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Daily Dose

Staph Infections Often Appear Quickly

1:30 to read

There has been a lot of questions lately about staph skin infections.  In fact, I am typing this just after seeing one of my patients with a fairly “classic” staph infection on their leg. 

Staph is the common term used when doctors are discussing Staphylococcus aureus, a bacteria that is known to cause infections and is  commonly seen with skin infections. These skin infections present as a boil, or cellulitis (infection of the skin and soft tissues), or impetigo, or other infections related to the skin. But in this case we are going to look at a boil (an abscess within the skin) and  surrounding cellulitis.

Staph infections often appear quickly, “almost overnight”, when a parent or child may notice a bump that may resemble a bite. But in this case this “bite” rapidly reddens and becomes tender and warm to the touch. It really looks “angry” and as my grandmother used to say “festers”. Parents will often call and say, “I think my child has a spider bite”, when in reality it is a brewing staph infection. When I hear spider biter, out of the blue, I think staph. I jokingly tell parents, “I don’t think there are enough spiders in the world to cause all of these “bites” that are really staph infections.” Since staph is a bacteria it is susceptible to antibiotics. But over the last several years we have seen children of all ages presenting with resistant staph infections, typically with MRSA or methicillin resistant staph. This is an important distinguishing factor, as this will determine which antibiotic is used to treat the infection.

In order to figure out which antibiotic to use, the doctor needs to culture the “pus” that is in the boil. That means growing the bacteria from the “bite, boil, infection” and identifying the bacteria, and from that culture the lab will also determine which antibiotic the bacteria is susceptible to. All of this information will ensure that your child is put on the appropriate antibiotic to treat the infection. At times it is necessary to drain the infection and in more serious cases, a child may be admitted for IV antibiotics. I often have parents ask, “Where did we get this?” Staph is everywhere, on our hands, in our noses and on other commonly shared objects like towels, changing tables and in locker rooms. Encourage your child to wash their hands, try to avoid touching their noses, and to avoid picking at cuts and bites.

Despite all of this, we all have micro-abrasions on our skin that are not even visible and that tiny staph bacteria can just hop on in and develop a random infection. Staph skin infections really do have a “typical” appearance. That is why I am showing you this picture. If you see your child suddenly develop a “bite” that looks like this, you need to call the doctor. The sooner the infection is treated the better. That’s your daily dose, we’ll chat again tomorrow! Send your question to Dr. Sue.

Daily Dose

Skin Lesion: Staph or Pimple?

1:30 to read

I just received an email question from a teenager who happened to attach a picture of a skin lesion she was worried about. I think it is great that teens are being proactive about their health and are asking questions about issues that are concerning to them.  BRAVO!!

So, this “bump” sounds like it started out as a possible “zit” on this 16 year old girl’s neck.  She admitted to lots of “digging” into the lesion and then became concerned that it didn’t seem to be getting any better.  She said that friends told her that it could be scabies, or possibly staph.  Leave it to friends to make you more apprehensive about the mystery bump. Looking at the picture it looks like it could be a simple pimple and in that case the best medicine is to LEAVE IT ALONE. The hardest thing to get teens to do (and also adults) is not to pick at pimples or bumps on their bodies, as this could lead to a skin infection. Many times just washing the “zit” and leaving it alone, it will go away.  When you go “digging” into it you break the skin and allow bacteria to enter the now open wound and you can get a skin infection. 

In many cases this may be due to staph or strep from your hands.  This may sometimes require a topical or oral antibiotic to treat the infection, when it may have been something that should have been left alone. There are skin infections that we are seeing in the community that are due to MRSA (methicillin resistant staph) which have become quite frequent in the last several years. In this case that small “bump” usually arises quite quickly, often times it is confused with an insect bite. But very quickly the bump becomes more inflamed, tender and often quickly grows in size. Many times there will be drainage from the bump which now resembles a boil.  In my experience the hallmark of MRSA infections is how quickly they arise and how painful they are.  They have a fairly classic appearance (see old post on Staph).

MRSA infections often have to be drained and require different antibiotics than ”regular” skin infections. In most cases it is necessary to obtain a culture of the drainage so that the appropriate antibiotic may be selected. In some circumstances the infection is quite extensive and may even require surgical drainage and IV antibiotics, requiring a stay in the hospital.  MRSA is a serious infection and is often seen in teens who share articles of clothing or participate in sports where they are showering, using equipment etc that is shared. Remember to use your own towels, and athletic equipment when you can.

This teen also asked “if you have staph would you have it forever?” In actuality, many of us harbor staph in our noses and we all rub our noses throughout the day and then touch other parts of our body as well as other objects. This then passes the bacteria from person to person, sometimes via another object. If you are not symptomatic, don’t worry about whether you have staph in your nostrils, but do adhere to good hand washing and try to keep your hands away from your face. For patients who have had recurrent skin MRSA infections, I often prescribe an antibiotic cream to be put in the nostrils as well as in the nostrils of all close contacts (family members). I also recommend that the patient bath in an anti-bacterial soap and take a bleach bath every week to help decrease the bacterial colonization with staph. It seems that this has helped prevent reoccurrences of staph for the individual as well as for other family members. Lastly, this is certainly not scabies, but we have an older post on that too with pictures!

That’s your daily dose for today. We’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Staph Skin Infections

With school back in session I have started seeing more skin infections secondary to methicillin resistant staph, or MRSA.With school back in session I have started seeing more skin infections secondary to methicillin resistant staph, or MRSA as it is often named. Staph skin infections have been common for years and typically caused impetigo that often appeared during summer months when children scratch bites and rashes and get them infected.

These skin infections are fairly easy to treat with common antibiotics, good hand washing, finger nail trimming and antibacterial soap. In the last several years pediatricians as well as adult physicians have started seeing resistant staph infections that seem to "come out of no where". A patient will often come in with the complaint, "I think a spider bit me". There just aren't that many spiders out there! The lesion begins as a tiny pustule, like a pimple, and rapidly expands and becomes hot to the touch, fiery red, very tender and may even spontaneously drain a purulent material. They are very painful. We see these lesions on babies buttocks thought to be secondary to bacteria on changing tables, and often on kids in involved in athletics who share towels, shirts, pads, helmets etc. If you think your child has a funny skin lesion that is rapidly getting worse, it means a visit to the doctor. Ideally they will be able to express some of the purulent discharge to culture the bacteria and begin treatment with the correct antibiotic. Many of these lesions need to be drained. Unfortunately, many of these resistant organisms are emerging secondarily to overuse of antibiotics when not needed (i.e. for a cold). That's another conversation for another day! That's your daily dose, we'll chat tomorrow!

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Daily Dose

Spider Bite or MRSA

Is it a spider bite or staph infection?While walking down the hallway in my office, I keep hearing more and more patients concerned about a “spider bite”.  Think about this: how many spiders could there be out there, especially in the winter and early spring months? Also, these “spider bites” occur on really weird places; a baby’s bottom, the inner thigh, or even on the palm of the hand.

The poor spiders are being maligned when in fact they have nothing to do with these random skin lesions at all. In most cases, a patient had never even seen the offending spider! In reality, all of those “spider bites” are often due to a community acquired MRSA (methicillin resistant Staph Areus) infection of the skin and soft tissue. The frequency of these infections continues and parents should be aware of the fact that an unusual “bite” that is becoming more tender, has surrounding redness (erythema), feels warm to the touch and may have the appearance of a large pimple or boil needs, to be examined. In some cases that I have seen, a parent has tried to open the lesion with a needle. DO NOT take needles, pins, finger nails or anything else to open the lesion!! I tell the older kids, “if your mom or dad comes at you with a needle run Toto run!!” Once a “spider bite” has been correctly diagnosed as a MRSA infection, it is appropriate to try and drain some of the purulent material for a culture. This is usually easily done in the pediatrician’s office. By obtaining some of the purulent discharge the correct diagnosis may be made, and an antibiotic that treats community acquired MRSA may be prescribed. For larger lesions it is appropriate to drain them, and this may be done under sterile conditions (no home needles). There are certain times a pediatric surgeon may need to actually drain these larger lesions. There have been numerous journal articles debating the pros and cons of drainage versus antibiotic use. In most cases in my office, we culture the drainage, and prescribe an oral antibiotic.  There are some articles that advocate drainage only without the use of antibiotics. There is not a definitive opinion on this and I would defer to your doctor to decide the appropriate individual treatment. So… if you think the spiders have invaded your home, think MRSA instead. That's your daily dose for today.  We'll chat again tomorrow.

Daily Dose

Bug Bite or Staph Infection?

I received another e-mail with an attached picture (you can take a look too) asking me my thoughts on what to do about this child’s bite. My first thoughts are, “is this really a bite, or is it an early staph infection?”I received another e-mail  asking me my thoughts on what to do about this child’s bite. My first thoughts are, “is this really a bite, or is it an early staph infection?”

This is often a common problem even in the office setting. A parent brings in a child and there is no history of a known bite, and at this time of year there really are not that many bugs creeping around biting our arms and legs. At the same time, the lesion looks fairly benign, it is not warm to the touch, or tender, and the patient or parents aren’t sure how long it has been there. When faced with this dilemma, I often take a “sharpie” marker and draw a circle around the area and instruct the parent to keep the area clean with an antibacterial soap (don’t worry, “sharpie” does not wash off that fast). I also have them give the child a dose of an antihistamine, like Benadryl (diphenhydramine), which might help if it is indeed a bite. Then we wait and watch. If it is a bite, in most cases it will look a little better by the following day, or at a minimum unchanged. In the case of a staph skin infection the area typically appears larger than the original “sharpie” mark. It is also usually hot, red and tender by now. It may have “declared” itself to be a bacterial infection as it has a purulent center that can be drained. When I say drained, I mean at the doctor’s office so it can be done in a sterile manner and also the purulent material may be sent for culture and sensitivity. DO NOT poke, squeeze, take a needle or anything to drain the lesion at home. Remember NO PICKING!! By doing this at home you may take a completely benign lesion that will go away on its own in several days, and actually break the skin and cause a secondary infection. This is hard for many to resist, but resist! If the said “bite” turns out to be an actual skin infection, then by culturing the drainage, the organism which is often staph, may be identified as a “staph” that is susceptible to many antibiotics, or it may indeed be the unfortunately more and more common MRSA. MRSA or methicillin resistant staph is causing frequent skin infections within the community rather what we previously thought of as a hospital infection. The most important thing is to pay attention to the “bite” and if is worsens make sure you go see the doctor. We should get up follow up in the next several days!! That’s your daily dose, we’ll chat again tomorrow.

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