Biomedical subjects
Publications and source records attributed to J A Witkowski.
Lesions of the threefold spectrum of bacterial infections usually can be diagnosed on the basis of the clinical picture, but sometimes laboratory studies and a therapeutic trial may be needed for confirmation. Fortunately, a number of effective antimicrobial agents and adjunctive measures are available for treatment.
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A fifty-year-old white woman noted a morbilliform eruption that involved her trunk, arms, and legs but spared her face, following oral administration of nifedipine, a calcium channel blocker. Other dermatologic reactions to nifedipine have included edema with erythema, erythromelalgia, exfoliative erythroderma, leukocytoclastic vasculitis, purpura, and fixed drug reactions.
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Cutaneous bacterial infections can be treated by a variety of modalities, although systemic antimicrobial agents usually provide the most efficacious and efficient means for treatment. Oral administration allows outpatient management, thus decreasing the overall cost of treatment. Although gram-negative organisms are increasingly implicated in dermatologic infections, the bacteria that are commonly found in skin infections include group A beta-hemolytic Streptococcus and Staphylococcus aureus, which cause many types of pyoderma or impetigo. Not every patient exhibits the common signs of bacterial skin infection, which can include redness, crusting, induration, increased local temperature, serous exudate, a purulent discharge, pustules, bullae, or a foul-smelling odor, as well as such symptoms as malaise, pain, and tenderness. Bacterial confirmation may also be difficult. Beta-lactam antibiotics, tetracycline, and erythromycin have proven useful in this setting; however, increasing resistance is problematic. The management of bacterial infections of the skin and skin structure has been expanded during the past decade with the introduction of the new fluoroquinolones--agents with a wide spectrum of antimicrobial activity and good pharmacokinetic characteristics. While the clinical efficacy of each agent must be considered in the light of risk of adverse events and potential drug interactions, ciprofloxacin, enoxacin, ofloxacin, and temafloxacin appear to be most useful for cutaneous bacterial infections.
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Infestations with Sarcoptes scabiei var hominis remain a problem in nursing home patients. While the traditional signs of scabies include burrows and red papules found on the fingerwebs, chest, waist, or genitalia, the elderly or infirm patient may have only a nonspecific pruritic eruption. Epidemics in skilled care facilities may be controlled and the scabies mite even eradicated from the institutions with appropriate diagnosis and adequate treatment of both patients and personnel and their contacts.
Ten putrid-smelling decubitus ulcers were successfully treated with metronidazole gel. Anaerobes were cultured from five ulcers and Wood's light examination was positive in four ulcers before treatment. The odor was eliminated after 36 hours of therapy. All results of post-treatment cultures of anaerobes and Wood's light examinations were negative.
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