosed with septic shock, you must have a probable or confirmed infection and both of the following:

1. The need for drugs to maintain blood pressure above or equal to 65 millimeters of mercury.
2. High levels of lactic acid in your blood (serum lactate). Too much lactic acid in your blood means your cells are not using oxygen properly.

When to see a doctor

Sepsis is most common in people who are hospitalized or have recently been hospitalized. People in the intensive care unit are especially vulnerable to developing infections that can lead to sepsis. If you develop signs and symptoms of sepsis after surgery or after hospitalization, seek immediate medical attention.

Causes of sepsis

Although any type of infection – bacterial, viral, or fungal – can lead to sepsis, the most likely options are:

• Pneumonia
• Infection of the digestive system (which has affected the stomach and colon)
• Infection of the kidneys, bladder and other parts of the urinary system
• Blood infection (bacteremia)

Risk factors

Sepsis and septic shock are more common:

• At a very young age
• Old
• With weakened immune system
• For diabetes or cirrhosis
• With frequent hospitalizations
• For wounds or injuries, burns
• When using invasive devices such as intravenous catheters or breathing tubes
• Previously received antibiotics or corticosteroids

Complications of sepsis

As sepsis develops, the blood supply to vital organs such as the brain, heart and kidneys is disrupted.Sepsis can cause blood clots to form in your organs, hands, feet, fingers and toes, leading to varying degrees of organ failure and tissue death (gangrene).

Most people recover from mild sepsis, but septic shock has a mortality rate of about 40 percent. Plus, an episode of severe sepsis can put you at greater risk for future infections.

Scabies – KVD No. 2

Scabies – a contagious parasitic skin disease caused by the scabies mite

Sarcoptes scabiei, accompanied by itching, worse in the evening and at night, and

papular vesicular eruptions.

Currently, scabies remains one of the most common parasitic

dermatoses in our country.

An increase in the number of patients with scabies usually accompanies wars, natural disasters,

social shocks due to population migration, economic downturn,

deterioration of social conditions.

As mentioned above, the causative agent of scabies is the scabies mite – Sarcoptes scabiei.

This species belongs to the family Sarcoptidae, group Acaridiae, suborder Sarcoptiphormes,

to the order of acariform mites Acariphormes.Representatives of the genus Sarcoptes currently

time known as parasites of more than 40 species of animal hosts belonging to 17.

families of 7 orders of mammals.

Morphological appearance of scabies mites of the Sarcoptidae family extremely

is unique and due to deep adaptations to intradermal parasitism.

The structure of itch pruritus, like most mites, is characterized by strict

by the constancy of the microstructures of the external skeleton, which is associated with their microscopic

sizes.

The female itch mite looks like a turtle. Its size is 0.25–0.35 mm.

Adaptations to intradermal parasitism are represented by multiple

setae, triangular cuticle outgrowths on the dorsal surface, spines on all

paws that serve as stops when gnawing through, chelicerae of gnawing type,

long elastic bristles on the tarsi of the hind legs, to maintain direction

moves forward only. Devices for ectoparasitism – sticky pneumatic

suckers on the forelegs, waxy bristles on the body and limbs creating

around the tick an extensive mechanoreceptor sphere and allowing orientation to

touch without eyes.The rate of movement of the female during the course is 0.5–2.5 mm / day, and at

skin surface 2–3 cm / min. Sexual dimorphism is characteristic of scabies mites.

The main function of males is fertilization. They are much smaller in size –

0.15-0.2 mm, have dense bristles on the body to protect against mechanical stress and

suckers also on the IV pair of legs for attachment to the female during mating. Ratio

females and males in scabies mites is 2: 1.

The life cycle of an itch mite is clearly divided into two parts: short-term

cutaneous and long-term intradermal. Intradermal is represented by two topically

separated periods: reproductive and metamorphic. Reproductive

is carried out by the female in the itch burrowing through her, where she lays eggs.

Hatched larvae emerge from the passages to the surface of the skin through the holes,

done by the female over the place of each clutch, settle on it and are introduced into

hair follicles and under the scales of the epidermis.Here their metamorphosis (molting) takes place:

through the stage of proto and teleonymph, new individuals (females and males) are formed. Females and

males of the new generation emerge on the surface of the skin, where they mate.

Daughter females migrate to the hands, wrists, feet, penetrate the skin and immediately begin

to lay passages and lay eggs. In rare cases, the introduction of females is possible in other

areas of the skin (buttocks, axillary areas, abdomen, etc.)) at the expense of

mechanical pressing. Clinically, this corresponds to scabious skin lymphoplasia.

Only females and larvae are invasive stages and participate in infection. At

at room temperature and at least 60% relative humidity, females keep

mobility 1–6 days. Even at 100% humidity, females can withstand on average up to 3

days, larvae – up to 2 days.

Scabies mites are characterized by a strict daily rhythm of activity.Afternoon female

is at rest. In the evening and in the first half of the night, she gnaws one or

two egg bends at an angle to the main direction of travel, in each of which

lays one egg. Before laying the egg, it deepens the bottom of the passage, and in the roof it makes

outlet for larvae. The second half of the night, the female gnaws a course in a straight line,

eating intensively, during the day – stops and freezes. The daily program is running

by all females synchronously.As a result, the scabby course on the patient’s skin has a convoluted

is a shape and consists of stroke segments called the daily stroke element. Back part

strokes are gradually exfoliated, and during a clinical examination of the patient, he at a time

consists of 4–7 diurnal elements and has a constant length of 5–7 mm. During life

the female passes 3–6 cm in the epidermis, the revealed daily rhythm of activity has

of great practical value. He explains the increased itching in the evening, predominance of

direct route of infection by contact in bed in the evening and at night, efficiency

appointments of anti-scab drugs at night.

Clinical picture

The clinic of scabies is due to the characteristics of the pathogen and the reaction of the host organism to

its implementation.

The incubation period for scabies has a different duration and depends on whether

, an adult female or larva got on the skin. In the first case, it is extremely short, and in

second is 2 weeks. Itching, as the main symptom of scabies, appears on time,

which range from 14 days to 6 weeks for primary infection and may be

is extremely short, limited to a few days during reinfection.Also shown,

that reinfection at the same time may be more difficult in already

sensitized persons, and the number of detected scabies mites in such

patients are often minimal [7, 9].

The typical form of scabies is characterized by itchy skin manifesting in

is greatest in the evening and during sleep. However, itching can be persistent. He

can be localized in certain areas of the skin or spread throughout the body, for

excluding the skin of the face and scalp.Extremely important feature

is the presence of itching in family or team members.

Examination reveals specific rashes. Main clinical

symptoms of scabies are scabies, polymorphic eruptions outside the passages,

characteristic lesions and symptoms named after the authors Ardi

(the presence of pustules and purulent crusts on the elbows and in their circumference), Gorchakova (the presence there

bloody crusts), Michaelis (the presence of bloody crusts and impetiginous

rashes in the intergluteal fold with the transition to the sacrum), Cesari (detection

itch burrows in the form of a slight elevation on palpation).

The characteristic places of localization of rashes are mainly flexion

the surface of the joints (wrist and elbow), as well as the anterolateral surface

abdomen, lower back, buttocks, genital area, while they are absent on the upper

half of the back. Scabies and eruptions are well pronounced in the interdigital and

axillary folds, on the areola of the breast of women, in the navel.

Rashes are represented by paired papules and vesicles, scabby passages,

eczematous pseudo-vesicles (pearl vesicles) on the skin of the lateral surfaces

fingers and palms; scabious ulcers, with crusts on the surface; as well as scabious

knots.

Atypical forms of scabies, often encountered in recent years, it seems to us

appropriate to classify and represent as follows:

scabies without skin lesions;

urticarial scabies;

scabies on the background of corticosteroid therapy;

nodular (with post-scabious nodules) scabies;

eczematized scabies;

scabies complicated by pyoderma;

Norwegian scabies;

infants and children scabies.

The first two forms are mainly due to allergic reactions.

Scabies without skin lesions may be beginner forms

diseases in people who observe the norms of body hygiene, but more often manifests itself as

allergic reaction to tick antigens during the period of illness or after treatment. This

the form of the disease is more often detected during active examination of persons who were in contact with

patients with scabies.

Urticarial scabies is represented by small blisters due to sensitization

to both ticks and their waste products. They occur more often on the front

surface of the torso, thighs, buttocks and forearms.

Scabies with local corticosteroid therapy, also called latent scabies,

as a result of suppression of immune reactions of the skin leads to the loss of specific symptoms

scabies. The disease acquires papulosquamous, papulovesicular, and sometimes even

hyperkeratotic nature of the rash.

Nodular scabies (scabious lymphoplasia) characterized by itchy nodules

red, pink or brown. On the surface of new knots,

to detect itch burrows. Characteristic localization: penis, scrotum,

axillary and intergluteal folds, areola. Nodules usually

are few in number. Sometimes they are the only diagnostic feature

scabies [2, 4].

Eczematized scabies occurs, as a rule, in people with allergic

predisposition.Lichenification foci may appear at the sites of scratching.

However, eczematous lesions usually come to the fore and the diagnosis of scabies is not

can always be suspected. Rashes appear on the hands, in the armpits

depressions, shins, hands. In advanced cases, rashes can acquire

disseminated, up to the development of erythroderma.

In persons with reduced body resistance to eczematized lesions by

places of scratching can be associated with a secondary bacterial infection in the form of impetigo

or ecthyma, staphylococcal folliculitis, boils and abscesses may occur.

Norwegian scabies (crusty, crusty) in the initial stages presented as common

scabies or disguised as atopic dermatitis, psoriasis, seborrheic dermatitis.

Characterized by keratinization, formation of scales or thick crusts. With a pronounced

immunodeficiency process can be generalized, with neurological

diseases – manifest as a limited area of ​​impaired sensitivity.

Infant and infant scabies is characterized by eruptions resembling

urticaria or childhood pruritus in the form of a large number of combed and covered

a crust of blisters with predominant localization in the perineum on the scrotum, in

axillary folds.The characteristic itch burrows can be found on the soles.

Diagnostics

Diagnosis of scabies, in addition to clinical data, is based on microscopic

confirmation of the diagnosis. However, this procedure requires considerable skill, experienced by

microbiologists and in some clinical forms is impracticable. Minimum

clinical manifestations of scabies also make it difficult to obtain sufficient

biological materials for research.The technique has advantages in

specialized institutions. There are several laboratory techniques

scabies diagnostics: mite extraction with a needle, thin section method, scrapings, alkaline

skin preparation.

Scabies is a contagious parasitic skin disease caused by the itch mite Sarcoptes scabiei, accompanied by itching, worse in the evening and at night, and papular vesicular rash.

Currently, scabies remains one of the most common parasitic dermatoses in our country.

An increase in the number of patients with scabies usually accompanies wars, natural disasters, social upheavals, which is caused by population migration, economic recession, worsening social conditions.

As mentioned above, the causative agent of scabies is the scabies mite – Sarcoptes scabiei. This species belongs to the Sarcoptidae family, the Acaridiae group, the Sarcoptiphormes suborder, the Acariphormes order of acariform ticks. Representatives of the genus Sarcoptes are currently known as parasites of over 40 host species belonging to 17 families of 7 orders of mammals.

The morphological appearance of itch mites of the Sarcoptidae family is extremely peculiar and is due to deep adaptations to intradermal parasitism. The structure of itch itch, like most mites, is characterized by the strict constancy of the microstructures of the external skeleton, which is associated with their microscopic size.

The female itch mite looks like a turtle. Its size is 0.25–0.35 mm. Adaptations to intradermal parasitism are represented by multiple bristles, triangular cuticle outgrowths on the dorsal surface, spines on all legs that serve as stops when gnawing through the course, gnawing chelicerae, long elastic bristles on the legs of the hind pairs of legs, to maintain the direction of travel only forward.Devices for ectoparasitism are sticky pneumatic suction cups on the forelegs, waxy bristles on the body and limbs, which create an extensive mechanoreceptor sphere around the tick and allow one to navigate by touch without eyes. The speed of movement of the female in the course is 0.5–2.5 mm / day, and on the surface of the skin, 2–3 cm / min. Sexual dimorphism is characteristic of scabies mites. The main function of males is fertilization. They are much smaller in size – 0.15–0.2 mm, have dense bristles on the body to protect against mechanical stress and suckers also on the fourth pair of legs for attachment to the female during mating.The ratio of females to males in scabies mites is 2: 1.

The life cycle of the scabies mite is clearly divided into two parts: short-term cutaneous and long-term intradermal. Intradermal is represented by two topically separated periods: reproductive and metamorphic. The reproductive is carried out by the female in the itch gnawing through her, where she lays eggs. The hatching larvae emerge from the passages to the surface of the skin through the holes made by the female above the place of each clutch, settle on it and penetrate into the hair follicles and under the scales of the epidermis.Here their metamorphosis (molting) proceeds: through the stage of proto- and teleonymph, new individuals (females and males) are formed. Females and males of the new generation come to the surface of the skin, where they mate. Daughter females migrate to the hands, wrists, feet, penetrate the skin and immediately begin to make passages and lay eggs. In rare cases, the introduction of females is possible in other areas of the skin (buttocks, axillary areas, abdomen, etc.) due to mechanical pressing. Clinically, this corresponds to scabious skin lymphoplasia.Only females and larvae are invasive stages and participate in the infection. At room temperature and relative humidity, at least 60% of females remain mobile for 1–6 days. Even at 100% humidity, females can withstand on average up to 3 days, larvae – up to 2 days.

Scabies mites are characterized by a strict daily rhythm of activity. During the day, the female is at rest. In the evening and in the first half of the night, she gnaws one or two egg knees at an angle to the main direction of the stroke, in each of which she lays an egg.Before laying the egg, it deepens the bottom of the passage, and makes an outlet for the larvae in the roof. In the second half of the night, the female gnaws a course in a straight line, intensively feeding, during the day it stops and freezes. The daily program is performed by all females synchronously. As a result, the itch course on the patient’s skin has a crimped shape and consists of sections of the course, called the daily stroke element. The posterior part of the stroke is gradually exfoliated, and during a clinical examination of the patient, it consists of 4–7 daily elements at a time and has a constant length of 5–7 mm.During her life, the female passes 3–6 cm in the epidermis; the revealed daily rhythm of activity is of great practical importance. He explains the intensification of itching in the evening, the predominance of a direct route of infection through contact in bed in the evening and at night, the effectiveness of prescribing anti-scab drugs at night.

Clinical picture

The clinical picture of scabies is due to the characteristics of the pathogen and the response of the host organism to its introduction.

The incubation period for scabies has a different duration and depends on whether an adult female or a larva got on the skin.In the first case, it is extremely short, and in the second it is 2 weeks. Itching, as the main symptom of scabies, appears in terms that range from 14 days to 6 weeks with a primary infection and can be extremely short, limited to a few days with reinfection. It has also been shown that reinfection at the same time can be more difficult in already sensitized individuals, and the number of detected scabies mites in such patients is often minimal [7, 9].

The typical form of scabies is characterized by itchy skin, which is most pronounced in the evening and during sleep.However, itching can be persistent. It can be localized to specific areas of the skin or spread throughout the body, with the exception of the face and scalp. An extremely important symptom is the presence of itching in family or community members.

Examination reveals specific rashes. The main clinical symptoms of scabies are scabies, polymorphic eruptions outside the passages, characteristic places of rashes, as well as symptoms named after the authors of Ardi (the presence of pustules and purulent crusts on the logs and in their circumference), Gorchakov (the presence of bloody crusts in the same place), Michaelis (the presence of bloody crusts and impetiginous rashes in the intergluteal fold with the transition to the sacrum), Cesari (detection of itch passages in the form of a slight elevation on palpation).

The characteristic places of localization of rashes are mainly the flexion surface of the joints (wrist and elbow), as well as the anterolateral surface of the abdomen, lower back, buttocks, genital area, while they are absent on the upper half of the back. Scabies and eruptions are well expressed in the interdigital and axillary folds, on the areola of the breast of women, in the navel. Rashes are represented by paired papules and vesicles, scabby passages, eczematous pseudo-vesicles (pearl vesicles) on the skin of the lateral surfaces of the fingers and palms; scabious ulcers, with crusts on the surface; as well as scabious nodules.

Atypical forms of scabies, which are often encountered in recent years, it seems to us appropriate to classify and present as follows:

scabies without skin lesions;

urticarial scabies;

· scabies on the background of corticosteroid therapy;

nodular (with post-scabious nodules) scabies;

eczematized scabies;

scabies complicated by pyoderma;

Norwegian scabies

Infant and infant scabies.

The first two forms are mainly due to allergic reactions.

Scabies without skin lesions can represent an early form of the disease in people who observe the norms of body hygiene, but more often manifests itself as an allergic reaction to tick antigens during the period of illness or after treatment. This form of the disease is more often detected during active examination of persons who have been in contact with a patient with scabies.

Urticarial scabies is represented by small blisters caused by sensitization to both ticks and their waste products.They occur more often on the front of the torso, thighs, buttocks, and forearms.

Scabies on the background of local corticosteroid therapy, also called latent scabies, as a result of suppression of the immune responses of the skin, leads to the loss of specific symptoms of scabies. The disease acquires papulosquamous, papulovesicular, and sometimes even hyperkeratotic nature of the rash.

Nodular scabies (scabious lymphoplasia) is characterized by the appearance of itchy nodules of red, pink or brown color.Scabies can be found on the surface of the new nodules. Typical localization: penis, scrotum, axillary and intergluteal folds, areola. The nodules are usually few in number. Sometimes they are the only diagnostic sign of scabies [2, 4].

Eczematized scabies occurs, as a rule, in people with an allergic predisposition. Lichenification foci may appear at the sites of scratching. However, eczematous lesions usually come to the fore and the diagnosis of scabies may not always be suspected.Rashes appear on the hands, armpits, legs, hands. In advanced cases, rashes can become disseminated, up to the development of erythroderma.

In persons with a reduced body resistance to eczematized lesions at the sites of scratching, a secondary bacterial infection in the form of impetigo or ecthym may occur, staphylococcal folliculitis, boils and abscesses may occur.

Norwegian scabies (crusty, crusted) in the initial stages is presented as ordinary scabies or disguised as atopic dermatitis, psoriasis, seborrheic dermatitis.Characterized by keratinization, the formation of scales or thick crusts. With severe immunodeficiency, the process can be generalized, with neurological diseases, it can manifest itself in a limited area of ​​impaired sensitivity.

Infant and infant scabies is characterized by rashes resembling urticaria or childhood pruritus in the form of a large number of combed and crusted blisters with predominant localization in the perineum on the scrotum, in the axillary folds.The characteristic itch burrows can be found on the soles.

Diagnosis of scabies

The diagnosis of scabies, in addition to clinical data, is based on microscopic confirmation of the diagnosis. However, this procedure requires considerable skill, an experienced microbiologist and, in some clinical forms, is not feasible. The minimal clinical manifestations of scabies also make it difficult to obtain sufficient biological material for research. The technique has advantages in specialized institutions.There are several methods for the laboratory diagnosis of scabies: extraction of the tick with a needle, the method of thin sections, scrapings, alkaline preparation of the skin.

MENACTRA vaccine

Meningococcal infection is an extremely serious and deadly bacterial infection caused by Neisseria meningitidis.

Clinical manifestations are extremely diverse: from asymptomatic carriage and nasopharyngitis to generalized forms (purulent meningitis, meningoencephalitis and meningococcemia with damage to various organs and systems).

Today, there are 12 serogroups (varieties) of this bacterium, of which 6 (A, B, C, W, Y, X) cause most severe forms of the disease. The peculiarity of the infection is that meningococcus has a polysaccharide capsule that protects it from attacks by the immune system.

Meningococcal diseases most often affect children in the first 5 years of life, as well as people with chronic diseases, immunodeficiency states who have undergone spleen removal, transplantation of internal organs, children visiting organized groups, as well as elderly people and travelers.The incubation period of the disease is on average 7 days, the manifestation can be lightning fast.

Meningococcus is transmitted primarily by airborne droplets, less often by household contact. The source of infection is a person with acute nasopharyngitis, with an acute generalized form of meningococcal infection, or a healthy carrier without any clinical manifestations.

The disease begins with the usual symptoms of a runny nose and fever, after a few hours or days there is a severe headache, fever reaches 40 ° C, there may be loss of consciousness, the appearance of a hemorrhagic rash.The rash is a hemorrhage from small pale pink dense swellings, pinpoint “star” elements, up to bruises located on the legs, buttocks and arms, and leaves behind a necrotic mass that must be removed.

Characteristic of the patient with meningitis: head thrown back, inability to bring the chin to the chest, legs are pulled to the stomach. The patient’s consciousness is confused, the reactions are inhibited, he is sluggish. Severe intoxication of the body due to poisoning with decay products of the affected tissues leads to disruption of the cardiovascular, respiratory systems and the death of the patient.With a favorable course of recovery, a long recovery period is preceded, but often the transferred meningococcal meningitis leads to damage to the central nervous system, seizures, epilepsy, decreased intelligence, hearing loss, gangrene of fingers, toes, ears.

In infants, regurgitation, monotonous crying, bulging and pulsation of the fontanelle and the rapid development of a soporous state occur.