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Patient Case: Bacterial Skin Infections

Patient Case: Bacterial Skin Infections

Discussion

A 28-year-old construction worker presents with a four-day history of a painful, swollen lesion on his left forearm. The lesion started as a small red bump but has grown larger, becoming tender, warm, and filled with yellowish pus. He also reports mild fever and fatigue but denies any recent travel or insect bites.

His medical history is unremarkable, with no known allergies or chronic illnesses. He mentions frequently getting minor cuts and scrapes at work but usually ignores them.

On examination, there is a 3 cm fluctuant, erythematous abscess with central purulent drainage. Surrounding cellulitis extends about 1 cm from the lesion. No lymphadenopathy is noted, and his vital signs are stable. A clinical diagnosis of a bacterial skin infection, likely a Staphylococcus aureus abscess, is made.

The abscess is incised and drained, and the patient is prescribed a short course of oral antibiotics. He is advised to keep the wound clean, avoid sharing personal items, and follow up if symptoms worsen or new lesions develop. Given his occupation, he is also educated on proper wound care and hygiene to prevent recurrent infections.

Questions
1. What is the most likely diagnosis in this patient?

a) Impetigo
b) Abscess with surrounding cellulitis
c) Contact dermatitis
d) Fungal skin infection

a) Staphylococcus aureus
b) Streptococcus pneumoniae
c) Candida albicans
d) Escherichia coli

3. What is the most appropriate initial management for this condition?

a) Incision and drainage with possible oral antibiotics
b) High-dose intravenous antibiotics only
c) Topical antifungal cream
d) No treatment, as the lesion will resolve on its own

4. What preventive measures should this patient take to avoid future infections?

a) Proper wound care and hand hygiene
b) Regular use of topical corticosteroids
c) Wearing tight bandages over all minor wounds
d) Avoiding antibiotics altogether

Reveal answers

Answers

  1. (b) Abscess with surrounding cellulitis
    • The presence of a painful, swollen lesion with purulent drainage, warmth, and surrounding cellulitis strongly suggests a bacterial abscess, most likely caused by Staphylococcus aureus. Impetigo (a) is a superficial skin infection with honey-colored crusts, contact dermatitis (c) is non-infectious and usually itchy, and fungal infections (d) are typically scaly rather than purulent.
  2. (a) Staphylococcus aureus
    • Staphylococcus aureus is the most common cause of skin abscesses, particularly in individuals exposed to frequent minor skin trauma. Streptococcus pneumoniae (b) is a respiratory pathogen, Candida albicans (c) causes fungal rather than bacterial infections, and Escherichia coli (d) is primarily associated with gastrointestinal and urinary tract infections.
  3. (a) Incision and drainage with possible oral antibiotics
    • The first-line treatment for an abscess is incision and drainage (I&D) to remove the pus. Oral antibiotics may be prescribed if there is extensive cellulitis, systemic symptoms, or risk factors such as immunosuppression. IV antibiotics (b) are unnecessary for uncomplicated abscesses. Antifungal creams (c) are not useful for bacterial infections, and watchful waiting (d) risks worsening infection.
  4. (a) Proper wound care and hand hygiene
    • Good hygiene and proper wound care reduce the risk of recurrent infections, especially for individuals in occupations with frequent skin injuries. Topical corticosteroids (b) can worsen bacterial infections by suppressing local immune responses. Tight bandages (c) may trap bacteria and delay healing. Avoiding antibiotics entirely (d) is not a preventive strategy but rather a way to reduce unnecessary antibiotic use.

write a short fictitious patient case on impetigo and ecthyma without putting the name in sub-saharan africa

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