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Year 3 Infection > 13. Skin and soft tissue infections > Flashcards

13. Skin and soft tissue infections Flashcards

1
Q

Who gets skin and soft tissue infections?

A

Diabetes leading to neuropathy and vasculopathy
Immunosuppresion
Renal failure
Milroy’s disease
Predisposing ski diseases (atopic dermatitis)

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2
Q

What else is important is good to consider

A

Site of infection and potential complications
Drug resistant strains? (MRSA)
Drug interactions
Drug allergies

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3
Q

What organism is very common for skin and soft tissue infections?

A

Staph Aureaus

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4
Q

What is impetigo?

A

Superfifical skin infection, highly infectious and common in children 2-5 years old.

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5
Q

How does impetigo present?

A

Ususally occurs on expose parts of the boies such as face, extremities and scalp.
Multiple vesicluar lesions n an erythematous base
Golden crust is highly suggestive of this diagnosis
Most commonly due to staph aureus

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6
Q

What are predisposing factors to impetigo?

A 
Skin abrasions
Minor trauma
Burns
Poor hygiene
Insect bites
Chickenpox
Eczema
Atopic dermatitis
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7
Q

What is the treatment of impetigo?

A

small areas of infection- topical antibiotics

Large areas of infections- oral antibiotics e.g. flucloxacillin

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8
Q

What is erysipelas?

A

Infection of the upper dermis. 70-80% is found on the lower limbs. there is a high recurrence rate

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9
Q

How does erysipelas present?

A

Red, bubbly stretched skin,
associated fever
regional lymphadenopathy and lmyphangitis
elevated borders, typically cuased by strep pyogenes

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10
Q

What are predisposing factors to erysipelas?

A 
Lymphoedema
venous stasis
obesity
paraparesis
diabetes
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11
Q

What is cellulitis

A

Diffuse skin infection involving deep dermis and subcutaneous fat

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12
Q

How does cellulitis present

A

spreading erythematous area with no distinct borders
Fever is common
Regional lymphadenopathy and lymphangitis
Possible of bactearemia
Staph aureus and strep pyogenes most common organisms

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13
Q

What are predisposing factors to cellulitis?

A

Diabetes
Tinea pedis (athletes foot)
Lymphoedema

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14
Q

How do you treat erysipelas and cellulitis?

A

Combination of anti staph and anti strep antibiotics

In extensive disease admit and treat with IV antibiotics and rest

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15
Q

What are the three follicle associated infections?

A

Folliculitis- single follicle involvement
Furuculosis- red, tender nodule surrounding a follicle with one draining point)
Carbuncles- deep abscess of several follicles with several draining points

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16
Q

What is folliculitus?

A

Circumscribed pustular infection of a hair follicle

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17
Q

How does folliculitis present?

A

Presents as small red papules
Central area of purulence that may rupture and drain
Most common organsism is staph aureus, not serious

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18
Q

What is furinculosis?

A

Furuncles commonly referred to as boils

Single hair nodule associate inflammatory nodules

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19
Q

How does furinculosis present?

A

Usually swelling ad redness on areas in the face,axilla, neck, buttocks. Staph aureus is the most common organism but systemic symptoms are uncommon. Mo treatment often required

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20
Q

What are the risk factors for furunculosis?

A 
Obesity 
Diabetes
Atopic dermatitis
Chronic kidney disease
Corticosteroid use
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21
Q

What are carbuncle’s?

A

Infections that involve multiple furuncles.

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22
Q

How do carbuncle’s present?

A

Often in back of neck, posterior trunk or thigh
Multiseptated abscesses
Purulent material may be expressed from multiple sites
Constitutional symptoms may be common

23
Q

How do you treat carbuncle’s?

A

Often require admission to hospital, surgery and IV antibiotics

24
Q

What is necrotising fasciitis?

A

An emergency of infectious disease, skin eating bacteria affecting any site in the body

25
Q

What organsisms cause necrotising fasciitis?

A 
Streptococci
Staphylococci
Enterococci
Gram negative bacilli
Clostridium
26
Q

What predisposes people to necrotitsing fasciitis?

A 
Diabetes mellitus
Surgery
Trauma
Peripheral vascular disease
Skin popping- injecting IV drugs but missing the vein
27
Q

What are the different types of necrotising fasciitis?

A

Type 1- mixed aerobic and anaerobic infection

Type II- monomicrobial, typically associated with strep pyogenes. Fast onset, sepsis comes on very quick.

28
Q

How does necrotising fasciitis present?

A

Rapid onset, unremitting pain, oedema, erythema
Heamorrhagic bullae, skin necorsis, crepitus
Systemic features e.g. fever, hypotension, tachycardia, delirium and multiorgam failure.

Parastesthia at site of infection points towards

29
Q

How do you treat Necrotising fasciitis?

A

Surgical review is mandatory, imaging may help but can delay treatment
Broad spectrum antibiotics- flucloxacillin, Gentamicin, clindamycin
Overall mortality high

30
Q

What is pyomyosisits?

A

Purulent infection deep within skeletal muscle often manifesting as an abscess

31
Q

How does it present?

A

fever, pain or woody muscle (pushing on muscle feels like pushing on wood)
If untreated leads to septic shock and death
infection often to damage to the msucele.
Common sites include:
Thigh
Calf
Arms
Glutes
Chest wall
Psoas muscle
Commonest cause is staph aureus

32
Q

How do you treat pyomyosistis?

A

Investigate using CT/MRI

Drainage with antibiotics cover depending on stain and culture results

33
Q

How do you treat pyomyosistis?

A

Investigate using CT/MRI

Drainage with antibiotics cover depending on stain and culture results

34
Q

What is septic bursistis?

A

Infection of te small sac like cavities that are lined by synovial membrane.

35
Q

How doe septic bursitis present?`

A

Infection is often from adjacent skin infection.
Peribursal cellulitis, swelling and warmth are common
Fever and pain on movement are also seen
Commonest cause is staph aureus

36
Q

What are the predisposing factors to bursitis?

A 
RA
Alcoholism
Diabetes
IV drug abuse
Immunosupression
Renal insufficiency
37
Q

What is the treatment of septic bursitis?

A

Diagnosis is based on aspiration of the fluid

Treat with antibiotics

38
Q

What is infectious tenosynovitis

A

Infection of the synovial sheaths that surround tendons

39
Q

How does infected tenosynovitis present

A

Flexor muscle associated especially in the hands
Penetrating trauma the most inciting event
Muscle will be in a semiflexed position
Tenderness over length of sheath and pain on extension
Most common cause is staph aureus

40
Q

How do you treat infected tenosynovitis?

A

Empircal antibiotcs and get the surgeons involved

41
Q

What are toxin mediated syndromes?

A

Often due to sueprantigens, group of pyrogenic atigens
Actvivate vast amount sof T cells causing endothelial leakage, haemodynamix hock, multiorgan failure adn eath
Mostly staph aureus and strep. pyogenes

42
Q

What is toxic shock syndrome?

A

Can be due to small skin infections are the use of high absorbency tampons

43
Q

How does toxic shock syndrome present?

A

Fever, hypotension, diffuse macular rash
3/6 involved- Liver, blood, renal GI, CNS, MSK
TSST1 is produced and induces antibody toxin

44
Q

How do you treat toxic shock syndrome?

A 
Remove offending agent
Intravenous fluids
Inotropes
Antibiotics
Intravenous immunoglobulins
45
Q

What is staphylococcal scalded skin syndrome?

A

Infection due to a particular strain of staph aureus producing exfoliative toxin A or B

46
Q

How does staphylococcal scalded syndrome present?

A

Characterised by widespread bullae and skin exfoliation
Usually occurs in children but rarely in adults

Treat with IV fluids and antibiotics

47
Q

What are intravenous catheter associated infections?

A

What they say on the tin

48
Q

How do intravenous catheter associated infections present?

A

local SST inflammation leading to cellulitis, common to have bacteraemia
Most common agents are MSSA and MRSA
Commonly form a biofilm which spills into the bloodstream
Can seed into other places e.g. endocarditis, osteomyetits

49
Q

Hwo do you treat intravenous catheter associated infections?

A

Remove cannula
Express any pus from the thrombophlebitis
Antibiotics for 14 days
Echcardiogram

50
Q

How do you prevent IV catheter associated infections

A

Do not leave unused cannulae
Do not insert cannulae unless yo are using them
Change cannulae every 72 hours
Monitor for thrombophlebitis
Use aseptic technique when inserting cannulae

51
Q

What are the classifications of surgical wounds?

A

Class I- clean wound

Class II- clean-contaminated wound- tracts entered but no unusual contamination

Class III- contaminated wound

Class IV- infected wound

52
Q

What are risk factors for surgical wounds becoming infected?

A 
Diabetes,
smoking
obesity
malnutrition
concurrent steroid use
colonisation with staph aureus
Shaving night before
break in sterile techniquw
perioperative hypoxia
53
Q

How do you diagnose surgical wound infections?

A

Avoid superfificla swabs, aim for dee structures and send cultures away
Consider an unlikely pathogen if obtained rom sterile site e.g. bone
Antibiotics to target organsim

Year 3 Infection (15 decks)

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