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BRS DERMATOLOGY > 1b Infections and Infestations of the Skin > Flashcards

1b Infections and Infestations of the Skin Flashcards

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1
Q

What is panton valentine leukocidin?

A
  • It is a beta-pore forming toxin released by Staphylococcus aureus
  • Increased morbidity, mortality, trasmissability
  • Painful, multi-site, recurrent, present in contacts
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2
Q

What are the extracutaneous presentations of panton valentine leukocidin (3)?

A
  • Necrotising fasciitis
  • Necrotising pneumonia
  • Purpura fulminans
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3
Q

What is the presentation?

A
  • Purpura fulminans
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4
Q

What is the presentation?

A
  • Necrotising fasciitis
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5
Q

A patient presents with the following symptoms:

What is the most likely diagnosis?

A
  • Panton valentine leukocidin releasing staphylococcus aureus
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6
Q

What are the risks of acquiring panton valentine leukocidin releasing staphylococcus aureus (5Cs)?

A
  • Close contact
  • Contaminated items
  • Crowding
  • Cleanliness
  • Cuts
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7
Q

How is panton valentine leukocidin releasing staphylococcus aureus managed (4)?

A
  • Abx (often tetracycline)
  • Nasal ointment (mupirocin)
  • Chlorhexidine body wash
  • Treat contacts
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8
Q

What is the presentation?

A
  • Folliculitis (follicular erythema; sometimes pustular)

May be infectious or non-infectious (in HIV)

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9
Q

A patient presents with the following symptoms:

What is the most likely diagnosis?

A
  • May be infectious (Staphylococcus aureus, particularly strains expressing panton valentine leukocidin (PVL))

OR

  • Non-infectious (in HIV)
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10
Q

How is folliculitis managed?

A
  • Antibiotics (usually flucloxacillin or erythromycin)
  • Incision and drainage is required for furunculosis
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11
Q

What is the presentation?

What is the cause?

A
  • Pseudomonal folliculitis
  • Staphylococcus aureus from hot tub, swimming pool, depilatories, wet suits
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12
Q

What is a furuncle?

A
  • A furuncle is a deep follicular abscess involving one follicle
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13
Q

What is a carbuncle?

A
  • A carbuncle is a deep follicular abscess involving several adjacent follicles

More likely to lead to complications such as cellulitis and septicaemia than a furuncle

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14
Q

What is the presentation?

A
  • Cellulitis
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15
Q

What is the cause of cellulitis (2)?

A
  • Streptococcus pyogenes
  • Staphylococcus aureus
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16
Q

How is cellulitis managed (1)?

A
  • Systemic antibiotics
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17
Q

What is the presentation?

A
  • Impetigo
    • Superficial bacterial infection, stuck-on, honey-coloured crusts overlying an erosion
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18
Q

What is the cause of impetigo?

A
  • Streptococci (non-bullous)
  • Staphylococci (bullous)

Impetiginisation: occurs in atopic dermatitis-> superimposed infection -> gold crusting

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19
Q

How is impetigo managed (1)?

A
  • Topical +/- systemic antibiotics
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20
Q

What is the presentation?

A
  • Ecthyma
    • Severe form of streptococcal impetigo
    • Thick crust overlying a ‘punch out’ ulceration surrounded by erythema
    • Usually on lower extremities
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21
Q

A patient presents with the following symptoms:

What is the diagnosis?

A
  • Staphylococcal Scalded Skin Syndrome (SSSS) due to exfoliative toxin

Neonates, infants or immunocompromised adults (In neonates, kidneys are immature so cannot excrete the exfoliative toxin quickly)

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22
Q

A patient presents with the following symptoms:
* Fever > 38.9oC
* Hypotension
* Diffuse erythema
* Involvement of ≥ systems: GI, CNS, renal, hepatic, muscular
* Mucous membranes (erythema)
* Hematologic (platelets < 100 000/mm3)

What is the diagnosis?

A
  • Toxic shock syndrome due to Group A Staphylococcus aureus strain that produces pyrogenic exotoxin TSST-1
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23
Q

What is the presentation?

A
  • Necrotising fascitis
    • Initial dusky induration (usually of a limb), followed by rapid painful necrosis of skin, connective tissue and muscle.
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24
Q

What is the cause of necrotising fascitis?

A
  • Usually synergistic: streptococci, staphylococci, enterobacteriacee and anaerobes > Blood and tissue cultures can determine organisms and sensitivities.
25
Q

What is syphillis cased by?

A

Treponema pallidum

26
Q

What are the features of primary syphillis?

A
  • Primary infection Chancre - painless ulcer with a firm indurated border
  • Painless regional lymphadenopathy one week after the primary chancre
  • Chancre appears within 10-90 days
27
Q

A patient presents with the following symptoms:

What is the diagnosis?

A

Secondary syphillis
- begins 50 days after chancre

28
Q

What are the features of secondary syphillis?

A
  • Malaise, fever, headache, pruritus, loss of appetite, iritis
  • ‘Great mimicker’ - low threshold for testing- strong index of suspicion required
  • Rash (88-100%) -Pityriasis rosea-like rash
  • Alopecia (‘moth-eaten’)
  • Mucous patches
  • Lymphadenopathy
  • Residual primary chancre
  • Condylomata lata
  • Hepatosplenomegaly
29
Q

What is Lues maligna?

A
  • Rare manifestation of secondary syphilis
  • Pleomorphic skin lesions with pustules, nodules and ulcers with necrotising vasculitis
  • More frequent in HIV manifestation
30
Q

A patient presents with the following symptoms:

What is the diagnosis?

A

Tertiary syphillis

31
Q

What are the features of tertiary syphillis?

A
  • Gumma Skin lesions - nodules and plaques
    > Extend peripherally while central areas heal with scarring and atrophy
    > Mucosal lesions extend to and destroy the nasal cartilage
    > Cardiovascular disease
    > Neurosyphilis (general paresis or tabes dorsalis)
32
Q

What is the treatment of syphillis?

A

IM benzylpenicillin or oral tetracycline

33
Q

A patient presents with the following symptoms:

What is the diagnosis?

A
  • Lyme disease
    • Annular erythema from Borrelia infected tick bite

Borreliosis; 1-30 days from infection
* Neuroborreliosis
* Arthritis
* Carditis

34
Q

What are features of Lyme disease?

A
  • Initial cutaneous manifestation erythema migrans (papule at bite site then progression to annular erythema of more than 20cm)
  • 1-30 days after infection, fever, headache
  • Multiple secondary lesions develop - similar but smaller to initial lesion
  • Neuroborreliosis
  • Facial palsy / other CN palsies
  • Aseptic meningitis
  • Polyradiculitis
  • Arthritis - painful and swollen large joints (knee is the most affected join)
  • Carditis
35
Q

Treatment of Lyme disease?

A

-serology not sensitive and Histopathology non-specific (even though high index or suspicion required to diagnose, treat regardless as risk of progression is worse that risk of abx)

36
Q

What are the different presentations of herpes simplex virus (HSV) (4)?

A
  • Oral lesions: cold sores
  • Genital lesions
  • Herpetic whitlow
  • Eczema herpeticum
37
Q

How is herpes simplex virus (HSV) diagnosed?

A
  • Swab for polymerase chain reaction
38
Q

How is herpes simplex virus (HSV) managed (2)?

A
  • Oral valacyclovir or acyclovir 200mg five times daily in immunocompetent localised infection
  • Intravenous 10mg/kg TDS X 7-19 days if severe, systemic or at risk
39
Q

A patient presents with the following symptoms:

What is the diagnosis?

A
  • Oral lesion caused by herpes simplex virus (HSV-1)

HSV-1 is mainly transmitted by oral-to-oral contact to cause oral herpes (which can include symptoms known as “cold sores”), but can also cause genital herpes. HSV-2 is a sexually transmitted infection that causes genital herpes. Both HSV-1 and HSV-2 infections are lifelong.

40
Q

A patient presents with the following symptoms:

What is the diagnosis?

A
  • Genital lesion caused by herpes simplex virus (HSV-2)

HSV-1 is mainly transmitted by oral-to-oral contact to cause oral herpes (which can include symptoms known as “cold sores”), but can also cause genital herpes. HSV-2 is a sexually transmitted infection that causes genital herpes. Both HSV-1 and HSV-2 infections are lifelong.

41
Q

A patient presents with the following symptoms:

What is the diagnosis?

A
  • Eczema herpeticum
    • Monomorphic, punched out erosions (excoriated vesicles)

It’s an emergency!

42
Q

A patient presents with the following symptoms:

What is the diagnosis?

A
  • Herpetic whitlow
    • HSV (1>2) infection of digits - pain, swelling and vesicles (vesicles may appear later)

Misdiagnosed as paronychia or dactylitis
Often in children

43
Q

A patient presents with the following symptoms:

What is the diagnosis?

A
  • Candidiasis (Candida Albicans)
44
Q

A patient presents with the following symptoms:

What is the diagnosis and what is it caused by?

A
  • Scabies caused by sarcoptes species:
    • Female mates, burrows into epidermis, lays eggs and dies
45
Q

What are the features of Candidiasis (Candida Albicans)

A
  • warm moist areas (diabetes M)
  • Erythema odema- thin purulent discharge
  • Usually intertriginous infection (skin folds) or oral mucosa common cause of vulvovaginitis
  • Can become systemic (immunocompromise)
46
Q

What is the treatment for scabies?

A

permethrin, oral ivermectin
- Two cycles of treatment are required

47
Q

A patient presents with the following symptoms
*black crusty lesions
*redness and swelling
*Hx of diabetes mellitus

What is the diagnosis?

A

Mucormycosis

48
Q

What are the symptoms of mucormycosis?

A
  • Presentation: oedema, then pain, then eschar
  • fever, headache, proptosis, facial pain, orbital cellulitis ‡ cranial nerve dysfunction
49
Q

What is the treatment for mucormycosis?

A

Aggressive debridement & antifungal therapy amphoteracin

50
Q

What are the associations of mucormycosis?

A

Diabetes mellitus (1/3 of patients) - DKA very high risk
Malnutrition
Uraemia
Neutropaenia
Medications: Steroids / antibiotics / desferoxamine
Burns
HIV

51
Q

A patient presents with the following symptoms:

  • Hyper/hypopigmentation

What is the diagnosis?

A

Pityriasis versicolor

52
Q

Features of Pityriasis versicolor

A
  • Hypopigmented, hyperpigmented or erythematous macular eruption +/ - fine scale
  • Malassezia spp.
  • Begins during adolescence (when sebaceous glands become active)
  • Flares when temperatures and humidity are high - Immunosuppression
53
Q

Treatment of Pityriasis versicolor

A

Topical azole

54
Q

What are dermatophytes?

A

Fungi that live on keratin

55
Q

What is a Kerion?

A

An inflammatory fungal infection that may mimic a bacterial folliculitis or an abscess of the scalp; scalp is tender and patient usually has posterior cervical lymphadenopathy
- Frequently secondarily infected with Staphylococcus aureus

56
Q

What is tinea capitis and what is it caused by?

A

Scalp ringworm- caused by Trichophyton tonsurans

57
Q

What species causes the most fungal infections and give example of what it causes.

A

Trichophyton rubrum e.g. tinea pedis (athlete’s foot) and onychomycosis

58
Q

What is the Id reaction?

A
  • Aka Dermatophytid reactions
  • Inflammatory reactions at sites distant from the associated dermatophyte infection
  • May include urticaria, hand dermatitis, or erythema nodosum
  • Likely secondary to a strong host immunologic response against fungal antigens

BRS DERMATOLOGY (9 decks)

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