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Correspondence |

Clinical Progression of CA-MRSA Skin and Soft Tissue Infections: A New Look at an Increasingly Prevalent Disease

Kenneth M. Lloyd, MD; Leah Marie Schammel, DO
Arch Dermatol. 2008;144(7):952-954. doi:10.1001/archderm.144.7.952.
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Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections of the skin and soft tissue are becoming increasingly prevalent in the general population.15 The type of patients now being seen with CA-MRSA and also the clinical pattern of CA-MRSA presentation require an adjustment of recognition skills on the part of physicians.

Moran  GJKrishnadasan  AGorwitz  RJ  et al.  Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 2006;355 (7) 666- 674
PubMed Link to Article[[XSLOpenURL/10.1056/NEJMoa055356]]
Grayson  ML The treatment triangle for staphylococcal infections. N Engl J Med 2006;355 (7) 724- 727
PubMed Link to Article[[XSLOpenURL/10.1056/NEJMe068152]]
Daum  RS Skin and soft-tissue infections caused by community-associated MRSA. N Engl J Med 2007;357 (4) 380- 390
PubMed Link to Article[[XSLOpenURL/10.1056/NEJMcp070747]]
Hota  BEllenbogen  CHayden  MKAroutcheva  ARice  TWWeinstein  RA Community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections at a public hospital: do public housing and incarceration amplify transmission? Arch Intern Med 2007;167 (10) 1026- 1032
PubMed Link to Article[[XSLOpenURL/10.1001/archinte.167.10.1026]]
Klevens  RMMorrison  MANadle  J  et al.  Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298 (15) 1763- 1770
PubMed Link to Article[[XSLOpenURL/10.1001/jama.298.15.1763]]
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Figure.

Painful skin lesion associated with community-acquired methicillin-resistant Staphylococcus aureus (MRSA). A, At first presentation, 5 days after onset, a very aggressive lesion is evident, with a large necrotic central area of ulceration surrounded by a perilesional zone of multiple, small, discrete pustular lesions; a large, intense, erythematous ring surrounds this area. B, On the seventh day from onset, the bacterial culture was growing MRSA. Therapy with ciprofloxacin was instituted at 500 mg/d. After 2 days of prednisone treatment, a considerable edema is seen, along with denudation of the epithelium over the central nodule and a boggy or pulpy consistency. The intensity of the inflammatory response peripherally is fading. The considerable subcutaneous mass beneath this lesion is not apparent in the photograph. C, At day 9, prednisone treatment was discontinued. A regression is evident of most of the acute inflammatory findings except for the large, boggy central mass that is breaking down. The tissue has the consistency of ground hamburger on probing, but the probing causes the patient little cutaneous sensation. D, At day 19, a 10-day regimen of tetracycline hydrochloride treatment was begun, 1 g twice daily. The sharply defined area of a leathery, fibrotic eschar pictured shows little inflammatory activity surrounding it. E, At 44 days from onset, a well-demarcated area of fresh granulation tissue is shown; peripheral reepithelialization is occurring, and a whitish halo is visible around the lesion. F, Completely healed area 3 months from the start of original symptoms.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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