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Skin and Soft Tissue Infections

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  • Authors: Anne Spichler Moffarah1, Mayar Al Mohajer2, Bonnie L. Hurwitz3, David G. Armstrong4
  • Editors: Randall T. Hayden5, Donna M. Wolk6, Karen C. Carroll7, Yi-Wei Tang8
  • VIEW AFFILIATIONS HIDE AFFILIATIONS
    Affiliations: 1: Department of Medicine, University of Arizona Health Sciences Center, Tucson, AZ 85721; 2: Division of Infectious Diseases, University of Arizona, Tucson, AZ 85721; 3: Department of Agricultural and Biosystems Engineering, University of Arizona, Tucson, AZ 85721; 4: Department of Surgery, Southern Arizona Limb Salvage Alliance (SALSA), University of Arizona Health Sciences Center, Tucson, AZ 85721; 5: St. Jude’s Children’s Research Hospital, Memphis, TN; 6: Geisinger Clinic, Danville, PA; 7: Johns Hopkins University Hospital, Baltimore, MD; 8: Memorial Sloan-Kettering Institute, New York, NY
  • Source: microbiolspec July 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0014-2015
  • Received 24 May 2015 Accepted 22 April 2016 Published 08 July 2016
  • Anne Spichler Moffarah, annespichler@gmail.com
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  • Abstract:

    The skin is colonized by a diverse collection of microorganisms which, for the most part, peacefully coexist with their hosts. Skin and soft tissue infections (SSTIs) encompass a variety of conditions; in immunocompromised hosts, SSTIs can be caused by diverse microorganisms—most commonly bacteria, but also fungi, viruses, mycobacteria, and protozoa. The diagnosis of SSTIs is difficult because they may commonly masquerade as other clinical syndromes or can be a manifestation of systemic disease. In immunocompromised hosts, SSTI poses a major diagnostic challenge, and clinical dermatological assessment should be initially performed; to better identify the pathogen and to lead to appropriate treatment, etiology should include cultures of lesions and blood, biopsy with histology, specific microbiological analysis with special stains, molecular techniques, and antigen-detection methodologies. Here, we reviewed the epidemiology, pathophysiology, clinical presentation, and diagnostic techniques, including molecular biological techniques, used for SSTIs, with a focus on the immunocompromised host, such as patients with cellular immunodeficiency, HIV, and diabetic foot infection.

  • Citation: Moffarah A, Al Mohajer M, Hurwitz B, Armstrong D. 2016. Skin and Soft Tissue Infections. Microbiol Spectrum 4(4):DMIH2-0014-2015. doi:10.1128/microbiolspec.DMIH2-0014-2015.

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/content/journal/microbiolspec/10.1128/microbiolspec.DMIH2-0014-2015
2016-07-08
2017-09-21

Abstract:

The skin is colonized by a diverse collection of microorganisms which, for the most part, peacefully coexist with their hosts. Skin and soft tissue infections (SSTIs) encompass a variety of conditions; in immunocompromised hosts, SSTIs can be caused by diverse microorganisms—most commonly bacteria, but also fungi, viruses, mycobacteria, and protozoa. The diagnosis of SSTIs is difficult because they may commonly masquerade as other clinical syndromes or can be a manifestation of systemic disease. In immunocompromised hosts, SSTI poses a major diagnostic challenge, and clinical dermatological assessment should be initially performed; to better identify the pathogen and to lead to appropriate treatment, etiology should include cultures of lesions and blood, biopsy with histology, specific microbiological analysis with special stains, molecular techniques, and antigen-detection methodologies. Here, we reviewed the epidemiology, pathophysiology, clinical presentation, and diagnostic techniques, including molecular biological techniques, used for SSTIs, with a focus on the immunocompromised host, such as patients with cellular immunodeficiency, HIV, and diabetic foot infection.

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Figures

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FIGURE 1

The Q-score system applies positive values to the number of polymorphonuclear cells (PMNs) and negative values to the number of squamous epithelial cells (SECs) observed in a direct Gram-stained smear of a wound ( 70 ). The score starts at a maximum value of 3, and subtracts values, but the score never goes lower than zero; no negative numbers are used in the final score—rather, all negative numbers are rounded up to zero. When these assessment values are added together, the resulting number represents the Q score, which is used to determine the extent of culture work up of potential pathogens ( 71 ). LPF, low power field.

Source: microbiolspec July 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0014-2015
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FIGURE 2

Description and diagnosis of, and comments on, selected fungal infections that presents as yeast in tissues.

Source: microbiolspec July 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0014-2015
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Tables

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TABLE 1

SSTI dermatological presentation and specific microorganisms in immunocompromised non-HIV patients

Source: microbiolspec July 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0014-2015
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TABLE 2

SSTI dermatological presentation with specific microorganisms in HIV-infected patients

Source: microbiolspec July 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0014-2015

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