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

1b Infections and Infestations of the Skin Flashcards

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
What is syphillis cased by?
Treponema pallidum
26
What are the features of primary syphillis?
* 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
A patient presents with the following symptoms: What is the diagnosis?
Secondary syphillis - begins 50 days after chancre
28
What are the features of secondary syphillis?
* 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
What is Lues maligna?
* Rare manifestation of secondary syphilis * Pleomorphic skin lesions with pustules, nodules and ulcers with necrotising vasculitis * More frequent in HIV manifestation
30
A patient presents with the following symptoms: What is the diagnosis?
Tertiary syphillis
31
What are the features of tertiary syphillis?
* 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
What is the treatment of syphillis?
IM benzylpenicillin or oral tetracycline
33
A patient presents with the following symptoms: What is the diagnosis?
* **Lyme disease** * Annular erythema from Borrelia infected tick bite ## Footnote Borreliosis; 1-30 days from infection * Neuroborreliosis * Arthritis * Carditis
34
What are features of Lyme disease?
* 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
Treatment of Lyme disease?
-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
What are the different presentations of herpes simplex virus (HSV) (4)?
* Oral lesions: cold sores * Genital lesions * Herpetic whitlow * Eczema herpeticum
37
How is herpes simplex virus (HSV) diagnosed?
* **Swab** for polymerase chain reaction
38
How is herpes simplex virus (HSV) managed (2)?
* **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
A patient presents with the following symptoms: What is the diagnosis?
* Oral lesion caused by **herpes simplex virus (HSV-1)** ## Footnote 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
A patient presents with the following symptoms: What is the diagnosis?
* Genital lesion caused by **herpes simplex virus (HSV-2)** ## Footnote 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
A patient presents with the following symptoms: What is the diagnosis?
* **Eczema herpeticum** * Monomorphic, punched out erosions (excoriated vesicles) ## Footnote It's an emergency!
42
A patient presents with the following symptoms: What is the diagnosis?
* **Herpetic whitlow** * HSV (1>2) infection of digits - pain, swelling and vesicles (vesicles may appear later) ## Footnote Misdiagnosed as paronychia or dactylitis Often in children
43
A patient presents with the following symptoms: What is the diagnosis?
* **Candidiasis** (Candida Albicans)
44
A patient presents with the following symptoms: What is the diagnosis and what is it caused by?
* **Scabies** caused by **sarcoptes species:** * Female mates, burrows into epidermis, lays eggs and dies
45
What are the features of Candidiasis (Candida Albicans)
- 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
What is the treatment for scabies?
permethrin, oral ivermectin - Two cycles of treatment are required
47
A patient presents with the following symptoms *black crusty lesions *redness and swelling *Hx of diabetes mellitus What is the diagnosis?
**Mucormycosis**
48
What are the symptoms of mucormycosis?
* Presentation: oedema, then pain, then eschar * fever, headache, proptosis, facial pain, orbital cellulitis ‡ cranial nerve dysfunction
49
What is the treatment for mucormycosis?
Aggressive debridement & antifungal therapy amphoteracin
50
What are the associations of mucormycosis?
Diabetes mellitus (1/3 of patients) - DKA very high risk Malnutrition Uraemia Neutropaenia Medications: Steroids / antibiotics / desferoxamine Burns HIV
51
A patient presents with the following symptoms: * Hyper/hypopigmentation What is the diagnosis?
Pityriasis versicolor
52
Features of Pityriasis versicolor
* 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
Treatment of Pityriasis versicolor
Topical azole
54
What are dermatophytes?
Fungi that live on keratin
55
What is a Kerion?
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
What is tinea capitis and what is it caused by?
Scalp ringworm- caused by Trichophyton tonsurans
57
What species causes the most fungal infections and give example of what it causes.
Trichophyton rubrum e.g. tinea pedis (athlete’s foot) and onychomycosis
58
What is the Id reaction?
* 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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