Cellulitis Information and Courses from MediaLab, Inc.
These are the MediaLab courses that cover Cellulitis and links to relevant pages within the course.
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|A clinical condition often associated with Streptococcus anginosus ("milleri") is:||View Page|
A 40-year-old woman with a long history of diabetes mellitis developed swelling and erythema of the left lower leg following superficial abrasion of the skin after a fall. The patient developed high fever and mild prostration. The cellulitis of the lower leg is shown in the image. Note in the photograph that the acute inflammation is most evident as red areas of streaking at the sites of abrasion. Blood cultures were obtained that turned positive in 18 hours.
|What is a major complication of toxic shock syndrome related to group A streptococci, leading to 50% mortality?||View Page|
A 35-year-old man presented in the emergency room with an erythematous, vesiculo-pustular lesion of the arm near the elbow (see image). One week previously he had scratched his arm on the antenna of his car while washing the windshield. He noticed a red area about three days after the incident, which then spread to involve the adjacent tissue. The central pustule developed on the day he was seen. Material from the center of the pustule was sent to the microbiology laboratory for culture.
|Which of the following result in most Eikenella cellulitis infections?||View Page|
|Healthcare (Hospital)-Associated MRSA versus Community-Associated MRSA|
As mentioned in the course introduction, MRSA infections fall into two general types: Healthcare-associated MRSA (HA-MRSA) Infections that occur in people who are, or have recently been, hospitalized. Community-acquired MRSA (CA-MRSA) Infections that are apparently acquired in the community There are a number of factors that distinguish HA-MRSA from CA-MRSA isolates. These factors are summarized in the table below. Factor HA-MRSA CA-MRSA Origin of strains Nosocomial infections Five isolates associated with healthcare settings: USA100, -200, -500, -600, -800 USA100 is the predominant isolate while USA 200 is the second most common isolate. USA700 has been isolated in both healthcare and community settings. Evolved from endemic methicillin susceptible S. aureus (MSSA) strains Two clones, USA300 and USA400, are associated with the majority of CA-MRSA infections in the United States. USA300 has emerged as the most prominent clone and is not found among hospital strains. Genetic lineage Isolates usually carry large SCCmec types I, II or III (34-67 kb) The larger size of SCCmecII and III permits the inclusion of other non-beta lactam resistance genes so that HA-MRSA strains tend to be multi-drug resistant Isolates carry a smaller SCCmec variant, predominantly type IV (24 kb), less often type V or variant VT. SCCmecIV (except for mecA) does not permit the inclusion of other non-beta lactam resistance genes so that CA-MRSA isolates exhibit resistance to only methicillin and erythromycin and are more often susceptible to other non-beta lactam antibiotics (eg., trimethoprim/sulfamethoxazole (SXT) and clindamycin). Affected population Largely affects older adults and people with weakened immune systems; those who have undergone surgical procedures are at increased risk. Healthy persons in the general population without established risk factors for MRSA acquisition Clinical syndromes Found at multiple sites, most commonly bloodstream infections, urinary tract infections (UTI) and respiratory tract infections Predominantly skin and soft tissue infections (SSTIs), such as abscesses, cellulitis, folliculitis and impetigo and a serious form of pneumonia Genes for Panton-Valentine Leukocidin (PVL) are associated with SCCmecIV; the clinical spectrum of infections caused by CA-MRSA is directly related to the presence of PVL genes, coding for the production of a cytotoxin that causes tissue necrosis and leukocyte destruction.
|Clean Up Your Act|
During a blood collection, bacteria that is present on the skin surface may adhere to the outside of the needle as it enters into the vein. This can allow bacteria to infect the puncture site. A serious infection of the blood (septicemia) or of the tissue (cellulitis) may result. To avoid an infection, it is imperative that the phlebotomist uses a technique that thoroughly cleanses the skin at the site prior to venipuncture.Once the phlebotomist locates a suitable vein for venipuncture, the site of the vein that will be punctured is cleaned with a pre-packaged wipe saturated with 70% isopropyl alcohol.The site is cleansed using a "target" motion beginning at the center of the site and moving outward in concentric circles applying enough pressure to move surface bacteria away from the puncture point. (This is demonstrated in the image on the right). It is not recommended to use a scrubbing back and forth motion to clean the site since you may drag bacteria from a dirty area back into the clean area. Allow alcohol to air dry for effective disinfection of the site. Never use non-sterile gauze to wipe dry the alcohol as this will contaminate the site.During the remainder of the procedure, the site must NOT be touched by anything that has not been cleaned in an identical manner. The phlebotomist should avoid retouching the site after cleaning. If it is absolutely necessary to re-palpate, the phlebotomist MUST clean the gloved finger in a manner identical to the above procedure. Make certain that no other piece of equipment touches the site. This includes ends of the tourniquet and gauze. If you suspect that your needle has touched the site before entry, dispose of the needle, re-clean the site and repeat the procedure using a new needle. If a patient complains that there is redness or pain at the puncture site, even hours or days after the procedure, immediately refer the patient to his/her physician for evaluation.