Bacterial infections

Dr Philip Marazzi outlines some commonly presented bacterial infections

Ascending lymphangitis
This patient sustained a minor injury on the base of the thumb. He ignored it and he then developed pain going up his arm. The red line can be seen clearly and shows the ascending infection in the lymphatic channels. If left untreated, the infection could affect the axillary lymph nodes. The infecting organism is usually Staphylococcus aureus, so flucloxacillin was used and successfully controlled the infection.


Impetigo is a commonly seen paediatric problem. It is most commonly caused by a staphylococcal or streptococcal infection, and presents with isolated, well-defined lesions covered in golden crusts of dried exudates. Impetigo can also occur in adults. The condition is infectious and may be spread by direct contact. Some patients may be nasal carriers of the bacteria. Treatment is normally with topical antibiotics or, in more extensive or severe cases, oral antibiotics.

Palm abscess

This female patient presented with a very painful hand. She had developed an abscess at the base of the ring finger after a minor injury. She has a history of rheumatoid disease and her immunosuppressed state may well have predisposed her to serious infections. She was admitted for assessment including X-ray to exclude bone involvement. She then underwent incision and drainage of the abscess and IV antibiotics were given to clear the residual infection.


This young woman has multiple major health problems arising mainly from her type-1 diabetes. As a teenager, she struggled to cope with her disease and subsequently developed a range of complications including major renal disease. Her brittle diabetes was controlled with an insulin pump. The abscess developed at a previous injection site. She has had problems with serious infections in the past, so was admitted for drainage and IV antibiotics.

Otitis media

Otitis media is a common infection that usually presents with a child complaining of a painful ear. Perforation of the tympanic membrane relieves the pressure and takes away most of the pain. The condition used to be treated almost immediately with a broad-spectrum antibiotic, such as amoxicillin. However, recent evidence has suggested that most of these infections are complications of viral upper respiratory tract infections which only require symptomatic measures.

Wound infection

Post-operative wound infections are unfortunately common and can be very serious. Recent years have seen increasing numbers of multi-resistant organisms developing in hospitals causing these potentially life-threatening infections. This image shows an appendectomy wound in a 75-year-old man 10 days after the operation. A strain of Escherichia coli was cultured from swabs. The patient was treated with antibiotics.


This woman was breastfeeding and developed mastitis, which is a relatively common problem. Her symptoms included redness and tenderness in the breast along with a fever. She was finding feeding very uncomfortable. Up to 30 per cent of women may develop mastitis, though it is quite rare for them to progress to abscess formation. She was given a course of antibiotics and advised about nipple care and wearing a well-fitted bra. She was able to continue breastfeeding.


This elderly lady has long-standing lymphoedema of her leg. This is a result of a lymphoma many years earlier treated with radiotherapy, leading to damage to the normal lymphatic channels. The chronic oedema in the tissues predisposes to infections. She has had a number of episodes of cellulitis in the past, which generally present very quickly as her infections progress quickly. The patient was treated with oral flucloxacillin and responded well on this occasion, not requiring hospital admission.

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