PedsCases: Pediatric Education Online · PedsCases Team

Skin and Soft Tissue Infections

March 24, 2024·17 min·1 clip

A 7-year-old girl presents with a painful, enlarging leg rash and yellow discharge—what's the diagnosis?

This educational episode from PedsCases focuses on formulating a clinical approach to pediatric skin and soft tissue infections. The host is Roy Calaf, a medical student at McGill University, and the content was developed with Dr. Cora, a pediatric hospitalist at the Montreal Children's Hospital. The learning objectives include recognizing clinical manifestations, classifying bacterial pathogens, identifying red flags, and discussing management. The episode begins with a case of a seven-year-old girl named Sarah who presents with a painful, erythematous leg lesion with yellow discharge, diagnosed as cellulitis. It explains that cellulitis typically presents with erythema, edema, and warmth, and is commonly caused by Group A Streptococcus or Staphylococcus aureus. The discussion differentiates cellulitis from an allergic reaction, noting that allergic reactions are itchy but not tender. Impetigo is described as a superficial infection characterized by a honey-yellow crust, also often caused by Staphylococcus aureus or Group A Streptococcus. Risk factors for less common pathogens include travel to endemic regions for Corynebacterium diphtheriae or lack of immunization for Haemophilus influenzae type B. Animal bites introduce pathogens like Bartonella or Pasteurella, while puncture wounds raise suspicion for polymicrobial or fungal infections. Red flags requiring urgent intervention include necrotizing infections, marked by pain disproportionate to appearance and systemic toxicity, and toxic shock syndrome. Investigations should include lesion culture, blood cultures for moderate-severe cases, and labs like CBC and CRP. A key insight is that antibiotic choice must consider palatability for pediatric compliance, with oral cefalexin and amoxicillin-clavulanate being favorable liquid options. For mild cellulitis, first-line outpatient treatment is oral cefalexin, while severe cases require IV cefazolin. In cases of penicillin allergy, alternatives like cefuroxime or TMP-SMX are considered, especially if MRSA is suspected. Animal or human bite infections are typically treated with amoxicillin-clavulanate to cover polymicrobial organisms. Necrotizing fasciitis management demands early surgical consultation and broad IV antibiotics like cefazolin, vancomycin, and clindamycin. The episode emphasizes that treatment duration (5-10 days) depends on clinical resolution and that patients should be stepped down to oral antibiotics when possible. It notes that local hospital guidelines, like those from Montreal Children's Hospital or Michigan Medicine, should be consulted, as protocols can vary. The tone is instructional and methodical, structured around a clinical case to guide learners through a systematic diagnostic and therapeutic process. This episode is ideal for medical students, pediatric residents, or any clinician seeking a structured review of common pediatric skin infections and their evidence-based management. Listeners looking for entertainment, broad medical commentary, or non-clinical perspectives would likely find this too specialized.

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