4036S1_05_FDA-Bisno

4036S1_05_FDA-Bisno - Tinea Pedis and Cellulitis of the...

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Tinea Pedis and Cellulitis of the Lower Extremities Alan L. Bisno, MD, FACP University of Miami School of Medicine
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Cutaneous disruption Trauma, surgery Burns Ulcers Varicella Dermatophytes Lymphedema, Lymphedema, venous insufficiency venous insufficiency Obesity Obesity Ischemia Ischemia IV drug abuse IV drug abuse Immunosuppression Immunosuppression Factors Predisposing to Lower Extremity Cellulitis
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Microbial Etiology of Eysipelas and Cellulitis Classic erysipelas is virtually always due to beta- hemolytic streptococci (BHS) The terms cellulitis and erysipelas are often used interchangeably in European literature. Cellulitis can be due to many microorganisms. Most cases are due to BHS or Staphylococcus aureus. Typical lower extremity cellulitis with diffuse spreading erythema is usually due to BHS of groups A, B,C, and G Baddour LM, BisnoAL. Amer J Med 1985; 79:155-159
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Recurrent Cellulitis Many patients with an episode of cellulitis experience repeated attacks. The percentage of patients in whom this occurs is variable, depending upon risk factors In one study, 77% of such patients had abnormalities of lymphatic drainage on scintigraphy It is believed that lymphatic damage is progressive with recurrent episodes, thus exacerbating the problem De Godoy JM et al. Lymphology 2000; 33: 177-180
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Antimicrobial Prophylaxis of Recurrent Cellulitis 31 patients with definite or presumptive streptococcal cellulitis of the LEs treated with 1.2 million units of benzathine penicillin G monthly for 12 months 70 patients who declined and 14 who received incomplete prophylaxis served as controls Recurrences rate was 12.9% in treated patients vs 19% in controls (NS) BPG reduced recurrences in pts. without but not in those with predisposing factors Wang J-H et al. CID 1997; 25: 685-689
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Antimicrobial Prophylaxis of Recurrent Cellulitis 40 pts. with venous insufficiency or “lymphatic
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4036S1_05_FDA-Bisno - Tinea Pedis and Cellulitis of the...

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