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SBM I.D. > 04-08 Skin, Soft Tissue and Bone Infx > Flashcards

04-08 Skin, Soft Tissue and Bone Infx Flashcards

1
Q

Spreading infx is usually from _______ which is treated with _______.

  • If 2° to trauma add ____
A

**distinguish focal vs. spreading**

Spreading infx (e.g. cellulitis) is usually from GROUP A STREP (a.k.a. STREP PYOGENES) which is treated with PENICILLIN to which it’s “exquisitely sensitive”.

—I.E. you DON’T NEED KEFLEX! (Overkill)

—Usuallly 2° to microtrauma (zipper, toenail infx, surgery)

If 2° to trauma, add Rx for MSSA/MRSA

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2
Q

Focal skin/soft tissues infx are usually caused by _________ and treated with ______.

A

we’re talking boils/furuncles/carbuncles

  • usually caused by STAPH AUREUS.
  • Treatment: Apply heat and drain if > 1cm; often sufficient.
  • Add abx if pt is sick or cellulitis is surrounding focus; cover for MRSA “unless you have a culture cooking”
  • best options: TMP/SMX > doxy > clinda
    • vanco if hospitalized
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3
Q

What is this?

  • bug?
  • tx?
A

impetigo

  • usually strep
  • Treatment
    • mild: topical mupirocin
    • more severe: cephalexin +/- TMP/SMX depending on likelihood of staph
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4
Q

What is this?

  • presentation?
  • causal organism?
  • tx?
A

Erysipelas

  • Well-demarcated, uniform erythema w/ systemic sx
  • Cause: Group A strep
  • Tx: penicillin
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5
Q

Cat bite infections

A

Pasturella

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6
Q

Human bite infxs

A

Eikenella

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7
Q

Fresh water trauma worry about…?

A

Aeromonas

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8
Q

Salt water trauma worry about…

A

Vibrio vulnificus

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9
Q

Rose gardener w/ nodular lesions worry about…

A

Spoptrichosis (fungal)

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10
Q

Fish tank owner w/ skin/soft tissue infx worry about…

A

Mycobacterium marinum

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11
Q

Name the tissue layers and the infections that occur at each level.

A

See image below

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12
Q

Treatment for pts w/ recurrent MRSA?

A

Nasal mupirocin, bleach baths, chlorhexidine washes

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13
Q

Necrotizing Faciitis

  • Presentation
  • Dx
  • Causative Bugs
  • Tx strategy
A
  • Presentation: rapidly spreading soft tissue infx, can be accompanied w/ systemic shock sx
  • Dx: MRI + culture
  • Bugs: usu Grp A Strep or Staph
    • more rare: Gm negs
  • Tx: often surgical debridement plus
    • broad spectrum abx
    • PLUS clinda (ribosomal inhib) to stop toxin elaboration
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14
Q

Paronychia

  • Presentation?
  • Tx?
A

Inflamm around nail bed

  • usually tx w/ “moist head” is enough
  • rarely drainage +/- abx
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15
Q

Folliculitis

  • Causal org?
  • Tx
A

Usu staph

tx w/ topical abx (e.g. Polymyxin B or mupirocin)

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16
Q

Anthrax presentation

  • bug name?
A

painless eschar in someone w/ exposure to animal hides or terrorists

  • Bacillus anthracis
17
Q

Lyme

  • Derm finding name?
  • non-derm findings?
  • should you check serology?
A
  • Erythema chronicum migrans
  • Non-Derm Findings
    • septic, monoarticular arthritis
    • facial nerve (CN VII) palsy
    • meningitis
    • complete heart block
  • If pt has ECM, no need for serology
    • also no need if suspected “chronic Lyme”
18
Q

Two ways of osteomyelitis spreading

A
  1. heamtogenous
  2. contiguous
19
Q

Contiguous Osteomyelitis

  • Pt population?
  • Risk factors?
  • w/o vasc insuff vs. w/ vasc insuff
    • s/sx differences between two
  • Common sites?
  • Pathogens?
  • Dx?
A

Contiguous focus infections and those due to vascular insufficiency are most common in those over 50 years old, reflecting increased likelihood of precipitating factors:

  • Surg, ortho surg (e.g., knee, hip replace)
  • History of DM and/or PVD
  • Trauma, incl open fxs
20
Q

Hematogenous Osteomyelitis

  • Presentation
  • Pt population?
  • Risk factors?
  • Which bone(s)?
A

Hematogenous Osteomyelitis

  • Presentation: local sx + systemic sx
  • Pt population: children
  • Risk factors?
  • Which bone(s): usually single, long bone
21
Q

Vertebral Osteomyelitis:

  • Pathophysiology
  • Most common bug?
    • Others in adults?
    • Old men?
    • IVDUs?
    • Sickle Cell pts?
  • Risk Factors?
  • S/Sx
  • Dx
A

Pathophys

  • Organisms reach the well-perfused vertebral body via spinal arteries.
  • Most often involves the lumbar or thoracic spine.
  • Infection spreads from end plate into disk space.

Most common bugs (95% single org)

  • Most common: 50% S. aureus
    • other adult paths: Viridans streptococci, including S. milleri;
  • E.coli and other enterics in~25%
  • Old men: Enterococci
  • IVDUs: S. aureus, P. aeruginosa, Serratia
  • Sickle: Salmonella spp., S. aureus

Risk Factors

  • Age > 50
  • Sickle cell
  • DM
  • Hemodialysis
  • Endocarditis
  • IVDU
  • Nosocomial bacteremia
  • Long-term vascular access
  • UTI, esp. elderly men
  • Preceding minor trauma or fall

S/Sx

  • Often starts insidious -> subacute or chronic
  • May have hx of fever +/- rigors weeks b4 presentation w/ back pain
  • Presents as back or neck pain (>90%)
  • Fever often low-grade or absent (50%)
  • Constitutional symptoms: anorexia, malaise
  • Percussion tenderness of spine and paraspinal muscles, with spasm (85%)

Dx

  • Cultures
  • Plain films: irregular erosions in end plates of adjacent vertebral bodies and narrowing of intervening disk space – virtually diagnostic
  • CT/MRI: may show epidural, paraspinal, retropharyngeal, mediastinal, retroperitoneal, or psoas abscess originating in the spine
22
Q

Treatment for General Osteomyelitis

A

See Slides 32 and 33

23
Q

Most sensitive and specific test of osteomylelitis?

A

MRI

24
Q

Tx for acute hematogenous osteo

A
  • Duration of therapy typically 4 to 6 weeks
  • Home therapy (OPAT) is appropriate for motivated and stable patients
  • Drugs with a long half-life, such as ceftriaxone vancomycin, and ertapenem, facilitate OPAT.
  • Children can be switched from parenteral to oral therapy after 5 to 10 days if signs of infection have resolved.
  • Few data support the use of oral therapy in adults except with quinolones (for GNRs) and possibly linezolid.
25
Q

Tx for vertebral osteomyelitis

A
  • Key: evaluate carefully for epidural abscess.
  • Usual duration for 6 weeks, but longer course if ESR and/or CRP do not normalize by end of planned course.
  • Surgery necessary only for:
    • Spinal instability
    • New or progressive neurologic deficits
    • Large soft tissue abscesses
    • Failure of medical therapy
  • Bed rest only until back pain improved.
26
Q

Tx of Chronic Osteo

A
  • Combined surgical and medical approach.
  • Thorough debridement of necrotic bone and abnormal soft tissues is essential.
  • Use of CT or MRI to delineate extent of infection before surgery.
  • After surgery, 4 to 6 weeks of parenteral therapy (or oral equivalent), based on culture data.
  • The benefit of prolonged oral therapy after 4 to 6 weeks i.v. is unproven, but often done.
27
Q

skeletal TB

A
  • Most commonly involves thoracic spine
  • Usually accompanied by abnormal chest x-ray, e.g., chronic fibrotic changes or nodules
  • Suspect TB on the basis of epidemiology (where a patient is from, likelihood of TB exposure), chest x-ray findings, and PPD or interferon- release assay.
  • Histopathology shows necrotizing granulomas, but the infection is “paucibacillary,” so stains may be negative (with culture taking 6 weeks)

SBM I.D. (14 decks)

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