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Source: Fish DN, Pendland SL, Danziger LH. Skin and Soft-Tissue Infections. In: DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach. 8th edition. Accessed July 21, 2012

  • Saint Anthony’s fire

  • Infection of superficial layers of skin and cutaneous lymphatics

  • Caused by β-hemolytic streptococci with S. pyogenes (group A streptococci), responsible for most infections.

  • Organisms gain access via small breaks in skin.

  • Infections common in infants, young children, elderly, and patients with nephrotic syndrome.
  • Commonly occurs in areas of preexisting lymphatic obstruction or edema.

  • Preexisting lymphatic obstruction or edema
  • Nephrotic syndrome

  • Lower extremities most common sites.

Signs and Symptoms

  • Flu-like symptoms (fever and malaise) prior to appearance of lesions
  • Infected area painful, often described as burning pain.
  • Lesions bright red and edematous, with lymphatic streaking.
  • Mild temperature elevation

Means of Confirmation and Diagnosis

Laboratory Tests

  • Complete blood count (CBC): leukocytosis common.
  • C-reactive protein generally elevated.
  • Cultures
    • Causative organism usually cannot be cultured.
    • Consider with more severe case or atypical findings such as fluid-filled blisters.

  • Rapid eradication of infection

Table 1. Evidence-Based Recommendations for Treatment of Skin and Soft-Tissue Infections
Table 2. Recommended Drugs and Dosing Regimens for Outpatient Treatment of Mild to Moderate Skin and Soft-Tissue Infections

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