Infectious Disease consult recommended, particularly if severely immunocompromised or if systemically unwell.
This category includes patients on immunosuppressive therapy,
transplant patients (solid/HSCT), HIV, cirrhosis, dialysis patients, and others.
Potential pathogen list is extensive, yet Strep and Staph predominate.
Necrotic lesions with surrounding cellulitis (i.e. ecthyma gangrenosum) can indicate pathogens such as Pseudomonas, Aspergillus, or Candida.
Bacterial culture, Gram Stain
Fungal culture
Mycobacterial culture, AFB
Viral culture/PCR
Histopathology