ErysipelasErysipelas is a more acute and inflamed variant of cellulitis. Although erysipelas is often described as distinct from cellulitis, the differences can be subjective. It is usually caused by group A streptococci and commonly occurs on the lower legs or the face. Erysipelas is redder, more sharply demarcated, and more superficial than typical cellulitis. Lymphatic streaking and systemic symptoms are common. Because erysipelas is more superficial, edema may be less prominent. Repeated episodes of erysipelas can lead to permanent lymphatic damage and chronic stasis.Some clinicians use penicillin as the drug of choice for erysipelas. Other organisms, especially S. aureus, may cause more than 20% of cases of erysipelas and these bacteria are often resistant to penicillin. Unless streptococcal infection has been confirmed by culture, many clinicians use a broader spectrum antibiotic to cover S. aureus as well.
Blistering Distal DactylitisBlistering distal dactylitis is a superficial infection of the anterior fat pad of the distal fingers. It is most commonly caused by group A beta-hemolytic streptococci. A painful vesicle or pustule forms in the skin adjacent to the nail bed. These pustules do not tend to protrude like those elsewhere on the body. They should be promptly incised and drained, followed by a 10-day course of antibiotics.
Perianal CellulitisPerianal cellulitis is another form of cellulitis caused by group A beta-hemolytic streptococci. It occurs most commonly in children. Patients may present with perirectal itching, rectal pain, or blood-streaked stools. Systemic symptoms are uncommon. On examination, marked circumferential erythema is noted extending as far as 3 cm from the anus. Because recurrences are common, culture should be performed before and after treatment with a 10-day course of oral antibiotics.
Pseudomonas CellulitisPseudomonas aeruginosa typically causes infections in the warm, moist areas that it colonizes: feet, nail beds (green nail), skin folds, foreskin (balanitis), ear canals, and burn sites. P. aeruginosa will not grow if normal, dry skin is inoculated.Pseudomonas infection is characterized by dusky red skin, blue-green Purulence, and a fruity odor. Pseudomonas also fluoresces green-white under a Wood’s lamp because it produces a compound called pyoverdin. Neglected lesions can become eroded and even necrotic.Localized infection can be treated with 5% acetic acid compresses for 20 minutes, four times daily until resolution. For Pseudomonas balanitis, topical mercurochrome twice daily is effective. These infections can also be treated with systemic first- or second-generation fluoroquinolones.*109/348/5*

Research in animal models has consistently shown that the administration of antibiotics before (or occasionally shortly after) an induced bacteremia can prevent IE on damaged heart valves. However, proof that this approach is effective in humans is lacking. One major problem with the available literature is that multiple studies repeatedly demonstrate that few high-risk patients take antibiotic prophylaxis. In the largest retrospective case-control studies to date, less than 25% of high-risk patients (based on preexisting structural heart disease) actually took antibiotic prophylaxis before a procedure for which it was indicated. This has led to very small groups of patients in whom an analysis of efficacy can be performed.- A large population-based case-control study of patients with IE in the Philadelphia metropolitan area failed to show that dental treatment was a risk factor for IE, thereby calling into question the role of prophylactic antibiotics before such treatments. Patients who took antibiotic prophylaxis were not protected against development of IE, but the number of patients who took prophylaxis was very small, making it difficult to draw a conclusion from this study alone.- One small (eight cases) case-control study from the Cleveland Clinic showed efficacy of antibiotic prophylaxis but was notable for questionable assignment of causality to distant dental procedures.- A Dutch national case-control study failed to show significant efficacy of antibiotic prophylaxis prior to medical or dental procedures.- A French case-control study concluded that procedures increase the risk of endocarditis but failed to show protective efficacy of antibiotic prophylaxis.To date, the available literature does not suggest a protective benefit of antibiotic prophylaxis. However, these studies have been underpowered to detect a protective effect as large as 20% or greater.*49/348/5*

Influenza is an acute infectious disease caused by several different viruses. It comes on suddenly with fever, muscular aches, chilliness, and a cough. After an attack, serious weakness is common for some weeks. Although outbreaks of influenza have occurred for centuries only in recent years have the different forms of virus associated with epidemics been isolated. Many forms of viruses related to influenza have been isolated since 1933. Vaccines for inoculating against these forms have been developed but routine immunization is not advised because the uncomplicated disease is rarely fatal and because the type or nature of the virus varies from one epidemic to another.
The virus of influenza is transmitted from one person to another by droplets of fluid coughed out of the nose, throat, and lungs. An epidemic usually reaches its peak in two or three weeks and then subsides in from four to eight weeks. The worst period of the year is winter and early spring. The influenza virus seems to be constantly present among human beings and epidemics occur under the specially favorable circumstances that aid spread of the virus and lessen resistance.
Influenza comes on suddenly after an incubation period of a few days. The common complaints are headache, drowsiness, fatigue, and chilliness, but there may also be general illness with nausea and vomiting. The fever starts to rise and usually hangs around 102° F. but may get up to 104° F. A cough with dryness and irritation of the throat and tightness across the chest are common. A running nose is not nearly as frequent as with the common cold. The person with influenza feels really sick and is disinclined towards work or amusement or even reading. Pain in the eyes, with some redness, may occur. The disease itself is uncomfortable but not too serious, but secondary complications through invasion by other germs causing pneumonia, ear infection or even inflammation of the brain may make it dangerous to life.
The sulfonamides and antibiotic drugs can prevent secondary complications of influenza but do not act specifically against the viruses. Most doctors recommend rest in bed, plenty of fluids, aspirin or other salicylates, codeine to quiet the cough and, if necessary, drugs to help the patient sleep. The condition must be watched most carefully when it affects the very old or very young who are more likely to get secondary infections and to be less able to resist the wear and tear that influenza causes.
Vaccines against influenza have been developed based on various viruses that may be concerned in epidemics as of the Asian influenza type. These are recommended particularly for old people and pregnant women. Infection with one type of virus does not confer immunity against other types.
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