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Bacteriology of Hand infections

- See Human Bite

- Bacteria Sensitive to Augmentin / Unasyn
    - staph aureus
           - along w/ streptococcus is the most common inciting organism in hand infections;
    - streptococcal Gr A beta hemolytic
           - shows cellulitis, lymphangitis, lymphadenopathy, fever, and a systemic toxic reaction;
           - in general, none of the Gr A organisms are resistant to penicillin or tetracycline, however, non Gr A organisms
                   may be resistant;
           - symbiotic infections:
    - erysipelothrix rhusiopathiae - Streptothrix -
    - pateurella multocida:
    - bacillus anthracis:
    - eikenella corrodens:
    - neisseria gonorrhoeae:
           - may produce a tenosyovitis or arthritis difficult to differentiate from the usual pyogenic infection;
           - smear for diplococcus and culture on special media may aid in dx;
           - penicillin is used for treatment;
    - treponema pallidum:
           - may cause a primary lesion that could be mistaken for a paronychia;
           - tertiary lesions may involve tendon sheaths, bone, and joint;
    - actinomyces bovis
           - enters thru an abrasion on the skin, assoc. w/ cattle, swine ect;
           - granuloma occurs that resembles TB, & sinus formation results;
           - infection may be resent to treatment;
           - treatment includes penicillin and potassium iodide;

- Misc Infections:
    - myobacterium tuberculosis:
           - may cause finger joint involvement as well as tenosynovitis or sking or bone lesions;
           - tuberculosis dactylitis is usually seen in children;
           - references: Spina Ventosa NEJM Case Records.
    - myobacterium marinum:
    - vibrio vulnificus:
    - blastomyces dermatitidis:
           - may occur in the fingers as a pustule that becomes larger and spreads peripherally;
           - center heals, leaving a central scar with a spreading perimeter;
           - if osseus lesions occur in the digits, they may be secondary to to pulmonary disease;
           - treatment is with dihydrosystilbamidine or amphotericin B;
    - aeromonas hydrophila: freshwater bacteria;
    - sporotrichum schenckii:
           - is a fungus that may be introduced into the extremity thru abrasions caused by thorns;
           - common in those who handle soil and plants;
           - delayed dx is common
                   - 4 months for lymphocutaneous form
                   - 25 months for deep infections (requires Ampho B or Ketoconazole)
           - abscess develops and spreads to the regional lymphatics, resulting in multiple granulomas, which occur along the
                   course of the lymphatics, and ulcerate as the area is ruptured;
           - potassium iodide is the drug of choice;
    - coccidioides immitis
           - may involve the hand and the ulnar and radial bursae;
           - it is an uncommon infection;

- Viral Infections:
    - lymphogranuloma vereeum: transmitted by a bite or scratch;
    - herpes
    - Images in Clinical Medicine. Contagious Ecthyma
    - Images in Clinical Medicine. Herpetic Whitlow

Abscesses secondary to parental abuse of drugs. A study of demographic and bacteriologic characteristics.

Bacterial colonization of mutilating hand injuries and its treatment.