It includes superficial bacterial folliculitis, superficial spreading pyoderma, and “puppy pyoderma” (also known as impetigo or juvenile pustular dermatitis). Staphylococci that have acquired the mecA gene are classified as methicillin (synonymous with oxacillin) resistant, signifying resistance to penicillins, cephalosporins, and carbapenems. Although the term pyoderma literally means “pus in the skin,” the pus may not always be visible to the naked eye. Poor hygiene and neglect are key elements in pathogenesis. pyoderma gangrenosum A rare, ulcerating skin disease in which the skin is infiltrated by neutrophils. Complete genome sequencing of S. pseudintermedius isolated from a dog with pyoderma has shown that S. pseudintermedius possesses a number of virulence factors that resemble those produced by S. aureus.11. 2 regions where staph like to hang out. Practice good hygiene (hand washing) to prevent zoonosis. Dogs with superficial pyoderma should be bathed with a shampoo recommended by its veterinarian. Define superficial pustular pyoderma. Ecthyma is usually a consequence of neglected impetigo and classically evolves in impetigo occluded by footwear and clothing. Prospective epidemiologic observations were made over a three-year period on children living in an area where superficial pyoderma is prevalent. Also, “hot tub” folliculitis may be caused by P. aeruginosa (see Chapter 180). may be further opportunistic pathogens. This papular dermatitis forms coalescing lesions as demonstrated by the erythematous plaque. Staphylococcus pseudintermedius (previously Staphylococcus intermedius) is the most common bacterium isolated from canine pyoderma and is usually limited to dogs. Most children (81%) developed skin infection. Deep bacterial infections, such as bite-wound abscesses and opportunistic (atypical) mycobacterium infections, are not responsive to topical antibacterials, so wound management and/or systemic treatment is the mainstay for these disorders. Additionally, protein A, staphylokinase, capsular polysaccharide, fibrinogen binding protein, and clumping factor A all act to aid in avoidance of being opsonized and phagocytosed. Intact skin is usually resistant to colonization or impetiginization, possibly due to absence of fibronectin receptors for teichoic acid moieties on S. aureus and group A Streptococcus. In many areas, the prevalence of CA-MRSA strains is over 50%.9. demodicosis, dermatophytosis). Histologically, the lesions of bullous impetigo show vesicle formation in the subcorneal or granular region, occasional acantholytic cells within the blister, spongiosis, edema of the papillary dermis, and a mixed infiltrate of lymphocytes and neutrophils around blood vessels of the superficial plexus. CANINE ACRAL LICK … 27.3 ). The existence of a real bacterial allergy is presumed and debatable. Ecthymatous lesions can evolve from a primary pyoderma or within a preexisting dermatosis or site of trauma. Dermatophytic folliculitis must be differentiated from S. aureus folliculitis. Lesions commonly arise on the skin of the face (especially around the nares) or extremities after trauma. Among the acute streptococcal pyodermas are impetigo, diffuse superficial streptococcal pyoderma, and ecthyma, an ulcer that forms beneath a dried phlyctena. Isolated staphylococcal folliculitis is common on the buttock of adults. Dogs with deep pyoderma may require daily baths with medicated shampoos diluted to one-half or one-quarter strength. self trauma from flea allergy, bacterial, deep bacterial folliculitis. Over the past 5 years, clonal spread of methicillin-resistant S. pseudintermedius has occurred across Europe and North America.12 Methicillin resistance has also been described among S. schleiferi and S. aureus isolates from dogs with pyoderma.8 These organisms encode an altered penicillin binding protein that incurs resistance to all β-lactam antimicrobials, and many also demonstrate resistance to fluoroquinolone antimicrobials. Ecthyma is a cutaneous pyoderma characterized by thickly crusted erosions or ulcerations. More typical epidermal collarettes in a dog with resolving pyoderma. Note how the dog's normal pigmentation masks the papular dermatitis. The most common underlying skin diseases are allergic dermatitis and endocrine diseases, but a variety of other skin diseases can also predispose to pyoderma. Premature discontinuation of therapy, inability to completely control the primary disease, and the use of fluoroquinilone antibiotics will likely perpetuate the resistant infection. In industrialized nations, S. aureus is the most common cause of superficial pyodermas (Box 176-1), but group A Streptococcus continues to be a common cause of pyoderma in developing countries. Bacterial culture: Staphylococcus species. If antibiotic resistance is suspected or confirmed, frequent bathing (up to daily) and frequent application of topical chlorhexidine solutions, combined with simultaneous administration of two different classes of antibiotics at high doses, seem to produce the best results. Surface pyoderma occurs when bacteria proliferate on the surface of the skin and incite an inflammatory response, without invading the skin. Superficial Canine Pyoderma is characterized by a condition called impetigo, which is another name for a localized skin infection. If the dog is severely pruritic, oclacitinib should be considered (3–7 days) over glucocorticoids. The lesions are slow to heal, requiring several weeks of antibiotic treatment for resolution. Additionally, methicillin-resistant Staphylococcus aureus (human MRSA) is becoming more common among veterinary species. Not particularly localized to one anatomic area. Pyoderma, a pyogenic cutaneous bacterial infection, is one of the most common skin diseases of dogs. Therefore, the patient's history, in combination with clinical and cytological findings, provide the clues suggestive of an antimicrobial-resistant infection (Box 3-2). It is a staph or other bacterial infection that targets wounds on your dog's skin, resulting in deep or superficial accumulations of pus beneath the skin. Sterile pyogranulomatous dermatitis. superficial spreading pyoderma. TSST-1 and the staphylococcal enterotoxins are also known as pyrogenic toxin superantigens. However, these antibodies are not the primary determinants of resistance to such infections. Superficial infection involves the epidermis and/or the follicular infundibulum , and includes impetigo, superficial folliculitis, superficial spreading pyoderma and some mucocutaneous pyoderma. Recently, two additional staphylococci have been isolated from cases of recurrent pyodermas, namely Staphylococcus schleiferi subsp schleiferi and Staphylococcus schleiferi subsp coagulans, both of which are frequently methicillin-resistant staphylococci. In veterinary medicine, MRS are becoming more common for reasons such as repeated systemic antibiotic exposure (especially fluoroquinolones), subtherapeutic administration of systemic antibiotics (dose or duration), long-term treatment with steroids, failure to identify and manage the underlying cause for repeated infection, and patient contact with human health care workers or facilities. Today, MRSA can be divided into Hospital-Associated (HA) or Community-Associated (CA) MRSA. Folliculitis is a pyoderma that begins within the hair follicle, and is classified according to the depth of invasion (superficial and deep), and microbial etiology (Box 176-5). Ecthymatous lesions were also present on the other leg, the arms, and the hands. Staphylococci are classified into two major groups: (1) the coagulase-negative Staphylococci and (2) coagulase-positive (S. aureus) Staphylococci. In some individuals, lesions resolve spontaneously; in others, the lesions extend into the dermis, forming an ulcer (see Section “Staphylococcal Ecthyma”). Pyodermas are caused by bacterial colonization or invasion of the skin by coagulase-positive staphylococci, usually Staphylococcus intermedius. This uncommon clinical presentation is mainly seen on the ventral body. In the condition known as superficial spreading pyoderma (SSP), pustules evolve into coalescing and expanding erythematous macules. Also, three noninfectious, inflammatory, follicular disorders are more common in black men: (1) pseudofolliculitis barbae, which occurs on the lower beard area (Fig. Pyoderma has three different types. Pyodermas are infections in the epidermis, just below the stratum corneum or in hair follicles. Although it is usual to say pyoderma, the plural pyodermas should be used, since there are a large number of bacterial diseases of the skin in this species, with different histopathological and clinical aspects. Severe erythematous dermatitis without the typical papular, crusting rash, which is more typical of pyoderma. Nasal carriers of S. aureus can present with a very localized type of impetigo confined to the anterior nares and the adjacent lip area (Fig. CANINE SUPERFICIAL SPREADING PYODERMA Diffuse, large, expanding epidermal collarettes Trunk/Abdomen/Rump Collies/Shelties/Crosses 27. Staphylococcus aureus: nasal carriage with impetigo. The prognosis is good if the underlying cause can be identified and corrected or controlled. The lesion is indistinguishable from a Demodex, dermatophyte, or yeast infection. SITES OF COLONIZATION IN NEONATES (AND SITES OF INFECTION), METASTATIC SKIN INFECTIONS ASSOCIATED WITH BACTEREMIA (OFTEN S. aureus ACUTE INFECTIONS ENDOCARDITIS), STAPHYLOCOCCAL TOXIN-ASSOCIATED SYNDROMES. This is the most common type of pyoderma. Also, a single course of oral azithromycin (in adults 500 mg on the first day, 250 mg daily on the next 4 days) has been shown to be equally as effective as dicloxacillin for skin infections in adults and children. When evidence exists for one of these infections, bacterial culture (including bacterial speciation) and susceptibility testing are indicated if systemic antibiotics are thought to be warranted because of the extent and severity of the pyoderma and inherent patient factors. Shetland sheep dogs often develop large superficial spreading areas of alopecia, erythema, and scaling. Contributing factors: immunosuppression, atopic dermatitis, preexisting tissue injury, and inflammation. Bullae initially contain clear yellow fluid that subsequently becomes dark yellow and turbid (see Fig. The frequency of isolation of group A Streptococcus makes such therapy a reasonable approach in most patients who have a significant degree of involvement. In superficial pyoderma, bacteria infect the superficial epidermal layers that lie immediately under the stratum corneum (the outermost layer of the skin) and the portion of the hair follicle above the sebaceous duct (the infundibulum) (Figure 84-1). Bullous pyoderma gangrenosum is also a superficial variant that affects the upper limbs and face more than the lower extremities. • Shetland sheep dogs often develop large superficial spreading areas of alopecia, erythema, and scaling. Superficial pyoderma is a superficial bacterial infection involving hair follicles and the adjacent epidermis. Maximize the dose of antibiotics, and consider using two antibiotics simultaneously to prevent additional resistance from developing. If untreated, invasive infection can complicate S. aureus impetigo with cellulitis, lymphangitis, and bacteremia, resulting in osteomyelitis, septic arthritis, pneumonitis, and septicemia. Short-coated dogs often present with a “moth-eaten” patchy alopecia, small tufts of hair that stand up, or reddish brown discoloration of white hairs. Secondary pyodermas are far more common and are associated with a persistent or recurrent underlying problem that alters the skin's resistance to infection. Surface pyodermas include the “fold” pyodermas (also known as intertrigo), “hot spots” (also known as pyotraumatic dermatitis), and mucocutaneous pyoderma, which commonly affects German shepherd dogs.1 The last probably has an immunologic as well as a bacterial etiology. Recently, intermediate-level resistance of MRSA to vancomycin has emerged and constitutes a potential further problem in treatment. Superficial pyoderma is one of the most common skin diseases in dogs but is rare in cats. If pustules are present, secondary Staphylococcus aureus infection must be ruled out. Superficial pyoderma is a superficial bacterial infection involving hair follicles and the adjacent epidermis. It proliferates in humid external conditions. Secondary pyodermas can be caused by: Papular crusting dermatitis with alopecia on the muzzle of a dog. Less commonly seen than superficial pyoderma, deep pyoderma breaks through hair follicles to involve the deep layers of the skin, resulting in furunculosis and cellulitis. Monitoring the infection with cytology and cultures with antibiotic sensitivities is important for determining when treatments can be stopped. S. aureus in pyodermas or STIs can invade the bloodstream, producing bacteremia, metastatic infection such as osteomyelitis, and acute infective endocarditis. It is often found in people with other underlying illnesses, such as inflammatory bowel disease, rheumatoid arthritis, or some hematological malignancies. Superficial bacterial pyoderma is one of the most common disorders in the dog. In older adults, S. aureus accounts for 9% of nosocomial infections and follows only Escherichia coli, Pseudomonas aeruginosa, and Enterococci in prevalence.5. Severe inflammation caused by secondary bacterial infection. Local treatment with mupirocin ointment or cream, removal of crusts, and good hygiene is sufficient to cure most mild to moderate cases.13 Retapamulin 1% ointment is also effective for localized impetigo and secondarily impetiginized dermatitis as well, although decreased efficacy against MRSA was noted in some trials.14 Fusidic acid is an equally effective topical agent for localized impetigo and has very few adverse effects topically. The most likely risk factors include previous exposure to fluoroquinilone antibiotics, subtherapeutic antibiotic dosing, and concurrent steroid therapy. Same dog as in Figure 3-34. Symptoms: In addition to the pus-filled reservoirs, pyoderma may initially present as a rash that may or may not itch. Given the potential for (reverse) zoonosis, veterinarians must practice good infection control practices with each case of pyoderma (e.g., washing hands, cleaning and disinfection), with these measures enhanced when MRS has been documented in the patient (e.g., gloves, protective outerwear, separation of MRS patient from rest of hospital patients). Pseudofolliculitis barbae. See Box 176-3 for differential diagnosis of bullous impetigo. Constitutional symptoms are absent. Note the early epidermal collarettes associated with some papules. Involved skin in individuals with atopic dermatitis, Superficial folliculitis (follicular or Bockhart impetigo), Foreign body (intravascular catheter, prosthetic device), Impetiginization of dermatoses such as atopic dermatitis, herpes simplex (superinfection), Pyodermas associated with systemic disease, Disseminated intravascular coagulation associated with staphylococcal bacteremia, Superficial (follicular or Bockhart impetigo), Deep (sycosis) [may progress to furuncle (boil) or carbuncle], Gram-negative folliculitis (occurs at the site of acne vulgaris, usually the face, with long-term antibiotic therapy), Syphilitic folliculitis (secondary; acneiform). self trauma from flea allergy, bacterial, deep bacterial folliculitis. Pyoderma associated with hair follicles causes hair loss (alopecia) as the pustules rupture. 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