Staphylococcus aureus

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Staphylococcus aureus genital skin infections vary in appearance and severity. The staphylococcal bacterium is characterized by gram-positive cocci in clusters under the microscope. Bacteria often gain access to underlying tissue through abrasions, burns, bites, cuts, fissures, or surgical incisions. Both community-acquired and hospital-acquired staphylococcal infections have continued to rise.

Genital staphylococcal infections are most often manifested as impetigo (superficial epidermal infection), folliculitis (superficial infection of follicular epithelium), furunculosis (deep suppurative infection of follicles, often with limited surrounding cellulitis), and cellulitis (infection of soft tissue.) Fairly often, one or more of these morphologies are present concomitantly.

Staphlococus Disease The Vaginal
Figure 9 Staphylococcal impetigo typically shows very superficial and fragile blisters manifested clinically by round erosions with peeling of the periphery, which represents the remnants of the blister roof.

Impetigo primarily affects children and there is no predilection for the genital skin. These lesions are characterized by very superficial vesicles produced by a staphylococcal toxin. The vesicle ruptures and leaves behind a superficial erosion and the development of a yellow crust surrounded by a base of erythema when occurring on keratinized skin (Fig. 9). The lesions are multiple and of varying duration.

Patients with folliculitis present with painful red papules overlying a hair follicle (Fig. 10). Folliculitis can be exacerbated by friction, shaving, or other trauma to the pubic hair-bearing area. These lesions sometimes enlarge to form furuncles, which are painful, red nodules measuring 1 to 2 cm (Fig. 11). The center of the lesion is filled with purulent material that releases by rupture or surgical incision. Carbuncles represent coalescing furuncles. Constitutional symptoms of fevers, generalized malaise, and chills are uncommon unless significant cellulitis is present.

Cellulitis consists of soft-tissue infection, usually accompanied by fever and other constitutional symptoms. Affected areas are painful, firm, edematous, and red, often with a peau d'orange appearance (Fig. 12). The area is sometimes purulent with abscess formation. This often occurs as extension from furunculosis or inoculation following trauma such as surgery, and it is more common in immuno-suppressed patients and those who are diabetic. Uncommonly, extension of infection to deeper tissues and progression to polymicrobial disease represent soft-tissue necrotiz-ing infection (Fournier's gangrene), often with anaerobic and gram-negative organisms.

Staphylococci produce many toxins such as cytotoxin, pyrogenic toxin, toxic shock syndrome toxin, and exfoliative toxin that characterize their destructive course. Toxic shock syndrome was first described in the 1980s associated with the introduction of extra superabsorbent tampons. Clinical manifestations are most often caused

Staph Lesion Labia

Figure 10 Bacterial folliculitis is almost always staphylococcal and exhibits scattered red papules and pustules; sometimes a hair can be visualized in the center of a lesion.

Figure 11 Furunculosis represents deep follicular infection that extends to surrounding tissue, producing a firm, tender red nodule.

by toxic shock syndrome toxin produced by S. aureus. Initial signs of infection may include myalgias, fevers, vomiting, and diarrhea. Patient status can decline within a matter of hours into hypovolemic shock and a dark red sunburn rash. On exam, vaginal inflammation and vaginal discharge are present. Local cultures

Staph The Vagina Lips

Figure 12 Cellulitis is characterized by diffuse inflammation and pain, often associated with systemic signs of infection; darkly complexioned patients often do not exhibit redness as a sign of inflammation, and instead the skin can be normal in color or apparently hyperpigmented.

and blood cultures are positive. Recently, nonmenstrual toxic shock syndrome has been defined in the literature and is associated with worsened renal and neurologic impairment.

The therapy of staphylococcal skin infections consists of antibiotics. Localized impetigo or folliculitis can be treated successfully with mupirocin ointment, but most skin infections are more widespread or deeper, responding best to systemic therapy. Essentially all S. aureus is resistant to penicillin, but until recently cephalexin, methi-cillin, oxacillin, and erythromycin were nearly always effective for these infections, especially when community acquired. Now, however, community-acquired methicillin-resistant disease has become common, in both urban and rural setting, sometimes accounting for the majority of infections and producing more severe disease than susceptible forms (31,32). Trimethoprim-sulfamethoxazole and vancomycin are usually effective for these patients, although resistance to these occurs at times. Fortunately, linezolid is a new antibiotic that is usually effective for methicillin-resistant S. aureus and available for oral administration (33). Unfortunately, there are now reports of resistance to linezolid from Germany (34). The treatment of toxic shock syndrome involves supportive care, fluid replenishment, and the addition of parenteral beta-lactamase-resistant antistaphylococcal antibiotics and aminoglycosides (Table 11).

Table 11 Staphylococcal Infection



Diagnosis Symptoms




Staphylococcal Tenderness,



Local sterile

infection burning,


herpes simplex,












possible incision,



and drainage


First choice—b-








cal antibiotics:



loma venereum




(penicillin V for

penicillin G-








aureus: depends

upon sensitivities

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How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

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