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IM - Genital Ulcers , Wound and Soft Tissue Infections

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tonystep1's version from 2017-08-08 05:45

Clinical Features and Treatment of Genital Ulcers With Regional Lymphadenopathy

Question Answer
Clean ulcer, raised / painless / usually singleBenzathine penicillin g (one dose IM) is the preferred agent - Primary Syphilis
Grouped papules , vesicles, pustules, ulcers / painful / often multipleTreat with oral and/or topical acyclovir for 7 to 10 days. - HSV
Purulent ulcer , shaggy border / painful / single in men but multiple in womenazithromycin (oral, one dose), ceftriaxone (IM, one dose), or an oral course of azithromycin, erythromycin, or ciprofloxacin. - Chancroid
Papule vesicle, ulcer / painless / usually singleThe treatment is doxycycline (oral for 21 days). - Lymphogranuloma venereum
Nodules, coalescing granuloatous ulcers / painless / single or multipleTrimethoprim-sulfamethoxazole and doxycycline - Granuloma inguinale
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CLINICAL FEATURES OF WOUND AND SOFT TISSUE INFECTIONS

Question Answer
CellulitisClassic findings of inflammation: erythema, warmth, pain, swelling // Fever (may or may not be present)
Necrotizing FasciitisClinical features may include fever and pain out of proportion to appearance of skin in early stages, so a high index of suspicion is important. Extension of infection leads to thrombosis of microcirculation, resulting in tissue necrosis, discoloration, crepitus, and cutaneous anesthesia
LymphadenitisIt presents with fever, tender lymphadenopathy of regional lymph nodes, and red streaking of skin from the wound or area of cellulitis
TetanusThe classic and earliest symptom is hypertonicity and contractions of the masseter muscles, resulting in trismus, or "lockjaw." // Progresses to severe, generalized muscle contractions including: a. Risus sardonicus-grin due to contraction of facial muscles b. Opisthotonos-arched back due to contraction of back muscles // Sympathetic hyperactivity
ErysipelasThe classic presentation is a well-demarcated, fiery red, painful lesion, most commonly on the lower extremities and the face. High fever and chills may be present
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TREATMENT OF WOUND AND SOFT TISSUE INFECTIONS

Question Answer
CellulitisTreat with a staphylococcal penicillin (e.g., oxacillin, nafcillin) or a cephalosporin (e.g. , cefazolin) . // Continue IV antibiotics until signs of infection improve. Follow up with oral antibiotics for 2 weeks.
ErysipelasTreatment for uncomplicated cases is IM or oral penicillin or erythromycin; otherwise treat as for cellulitis.
Necrotizing FasciitisAntibacterial treatment alone is not sufficient. Rapid surgical exploration and excision of devitalized tissue is an absolute necessity!
LymphadenitisIt usually responds well to treatment. Treat with appropriate antibiotics (penicillin G , antistaphylococcal penicillin, o r cephalosporin) and warm compresses // Wound drainage may ultimately be necessary.
TetanusAdmit the patient to the ICU and provide respiratory support if necessary. Give diazepam for tetany. // Neutralize unbound toxin with passive immunization-give a single IM dose of tetanus immune globulin (TIG). // Provide active immunization with tetanus/diphtheria toxoid (Td). // Thoroughly clean and debride any wounds with tissue necrosis
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DIAGNOSIS OF WOUND AND SOFT TISSUE INFECTIONS IS MAINLY CLINICAL

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