Treatment
Since most cases are caused by streptococci andS. aureus, therapy should be directed against
the pathogen. With the widespread occurrence of methicillin-resistantStaphylococcus aureus
(MRSA) among strains of community-associatedS. aureusinfection, the agents should be active
against MRSA. Available oral options for MRSA include trimethoprim/sulfamethoxazole,
linezolid, clindamycin, and doxycycline. Specific treatment for bacterial causes is warranted
after an unusual exposure (human or animal bite or exposure to fresh or salt water), in patients
with certain underlying conditions (neutropenia, splenectomy, or immunocompromised), or in
the presence of bullae and is described in Table 2.
ERYSIPELOID
The localized cutaneous infection caused byErysipelothrix rhusiopathiaepresents as a subacute
cellulitis (termed “erysipeloid”). It is usually due to contact with fish, shellfish, or infected
animals. Contact with this pathogen may occur in recreational settings, domestic exposures,
abattoirs, or after lacerations among chefs (37). Between one and seven days after exposure, a
red macularpapular lesion develops, usually on hands and finger. Lesions are slightly raised
and violaceous. Regional lymphadenopathy occurs in about one-third of cases. Other
organisms that cause skin and skin structure infections following exposure to water and
aquatic animals include Aeromonas, Plesiomonas, Pseudallescheria boydii, and V. vulnificus.
Mycobacterium marinumcan also cause skin infection, but this infection is characterized by a
more indolent course. ForErysipelothrixbacteremia or endocarditis penicillin G (12–20 million
units IV daily) is the drug of choice, alternative antimicrobials include ciprofloxacin,
cefotaxime, or imipenem-cilastatin.
CHANCRIFORM LESIONS: ANTHRAX
A bioterrorism-associated anthrax outbreak occurred suddenly in the United States in 2001.
Out of the 22 cases 11 had the cutaneous form (38). After incubation of one to eight days, a
painless, sometime pruritic, papule develops on an exposed area. The lesion enlarges and
Figure 3 Cutaneous metastases from inflammatory
breast carcinoma resembling facial cellulitis. Diagnosis
was confirmed on biopsy of middle turbinate and nasal
septum, which showed vascular tumor emboli.300 Sharma and Saravolatz