Bacterial Skin Infections in the Elderly

Abstract

Skin and soft tissue infections are quite common in elderly people. A number of special conditions and circumstances need to be considered in the diagnosis and therapy. It is important to try to establish the causative organism, exclude other cutaneous disorders and identify precipitating factors. Treatment modalities include antiseptics, topical and systemic antibacterials, dressings and biotherapy. Skin infections presenting with erythema, blisters, pustules, and ulcerations or in body folds are described in detail. Cellulitis and infected ulcers are the most commonly encountered cutaneous infections in the elderly. Accurate and quick diagnosis and treatment are imperative to prevent significant morbidity and mortality. Appropriate antibacterials, antiseptics and dressings are necessary depending on the severity of the clinical presentation and resistance patterns. Laboratory tests, such as skin swabs, to establish the exact pathogen take time and the results might represent colonisation rather than infection of the skin. Cellulitis should be clinically distinguished from erysipelas and necrotising fasciitis. The latter is a life-threatening condition, which in the majority of cases requires surgical debridement of the infected tissue. Blisters and honey-coloured crusts are typical features of impetigo. It is very contagious and close contacts should be examined. Folliculitis is a commonly seen skin infection, which often responds to the use of antiseptics and topical antibacterials. More severe pustular skin eruptions, such as furunculosis and carbunculosis, usually require treatment with systemic antibacterials. Intertrigo and erythrasma have a predilection for the body folds, especially the axillae and groin, and topical therapy is usually sufficient. Secondary skin infections are often the result of persistent pruritus associated with increasing dryness of the aging skin. Emollients and antihistamines are useful measures. Primary cutaneous disorders and systemic diseases should be excluded with the aid of appropriate investigations, such as blood tests and skin biopsy. Staphylococcus aureus and beta-haemolytic streptococci are the most common causative organisms of cutaneous infections.

Cytologic findings inDemodex folliculitis: A case report and review of the literature

“…Though infections usually occur as the result of skin disruption, they may also occur as a consequence of microorganism overgrowth in intact skin, particularly in immunocompromised patients. [1][2][3][4][5][6] Common clinical manifestations of skin infection include erythema, pustules, blisters, and ulceration. For the pathologist, accurate morphologic recognition of microorganisms in biopsy and cytologic specimens is paramount in facilitating appropriate therapy.…”

Prevalência de dermatoses em idosos residentes em instituição de longa permanência

“…Alterações histológicas, como a atrofia da junção dermoepidérmica, variações na espessura da pele, atipias nucleares, diminuição de aproximadamente 15% dos melanócitos por década (densidade que dobra em áreas expostas ao sol), decréscimo das células de Langherans, atrofia da derme acompanhada de diminuição de fibroblastos e mastócitos, alterações da circulação sanguínea e das terminações nervosas são fatores intimamente relacionados à instalação das lesões [5][6][7]12 . Por outro lado, a menor atividade de várias funções, como renovação celular, resposta a traumas, percepção sensorial, proteção mecânica, resposta imune e vascular, termo regulação, produção de suor e de vitamina D constituem, entre outras, situações extremamente favoráveis ao desenvolvimento de dermatoses 5,12 . Em relação à radiação solar, alterações como perda de colágeno, ruptura de elastina e diminuição de glicosaminoglicans 13 podem favorecer a ocorrência de doenças inflamatórias e/ou infecciosas, e particularmente as lesões pré-cancerosas e as neoplasias malignas 14 .…”

“…Staphylococcus aureus e Streptococcus B-hemolítico são os patógenos mais comuns e sua presença é, em geral, de significância DINATO SLM ET AL. clínica 12 . Em nosso estudo foram detectados dois casos (2,6%) de infecção bacteriana de pele (erisipela).…”

Common cutaneous disorders in the elderly

“…The most common ones are cellulitis and infected ulcers in this age group. 42 Cellulitis is a bacterial infection of the lower dermis and subcutaneous soft tissue, most often caused by Staphylococcus aureus or Group A beta-hemolytic streptococci, presenting with a tender sharply bordered erythematous warm edematous plaque, sometimes superimposed with vesicles, erosions, hemorrhage, abscess, or necrosis on the plaque, or accompanied by lymphangitis. 43 It often affects the lower legs, which usually follows interdigital fungal infection of the feet.…”

“…Initial management should be penicillinase-resistant penicillin, such as flucloxacillin or dicloxacillin for 10 days. 42 More severely ill patients, particularly those with medical disorders, such as diabetes mellitus, should be hospitalized and treated. Of note, there has been an alarming increase in the prevalence of methicillin-resistant S. aureus infection in the past decade, particularly in Taiwan.…”