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Staph Skin Infections

What is Staph Infection?

Staphylococcus infection, or simply Staph infection, is a group of infections caused by Staphylococcus [1]. Staphylococcus, a bacterium which is gram-positive, is one of the major causes of infection in humans and animals [2].

This group of bacteria are normally present in the areas of the body such as mouth, nose, genitals, and anus [3]. There are various types of staphylococci. The most common cause of infections worldwide is the Staphylococcus aureus (S. Aureus).

Staph infections vary from minor to life-threatening ones. It can start when a break or cut into the skin is made, causing the bacteria to enter and infect it [3]. In some, it may not show symptoms or may just be a minor infection. But if these bacteria are able to invade the deeper portions of the body, it can be deadly. These may enter the vital body parts such as the blood vessels, bones, joints, heart, and even lungs [4].

 

Staph Infection Causes

In most people, Staph bacteria reside on their skin without experiencing problems. However, when the skin’s integrity is destroyed through abrasions or cuts, bacteria are given the chance to enter it. If the bacteria that entered the skin become successful in breaking through despite the skin’s defense mechanisms, Staph skin infections occur [5].

 

How does Staph Infection Spread?

Infections caused by Staphylococcus can spread from person to person. Here are some ways on how it can be transmitted:

  • Sharing of items: clothes, bed linens, towels, razor, toys, sports equipment
  • Skin to skin contact with infected person or pet
  • Sneezing: Happens when an infected person sneezes and the droplets fall on the damaged skin of another person
  • Picking of nose, scratching the skin [7]

 

Risk Factors in Acquiring Staph Infections

Invasive Devices

Medical tubings inserted through the skin can increase the risk of the entrance of bacteria into the system. This involves the medical invasive devices or procedures such as:

  • Intravenous catheters
  • Dialysis
  • Urinary catheters
  • Nasogastric tubes or feeding tubes [4]

Recent hospitalization

Hospital-acquired infections are usually caused by Staph bacteria. Though there are vigorous attempts to eliminate these bacteria, it still cannot be removed completely. Hospital-acquired infections mostly affect people with conditions like:

  • Surgical wounds
  • Immunosuppression or weakening of immune systems
  • Burns
  • Blood disorders: Leukemia, anemia, lymphoma
  • Medical problems like diabetes mellitus [4, 5]

Medications

Taking medications can also cause a person to be prone to Staph infections. These medications include:

  • Retinoids
  • Cytotoxics
  • Immunosuppressives
  • Systemic steroids [6]

Nutritional State

  •  Malnutrition
  • Alcoholism [6]

 

Staph Infection Symptoms

Skin and soft tissue infection

The common sites affected by Staphylococcus infection are the skin and the soft tissues. The symptoms of infection in these areas are:

1. Abscess

  • Also known as boils, these are lumps that form on the skin surface or beneath it. It is swollen, reddish, painful, and warm to touch.
  • These are usually filled with pus.  [1, 8]

2. Cellulitis

  • This refers to the condition in which the underlying layers of the skin are infected.
  • It is usually comes from the skin injuries such as scrapes or cuts in wherein the bacteria enter the body.
  • Mostly, it appears on the arms or legs but it may also occur on the other parts of the body.
  • Its symptoms are tenderness, redness, and swelling of the infected site. [8]

Invasive infections

This type of infection occurs as a result of the complication of a skin infection. Its symptoms have a wide range and may be more severe.

  • Shortness of breath
  • High Fever (usually above 38 degrees Celsius), chills, malaise
  • Hypotension (low blood pressure) and dizziness especially when getting up
  • Disorientation or confusion [1, 8]

 

Types of Staphylococcus Aureus Infections

Localized Skin Infections

1. Boils

Also referred to as skin abscess, boil is a skin condition wherein there is an accumulation of pus in the skin. This appears as reddish pockets on the skin which are painful and swollen.

  • Cystic Acne: This appears as group of lesions resulting from the accumulation of oil and dead skin cells at the sebaceous glands.
  • Hidradenitis suppurativa: These are boils which may be located at the groin, armpits, underside of the breasts, anal area, and inner thighs. This is due to clogged sebaceous glands and generally occurs in puberty.

2. Folliculitis

It is defined as the infection of the hair follicles usually caused by Staphylococcus bacteria. It usually affects the scalp, face, neck, limbs, genital area and trunk, where there is growth of hair. It appears as reddish, pus-filled blisters which are painful.

Staph infection-folliculitis

Picture 1: Folliculitis Picture

Source: atlasdermatologico.com.br

  • Folliculitis barbae: folliculitis located at the beard in men
  • Stye/hordeolum: folliculitis occurring on the edge of either lower or upper eyelids

staph infection-stye

Picture 2: Stye Eye Infection Picture

Source: riddlescape.com

  • Furuncle: Occurs as a result of folliculitis when it affects the adjacent skin tissue as well. Usually, it is found on the legs, arm, or neck.

Staph infection-furuncle

Picture 3: Furuncle on the neck

Source: atlasdermatologico.com.br

  • Pilonidal cyst: Develops from the irritation and infection of hair follicles. It mostly appears between the buttocks caused by prolonged period of sitting.

3. Cellulitis

  • This is the term used when referring to the infection which affects the underlying skin tissues. It is characterized by swelling, tenderness, redness, and warmth of the infected area.

Staph infection-cellulitis

Picture 4: Cellulitis on the leg

Source: skinsight.com

4. Paronychia

  • This condition refers to the infection of the skin folds of the nails.
  • This usually occurs due to factors such as finger sucking, nail biting, ingrown nails, wearing artificial nails, or any condition in which the hands are constantly hands (dentists or bartenders).

Staph infection-paronychia

Picture 5: Acute Paronychia

Source: atlasdermatologico.com.br

Deep Localized Infections

1. Osteomyelitis

  • Infection located at the bones and bone marrow

2. Septic Arthritis

  • Condition in which the joints are invaded by an infectious agent such as Staphylococcus which leads to the infection of the joints

3. Wound Staph Infection

  • This occurs 48 hours to 30 days following surgery or injury of the skin.

Diffuse skin infection

1. Impetigo

  • A highly contagious skin condition in which crusts form over the skin due to Staph infection.
  • This is common among pre-school children, but may also occur in adults.

Staph infection-impetigo

Picture 6: Impetigo

Source: atlasdermatologico.com.br

Systemic Infections

1. Pneumonia

  • Infection occurring to either one or both lungs

2. Acute infective Endocarditis

  • A serious heart condition wherein the heart valves are infected usually by Staph bacteria.

3. Septicemia

  • Condition wherein there is the presence of infectious organisms in the bloodstream leading to sepsis.

4. Gastroenteritis

  • A gastrointestinal disorder wherein there is inflammation of the stomach and the small intestine.

Toxinoses

1. Scalded skin syndrome

Staph infection-SSSS

Picture 7: Staphylococcal Scalded Skin Syndrome (SSSS) Picture

source : dermnetnz.org

  • This condition is characterized by the appearance of extensive red rashes which are scald-like. It is caused by the release of the toxins coming from Staphylococcus aureus.
  • Usually occurs in children (5 years of age) who don’t have sufficient antibodies to prevent the toxic effects caused by the presence of these bacteria. [2, 7, 9]

Staph Infection Diagnosis

Physical Examination

  • If the skin infection is only minor and simple, it is diagnosed by appearance alone without needing to perform laboratory testing. [10]

Culture Sampling

  • For the serious cases of Staph infections, it is recommended to obtain samples of blood, body fluids, or tissue for culturing.
  • All affected skin areas which have crusts, pus, blisters, or any kind of drainage must be cultured.
  • This is done to evaluate if the bacteria involved are the MRSA type or resistant to methicillin antibiotics. Also, it is performed to determine which antibiotic should be given to the patient. [4, 10, 11]

 

Staph Infection Treatment

Antibiotic Treatment

Before the doctor can prescribe the antibiotics, it is essential to determine the type of Staph bacteria responsible for the infection [4]. Usually, minor staph skin infections can be treated with antibiotic creams or tablets. However, if it is determined that the staph infection is invasive, a more serious treatment is needed. This will actually involve the use of intravenous or injected antibiotics [1].

1. Antibiotic for non-MRSA infections

  • Clindamycin, dicloxacillin, nafcillin, cefazolin [11]

2. Antibiotics for MRSA Infections

  • Rifampin, vancomycin, linezolid
  • Vancomycin is commonly used in serious conditions of Staph infection because many strains of bacteria are resistant to some antibiotics and other traditional medications. Also, its effectiveness is at its most optimal state when giving intravenously. [4, 11]

Surgical management

1. Pus drainage

  • This is considered as the main surgical management when it comes to treating Staph infections.

2. Wound drainage

  • The doctor may also order draining of the wound by creating an incision to drain any kinds of fluids that may have accumulated there.

3. Debridement

  • This is a procedure which involves the surgical removal of the dead tissues in the body.

4. Surgical removal of infection source

  • Infected artificial grafts, pacemakes, heart valves
  • Removal of intravenous lines [4, 5, 11]

 

How to Prevent Staph Skin Infections?

Good Hygiene

  • Handwashing with soap and warm water – most important and effective way to prevent infection
  • Use of hand sanitizer or alcohol
  • Refrain from biting nails, picking nose, and scratching the skin
  • Do not share personal items with others such as clothes, towels, razors [4, 7]

Use of personal protective equipment

  • This is especially done by people who work at the hospitals.
  • Protective garments such as gowns, gloves, and masks are worn to lessen chance of getting infections. [11]

Maintain clean surroundings

  • Good housekeeping
  • Cleaning pools, athletic equipment, and seats prior to use [7, 9]

 

References:

1. http://www.nhs.uk/conditions/Staphylococcal-infections/Pages/Introduction.aspx

2. http://en.wikipedia.org/wiki/Staphylococcal_infection

3. http://www.webmd.com/skin-problems-and-treatments/guide/staph-infection-cellulitis

4. http://www.mayoclinic.com/health/staph-infections/DS00973

5. http://www.dermnetnz.org/bacterial/staphylococci.html

6. http://www.defensesoap.com/staph-skin-infection.html

7. http://www.healthhype.com/staph-skin-infections.html

8. http://www.health.state.mn.us/divs/idepc/diseases/staph/basics.html

9.http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Staphylococcus_aureus_golden_staph

10. http://www.medicinenet.com/staph_infection/page3.htm

11. http://www.emedicinehealth.com/staphylococcus/page5_em.htm#staph_infection_diagnosis



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