Last updated on 14 Jun 2017 at 3:51 PM (ID07)

Skin and soft tissue infection
A 55 year old NZ European man, who is overweight, attends his GP's practice with a painful red rash across his left foot. His foot is warm and swollen and he has an antalgic gait.

 

Applied Science for Medicine
Anatomy and physiology of the skin
Skin and soft tissue infections caused by Staphylococcus aureus (including methicillin-resistant S. aureus (MRSA)) and Streptococcus pyogenes
Host response to bacterial infection
Colonisation with S. aureus and S. pyogenes
Pharmacology of penicillin, flucloxacillin, macrolides, clindamycin, antifungal agents; therapeutic options to treat MRSA

Clinical and Communication Skills
Elicit a history from a patient with a rash
Examination of a rash; include other structures if relevant (e.g. joint if rash lies over it)
Describe a rash using dermatological terminology
Recognise dermatophyte infection
Interpret skin scrapings, skin swabs and blood cultures
Management of cellulitis, boils and tinea
Antimicrobial stewardship; non pharmacological management of boils
Antibiotic selection: intravenous/oral and consideration of antimicrobial resistance
Management of the patient with recurrent boils
Recognise and manage common skin and soft tissue infection (including ingrown toe nail) in primary healthcare setting

Personal and Professional Skills
Importance of hand hygiene in the clinical environment
Communicate understanding of the social impact of skin and soft tissue infections
Confidentiality

Hauora Māori
Ability to cater for differential health literacy needs of patient and whānau
Understanding of disproportionate impact of socioeconomic deprivation on Māori

Population Health
Epidemiology of cellulitis, MRSA infections
Social determinants of skin and soft tissue infection (including consideration of overcrowding, cost of treatments)

 

Conditions to be considered relating to this scenario

Common

cellulitis, boil/furuncle, carbuncle, allergic reaction, venous insufficiency, dermatitis, erysipelas, tinea pedis, impetigo

Less common but 'important not to miss'

necrotizing fasciitis, hidradenitis suppurativa