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DERM > BACTERIAL & VIRAL SKIN INFECTIONS > Flashcards

BACTERIAL & VIRAL SKIN INFECTIONS Flashcards

1
Q

may follow impetigo

A

post-strep glomerulonephritis

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2
Q

IMPETIGO

A
  • high incidence in children
  • self limiting (will eventually go away), but if not treated = may last for weeks to months
  • Post-strep Glomerulonephritis may follow impetigo**

PE
⦁ nonbullous and/or bullous
⦁ have vesicles and bullae containing clear yellow or slightly turbid fluid without surrounding erythema
⦁ superficial small vesicle or pustules 1-3 cm lesions
⦁ golden-yellow, honey crusted lesions

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3
Q

IMPETIGO TREATMENT

A

bactroban/mupirocin ointment

  • in severe cases = oral antibiotics to cover for staph/MRSA = Bactrim, Clinda or Doxy
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4
Q

MOST RAPIDLY LETHAL FORM OF SEPTIC SHOCK

A

MENINGOCOCCEMIA

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5
Q

MENINGOCOCCEMIA

A
  • Neisseria Meningitidis

Highest incidence

  • between 6 months to 3 years old
  • midwinter or early spring

MOST RAPIDLY LETHAL FORM OF SEPTIC SHOCK

Waterhouse–Friderichsen syndrome- septic shock is the result of the adrenal glands being involved; get hemorrhagic adrenal necrosis –> develop acute septic shock

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6
Q

Waterhouse–Friderichsen syndrome- septic shock is the result of the adrenal glands being involved; get hemorrhagic adrenal necrosis –> develop acute septic shock

A

meningococcemia

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7
Q

physical exam for meningococcemia

A 
⦁	high fever
⦁	tachycardia
⦁	mild hypotension
⦁	signs of meningeal irritation....(photophobia, nuchal rigidity, headache)
⦁	patient appears acutely ill
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8
Q

meningococcemia rash

A

EARLY EXANTHEM

  • occurs soon after onset
  • have pink 2-10mm macules/papules that are sparsely distributed on trunk / lower extremities, face, palate, conjunctivae

LATER LESIONS

  • petechiae in center of macules
  • lesions become hemorrhagic within hours, purpura
  • purpura fulminans, hemorrhagic bullae
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9
Q

diagnostics for meningococcemia

A

⦁ blood cultures
⦁ pus from nodular lesions shows gram negative diplococci
⦁ D-dimers

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10
Q

treatment for meningococcemia

A

⦁ Cefotaxine (Claforin)
⦁ Ceftriaxone (Rocephin)
⦁ hemodynamic stabilization

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11
Q

cause of meningococcemia

A
  • Neisseria Meningitidis
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12
Q

cause of impetigo

A

strep or staph or both

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13
Q

cause of bacterial endocarditis

A

⦁ staph aureus

⦁ strep viridans

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14
Q

risk factors for bacterial endocarditis

A

elderly
IVDU
prosthetic valves

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15
Q

bacterial endocarditis

A

have proliferation of microorganisms (staph aureus or strep viridans) on the endocardium of the heart

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16
Q

symptoms of bacterial endocarditis

A 
⦁	fever
⦁	chills
⦁	sweats
⦁	anorexia / weight loss
⦁	malaise

basically all the general symptoms**

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17
Q

PHYSICAL EXAM FOR BACTERIAL ENDOCARDITIS***

A

⦁ heart murmur
⦁ arterial emboli (may have abdominal pain due to emboli to liver etc)
⦁ splenomegaly (if you feel for it!)

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18
Q

JANEWAY LESIONS

OSSLER’S NODES

A

BACTERIAL ENDOCARDITIS

janeway lesions = nontender hemorrhagic maculopapular lesions on palms & soles

osler’s nodes = painful red nodules on fingertips

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19
Q

skin lesions with bacterial endocarditis

A

⦁ Janeway lesions = nontender hemorrhagic maculopapular lesions on palms & soles (thought to be due to miroemboli, or may be autoimmune phenomenon due to reaction to bacteria)

⦁ Osler’s nodes = painful red nodules on fingertips

⦁ Subungual splinter hemorrhages - in order to be pathological = should be off the edge of the nail - in the middle of the nail, but doesn’t go to the tip of the nail

⦁ Petechial lesions = small, non-blanching, reddish-brown macules on extremities, upper chest, mucus membranes; occur in crops. Get asymptomatic red streaks in nail bed

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20
Q

diagnostics for bacterial endocarditis

A
  • blood cultures
  • CBC
  • BMP
  • Coags
  • Echo
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21
Q

treatment for bacterial endocarditis

A

⦁ PCN G
⦁ Nafcillin
⦁ Gentamycin
⦁ Vanco or Zyvox in MRSA

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22
Q

RMSF caused by

A

Rickettsia ricketsii spirochete

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23
Q

Rickettsia ricketsii spirochete

A

RMSF

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24
Q

RMSF

A
  • Caused by Rickettsia ricketsii spirochete
  • common in May through September (summer months)
  • can be fatal if not treated, especially in the elderly

HISTORY

  • hx of tick bite given in 60% of cases
  • ask about outdoor activity (camping, etc)
  • Prodrome of anorexia, irritability, and malaise***** (before other symptoms that appear 1-2 weeks after tick bite)
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25
Q

RMSF has a prodrome of

A

anorexia
irritability
malaise

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26
Q

Symptoms of RMSF

A 
symptoms appear 1-2 weeks after tick bite
⦁	fever (> 102)
⦁	chills
⦁	weakness
⦁	Headache***
⦁	Photophobia***

tick bite, then prodrome of irritability, malaise, anorexia

then have symptoms 1-2 weeks later of headache, photophobia, fever, chills, weakness

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27
Q

RMSF Rash

A

⦁ only 49% get a rash
⦁ initially 2-6mm pink blanching macules that begin on extremities and spread centrally*
- rash begins on wrists, forearms, ankles, and later on palms
⦁ evolve to papules & petechiae over hours to couple of days

*one of the few conditions where palms & soles develop the rash - just get the rash here later on compared to extremities

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28
Q

⦁ initially 2-6mm pink blanching macules that begin on extremities and spread centrally*
- rash begins on wrists, forearms, ankles, and later on palms

A

RMSF

*one of the few conditions where palms & soles develop the rash - just get the rash here later on compared to extremities

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29
Q

treatment for RMSF

A

⦁ Doxycycline
⦁ Chloramphenicol if pregnant

  • start antibiotics if diagnosis is even suspected!!
  • *Per CDC, give doxy even to children now - less effect on teeth than Tetracycline

Mortality rate = about 60% in elderly

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30
Q

if pregnant, tx for RMSF

A

chloramphenicol

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31
Q

Borrelia burgdorferi spirochete from a tick bite

A

LYME DZ

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32
Q

lyme dz rash

A
  • appears several days after infection, or not at all (unlike RMSF where get rash 1-2 weeks later if get rash)
  • can last a few hours or up to several weeks
  • can have very small or very large lesions
  • can mimic hives, eczema, sunburns, poison ivy, flea bites
  • can itch, feel hot, or may not be felt at all
  • can disappear, but then return several weeks later if not treated

**Typical target lesion

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33
Q

lyme dz symptoms

A

several days or weeks after bite, patient develops flu-like symptoms

⦁	headache
⦁	stiff neck
⦁	aches and pains in muscles and joints
⦁	low-grade fever and chills
⦁	fatigue
⦁	poor appetite
⦁	sore throat
⦁	swollen glands
⦁	After several months, arthritis-like symptoms may develop, including painful and swollen joints
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34
Q

how is lyme dz diagnosed?

A
  • difficult to diagnose because symptoms are not consistent, and may imitate other conditions. Primary symptom = rash, but this may not be present in upt o 10-15% of cases
  • diagnosis for Lyme dz = clinical - must be made by a provider experienced in recognizing LD
  • diagnosis usually based on symptoms & hx of tick bite. Testing generally done to elimiate other conditions, and may be supported through blood & lab tests, although, these tests are not absolutely reliable for diagnosing LD
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35
Q

lyme dz treatment

A

⦁ Doxy for adults & children > 8

⦁ Amoxicillin for adults, children, pregnant or breast feeding

36
Q

pregnant women tx = chloramphenicol

A

RMSF

37
Q

pregnant women tx = amoxicillin instead of doxy

A

lyme dz

38
Q

causes of cellulitis

A

staph
group A strep

  • hx of trauma, or may be unaware of wound of entry
  • may include dog, cat or human bite
39
Q

cellulitis can occur in anyone, but common with ________ & __________

A

diabetes

PVD

40
Q

cellulitis PE

A
  • warmth, erythema, edema and tenderness of affected area
  • the margin of cellulitis will NOT be palpated
  • cellulitis with violaceous color & bullae suggests infection with strep pneumoniae
41
Q

Cellulitis characterized by violaceous color and bullae suggests infection with

A

strep pneumo

42
Q

uncomplicated cellulitis

A

⦁ small area of involvement
⦁ minimal pain
⦁ no systemic signs of illness (fever / chills / dehydration / altered mental status / tachypnea / tachycardia / hypotension)
⦁ no risk factors for serious iillness

no work-up required

43
Q

work-up for complicated cellulitis (signs of systemic infection)

A

⦁ CBC
⦁ blood cultures
⦁ CMP

44
Q

treatment for mild cellulitis

A
  • staph & strep coverage

MILD
⦁ bactrim, clinda, doxy = covers MRSA
⦁ Keflex
⦁ Dicloxacillin

45
Q

treatment for complicated cellulitis

A 
- hospitalization for IV antibiotics (to cover MRSA+)
⦁	Ancef (Cephalexin)
⦁	Ceftriaxone (Rocephin)
⦁	Ampicillin - Sulbactam
⦁	Zyvox (Linezolid)
46
Q

cause of Erysipelas

A

group A beta hemolytic strep

also causes cellulitis - along with staph

47
Q

fiery-red, indurated, tense, and shiny plaque. Known as “St Anthony’s fire”.

A

Erysipelas

48
Q

raised sharply demarcated advancing margins

A

erysipelas

49
Q

cellulitis vs erysipelas

A

erysipelas = lymphatic component & sharp margins

cellulitis = no lymphatics & no sharp margins

50
Q

ERYSIPELAS

A

CAUSE
⦁ group A hemolytic strep

  • begins as small erythematous patch - progresses to a fiery-red, indurated, tense, and shiny plaque = known as “St. Anthony’s Fire”
  • lesion classically exhibits Raised, sharply demarcated, advancing margins which differentiate it from cellulitis, as cellulitis has no lymphatic component, and has indiscreet margins
  • inflammation - warmth, edema, and extreme tenderness
  • Lymphatic involvement often manifested by overlying skin streaking and regional lymphadenopathy. More severe infxns - may exhibit vesicles & bullae
51
Q

ERYSIPELAS HAS A PRODROME OF

A

fever
chills
malaise

(what else has a prodrome? = RMSF)

52
Q

treatment for erysipelas

A 
⦁	Penicillin G (also used to treat bact. endocarditis)
⦁	Penicillin VK
⦁	Dicloxacillin (Dynapen)
⦁	Keflex (Cephalexin)
⦁	Clindamycin
⦁	Erythromycin
⦁	May need analgesics for pain
53
Q

treatment for human bite

A

⦁ Augmentin (Amoxicillin-clavulanate)
⦁ Moxifloxicin (Avelox) - not for pts under 18
⦁ Clindamycin
⦁ don’t forget about a tetanus shot** - give in OPPOSITE extremity
⦁ patient must f/u in 1-2 days

54
Q

human bite

A
  • common in young males
  • think about anaerobes

Routine Lab studies = generally not indicated because the injured population is usually young & healthy. Diagnosis of infection = clinical

Xray = Osteomyelitis, metacarpal head fracture

  • closed fist injuries (fist hits teeth)
  • chomping type injury
  • puncture wound on head from clashes with teeth
55
Q

DOG & CAT BITES

A
  • consider tetanus & rabies prophylaxis for all wounds
  • bacteria for cat bites = Pasteurella
  • more penetrating wounds with cat bites because of sharp teeth
  • cat bites = higher risk of infection

CLOSURE

  • Primary closure for wounds that can be cleaned effectively, but more often left open to heal.
  • Facial wounds can be closed
  • Lower extremity wounds need delayed closure
  • Patient follow-up in 1-2 days
56
Q

treatment for dog / cat bites

A 
⦁	Augmentin (amoxicillin-clavulanate)
⦁	erythromycin
⦁	Bactrim DS / Septra DS
⦁	Clindamycin
⦁	Cipro
57
Q

cat bite bacteria

A

pasteurella

58
Q

bacterial causes of necrotizing fasciitis

A

⦁ Group A hemolytic strep
⦁ Staph
⦁ both

(just like with cellulitis)
(erysipelas = just GABHS)

59
Q

progressive, rapidly spreading, inflammatory infection located in the deep fascia, with secondary necrosis of the subcutaneous tissues

A

necrotizing fasciitis

60
Q

most common cause of necrotizing fasciitis

A

GABHS

61
Q

most important signs of necrotizing fasciitis

A

tissue necrosis, putrid discharge, bullae, severe pain, gas production, rapid burrowing through fascial planes, and lack of classical tissue inflammatory signs

62
Q

diagnosis of necrotizing fasciitis

A 
⦁	CBC with differential
⦁	Chem panel
⦁	Blood and tissue cultures
⦁	Urinalysis
⦁	Arterial blood gas
⦁	Xray
⦁	CT
⦁	Biopsy is best to use when diagnosing
63
Q

treatment for necrotizing fasciitis

A 
⦁	aggressive antibiotics
⦁	hemodynamic stabilization
⦁	surgical consult for debriding
⦁	ID specialist
⦁	hyperbaric specialist
ANTIBIOTICS
⦁	Ceftriaxone (Rocephin)
⦁	PCN-G
⦁	Clindamycin (Cleocin)
⦁	Flagyl
⦁	Gentamicin (Garamycin)
⦁	Chloramphenicol
⦁	Ampicillin
64
Q
  • chronic, suppurative disease of apocrine gland-bearing skin
A

hidradenitis suppurativa

65
Q

apocrine duct or gland

A

HS

66
Q

predisposing factors to HS

A

⦁ obesity
⦁ genetic disposition to acne
⦁ apocrine duct obstruction

67
Q

common sites for HS

A

⦁ Axilla

⦁ anogenital region

68
Q

HS TREATMENT

A 
⦁	ILK - triamcinolone
⦁	PO steroids - prednisone
⦁	surgery - I&D = last resort! - will just come back...
⦁	Oral ABX
	- Erythromycin
	- Tetracycline
	- Minocycline
⦁	Isotretinoin
69
Q

which HSV herpetic whitlow

A

HSV I

70
Q

diagnosis of HSV

A
  • inspection
  • Tzanck smear = see giant multinucleated cells
  • Direct immuno-fluorescence antibody
  • culture (viral)
71
Q

HSV treatment

A

⦁ cool compresses
⦁ air or heat lamp - dry of lesions
⦁ Penciclovir (denavir) = topical
⦁ Famciclovir (Famvir) or Valacyclovir (Valtrex)
⦁ Acyclovir = less expensive, but have to take more often
⦁ pain control PRN

72
Q

when is chickenpox contagious from

A

⦁ is highly contagious from 2 days before onset of rash until all lesions have crusted

73
Q

chicken pox rash

A
  • appears on face & scalp, then spreads inferiorly to the trunk (centripetal)
    ⦁ vesicles - “dew drops on a rose petal”
    ⦁ pruritic
    ⦁ become pustules & crust over
74
Q

treatment for chicken pox

A
  • usually self-limiting
  • if symptomatic
    ⦁ benadryl for pruritus
    ⦁ tylenol for fever
  • Systemic
    ⦁ Acyclovir (Zovirax)
75
Q

SHINGLES

A
  • more than 60% are > 50 y/o
  • involves dermatomes
  • reactivation of varicella virus in cutaneous nerves from earlier varicella
  • triggering factors
  • unilateral, very painful
  • flu like prodrome
76
Q

complications of shingles

A

Postherpetic neuralgia

Temporary motor paresis

77
Q

common locations for shingles

A

⦁ Thoracic
⦁ Trigeminal
⦁ Lumbosacral
⦁ Cervical

78
Q

shingle lesions

A 
⦁	Papules to vesicles-bullae 
⦁	Pustules to crusts
⦁	Erythematous, edematous base with superimposed clear vesicles, sometimes hemorrhagic
⦁	Vesicle is oval or round
⦁	Can have regional lymphadenopathy
79
Q

warts are caused by

A

hpv

80
Q

treatment for shingles

A
  • famvir, valtrex or acyclovir 800mg 5xd for 7-10 days
  • oral steroids are controversial
  • antibiotic cream to prevent secondary infections
  • if extremely painful = - Ultram PO (tramadol)
  • burrow’s solution or cool tap water compresses
81
Q

treatment of genital warts

A 
- all genital warts should be treated
⦁	Podophyllum = treats small areas
⦁	Trichloroacetic acid = particularly helpful for vaginal warts
⦁	Cryosurgery
⦁	CO2 laser
⦁	Electrosurgerry

Treatment does not ensure elimination of wart virus from the area

82
Q

Round, flat and smooth warts =

A

plane warts (flat warts)

83
Q

warts that are Long and thin in shape= Can grow rapidly on the eyelids,neck and armpits.

A

filiform warts

84
Q

multiple plantar warts in clusters. Same color as the persons skin

A

mosaic warts

85
Q

MOLLUSCUM

A

Discrete, 2 - 5 mm, umbilicated, dome-shaped papules
Spread by autoinoculation, scratching, or touching a lesion
Common on face, trunk, extremities in children
Common in genital and pubic areas in adults

86
Q

molluscum treatment

A 
- self-limiting - not necessary to treat in children, but can with
⦁	curettage
⦁	cryosurgery
⦁	TCA / podophyllin
⦁	Retin-A cream
⦁	Cantharidin

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