SKIN INFECTIONS: BACTERIAL FOLLICULITIS
Signs and Symptoms
Patients with folliculitis have scattered pustules and small red papules centered around hair follicles. Lesions may be mildly pruritic or painful. Systemic symptoms are very rare.
Pustules are confined to hair follicles, typically in one region of the body such as the chest, thighs, or back. However, follicles throughout the body can become infected over the course of a few days. In bacterial infections, most pustules still have a hair shaft protruding from the center. There may be some surrounding erythema and slight swelling.
Main Causes
Staphylococcal Folliculitis: Staphylococcal infection should be suspected if erythema, swelling, and tenderness are striking. If needed, culture should be performed by shaving a pustule with a scalpel and sending the whole pustule for culture. Oral antibiotics are preferred when staphylococcal infection is suspected.
Gram-Negative Folliculitis: The gram-negative organisms Klebsiella, Enterobacter, and Proteus can also cause folliculitis. Infection typically occurs on the faces of acne patients treated with long-term antibiotics active against gram-positive organisms. Topical erythromycin is usually effective. Severe cases are treated using amoxicillin-clavulonate (Augmentin) or even isotretinoin (Acutane).
Hot Tub Folliculitis: Folliculitis acquired from wet objects such as hot tubs, whirlpools, loofah sponges, or wet suits is usually caused by Pseudomonas aeruginosa. Lesions appear on exposed areas of the trunk and extremities between 6 and 72 hours after contact. In immunocompetent patients, lesions typically resolve spontaneously within 10 days. Treatment is not required, but the source should be cleaned and new tub water properly sanitized. Pseudomonas in a loofah sponge is killed when the sponge is simply allowed to dry completely. Soaks in 1% to 5% acetic acid, topical silver sulfadiazine cream, or garamycin cream may be helpful. If needed, systemic fluoroquinolones can also be used.
Treatment
Topical antibiotics work well in most cases of superficial bacterial folliculitis. Antibiotics should be targeted against the presumed etiologic organisms. Therapy should be continued until lesions resolve.
If follicles are widely distributed, systemic antibiotics can be used.
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FEVER IN RETURNED TRAVELERS: TRAVEL HISTORY
Questions regarding the travel history should focus on the following factors.
Exact Travel Itinerary
The risk of acquiring a travel-related infection depends on the precise geographic location and length of stay in each destination. Specific regions visited within each country should be determined, because some infections are focally transmitted, and risk is only present when traveling in endemic areas. The Centers for Disease Control and Prevention publishes an excellent reference, Health Information for the International Traveler, detailing specific infections that are found in different locations. Infections can be acquired en route, and layovers and intermediate stops should be identified. The type of transportation is also relevant, since outbreaks of many types of infections have been linked to airplanes, trains, and cruise ships.
Purpose of Travel
Determining the reason for travel can further assist in assessing the risk for certain infections. Business travelers typically stay in modern accommodations in urban centers and have fewer disease exposures. Adventure travelers usually spend considerable periods of time in rural settings, where the possibility for disease exposure is greater.
Accommodations
Tourists who stay in modern hotels in major urban centers generally have fewer exposures than backpackers or volunteer workers who spend significant time in rural settings with the local population. People who visit family and friends while abroad are also at increased risk for becoming ill during travel, since they often stay in local homes away from usual tourist routes. These individuals also are more likely to forgo recommended vaccines and chemoprophylactic regimens.
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FEVER IN RETURNED TRAVELERS: TRAVEL HISTORYQuestions regarding the travel history should focus on the following factors.
Exact Travel ItineraryThe risk of acquiring a travel-related infection depends on the precise geographic location and length of stay in each destination. Specific regions visited within each country should be determined, because some infections are focally transmitted, and risk is only present when traveling in endemic areas. The Centers for Disease Control and Prevention publishes an excellent reference, Health Information for the International Traveler, detailing specific infections that are found in different locations. Infections can be acquired en route, and layovers and intermediate stops should be identified. The type of transportation is also relevant, since outbreaks of many types of infections have been linked to airplanes, trains, and cruise ships.
Purpose of Travel Determining the reason for travel can further assist in assessing the risk for certain infections. Business travelers typically stay in modern accommodations in urban centers and have fewer disease exposures. Adventure travelers usually spend considerable periods of time in rural settings, where the possibility for disease exposure is greater.
AccommodationsTourists who stay in modern hotels in major urban centers generally have fewer exposures than backpackers or volunteer workers who spend significant time in rural settings with the local population. People who visit family and friends while abroad are also at increased risk for becoming ill during travel, since they often stay in local homes away from usual tourist routes. These individuals also are more likely to forgo recommended vaccines and chemoprophylactic regimens.*198/348/5*
OTITIS MEDIA, OR МIDDLЕ EAR INFECTION
Infection of the interior of the ear after a sore throat is not nearly so frequent as such infections used to be. The specific action against staphylococci, pneumococci, streptococci, and other germs that infect noses and throats wrought by the antibiotic drugs and sulfonamides has enormously reduced such complications. However, neglect of a sore throat or a virulent infection may occasionally be followed by spread of the germs to the middle ear. One or both ears may be infected. The condition usually begins with a pain in the ear and a high fever. The pain is continuous, but may be irregular, and is usually worse at night. When the doctor looks at the eardrum it is seen to be bulging. If the drum is not opened the pressure may cause it to burst. Then a thin watery discharge will come out, often changing to thick creamy pus. When the eardrum is cut or bursts the pain stops immediately and usually the temperature falls. The discharge may persist for a long time.
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OTITIS MEDIA, OR МIDDLЕ EAR INFECTIONInfection of the interior of the ear after a sore throat is not nearly so frequent as such infections used to be. The specific action against staphylococci, pneumococci, streptococci, and other germs that infect noses and throats wrought by the antibiotic drugs and sulfonamides has enormously reduced such complications. However, neglect of a sore throat or a virulent infection may occasionally be followed by spread of the germs to the middle ear. One or both ears may be infected. The condition usually begins with a pain in the ear and a high fever. The pain is continuous, but may be irregular, and is usually worse at night. When the doctor looks at the eardrum it is seen to be bulging. If the drum is not opened the pressure may cause it to burst. Then a thin watery discharge will come out, often changing to thick creamy pus. When the eardrum is cut or bursts the pain stops immediately and usually the temperature falls. The discharge may persist for a long time.*24/318/5*