derm - infections and infestations Flashcards
what conditions can staph aureus infection cause
ecthyma impetigo cellulitis folliculitis: furunculosis, carbuncles staph scalded skin syndrome superinfects other dermatoses
how does staphylococcus cause infections
expresses virulence factors e.g toxins, haemolysin, leukocidin, peptidoglycan layers etcc that confer pathogenic properties
what virulence does strept possess that leads to infections
strept pyogenes - attaches to epithelial surface via lipoteichoic acid portion of fimbriae
- has m proteins (antiphagocytic) and hylauronic acide capsule
- produces erthrogenic exotoxins
- produces streptolysins S and O
what conditions can strept cause
ecthyma cellulitis impetigo erysipelas scarlet fever necrotising fascitis superinfects other dermatoses
what is folliculitis
follicular erythema - sometimes pustular
can be infectious/non infectious
recurrent cases may arise from nasal carriage of ataph aureus particularly strains expressing pvl
eosinophilic(non infectious) is associated with hiv
what are the treatments for follicultis
antibiotics - usually flucloxacillin or erythromycin
incision and drainage is required for furunculosis
what is difference between furuncle and carbuncle
furuncle = deep follicular abcess carbuncle = composes or furuncles and involves adjacent hair follicles
why do some patients develop recurrent staph impetigo or recurrent furunculosis
have established themselves as part of resident microbial flora (in particular nasal flora) immunodeficiencies : -hypogammaglobulinaemia - chronic granulomatous disease - AIDS - diabetes mellitus
what is panton valnetine leukocidin staph aureus
pvlsa
beta pore forming exotoxin
causes leukocyte destruction and tissue necrosis
= higher morbididity,mortality and transmissibility
in skin: recurrent and painful abcesses, follliculitis and cellulitis
*often painful, more than one site, recurrent, present in contacts
extracutaneous: necrotising pneumonia, necrotising fascitis and purpura fulminans
what are the 5c’s risk of acquiring pvla
close contact e.g hugging, contact sports contaminated items crowding cleanliness cuts and grazes
what is the treatment for pvla
antibiotics - tetracycline
decolonisation e.g chlorhexidine body wash for 7 days
nasal application of mupirocin ointment for 5 days
treatment of close contacts
what is psedomonal follicultis
associated with hot tub use, swimming pools and wet suits
appears 1-3 days after exposure, as diffuse truncal eruption
causes follicular erythematous papule
rarely - abcesses, lyphangitis and fever
most cases self limited - no treatment req
severe/recurrent cases can be treated with oral ciprofloxacin
what is cellulitis
infection of lower dermis and subcut tissue
tender swelling with ill defined,blanching erythema or oedema
most causes = strept pyogenes and staph aureus
oedema = predisposing factor
what is the treatment for cellulitis
systemic antibiotics
what is impetigo
superficial bacterial infection, stuck on honey coloured crusts overlyig an erosion
caused by strepttococci (non bullous) or staph (bullous)
caused by exfoliative toxins a and b, split epidermis by targeting desmoglein 1.
affects face: perioral, ears and
treatment of impetigo
treatment with topical and with or without systemic antibiotics
what is impetiginisation
refers to superficial infections
occurs in atopic dermatitis
typically gold crust and caused by staph aureus
what is ecthyma
severe form of strept impetigo
-thick crust overlying punch out ulceration surrounded by erythema
usually in lower extremities
what is staph scalded skin syndrome
usually in neonates, infants and immunocompromised adults
due to exfoliative toxin
infection occurs at distant site i.e conjunctivitis/abcess
organism cannot be cultured from denuded skin
in neonates - kidneys cannot excrete exfoliative toxin quickly
diffuse tender erythema with rapid progression leads to flaccid bullae, wrinkle and exfoliate leaving oozing erythematous base
clinically resembles sjsten
what is toxic shock syndrome
febrile illness caused by group a staph aureus strain that produces pyrogenic exotoxin tsst1
signs and symptoms of toxic shock syndrome
fever >38.9
hypotension
diffuse erythema
involvement of: gi,muscular,cns,renal and hepatic systems
mucous membranes - erythema
haematological (plts <1000000)
desquamation of palms ans soles 1-2 wks after resolution of erythema
what is erythrasma
infection of corynebacterium minutissiumum
well demarcated patches in interriginous areas
initially pink and becomes brown and scaly
what is pitted keratolysis
pitted erosions of soles
caused by corynebacteria
what is pitted keratolysis treated by
topical clindamycin
what is eryspipeloid
erythema and oedema of hand after handling of raw fish/meat
extends slowly over weeks
caused by erysipelothrix rhusiopathiae
what is anthrax
painless necrotic ulcer with surrounding oedema and regional lymphadenopathy (with pain in lymph nodes) at site of contact with hides, bone meal or wool infected with bacillus antracis
what is blistering distal dactylitis
rare infection caused by strept pyogenes or staph aureus
typically in young children
1/more tender superficial bullae on erythematous base on volar fat pad of a finger
toes may rarely be affected
what is erysipelas
infection of deep dermis and subcutis
casued by beta haemolytic strept or staph aureus
painful
prodrome of malaise,fever and headache
presents as erythematous indurated with sharply demarcated border and cliff drop edge +- blistering
face and limb +- red streak of lymphangitis and local lymphadenopathy
portal of entry must be sought e.g tinea pedis
how is erysipelas treated
with intravenous antibiotics
what is scarlet fever
disease of children
caused by upper rti with erythrogenic toxin producing strept pyogenes
preceded by sore throat,headache, malaise,chills, anorexia and fever
eruption begins 12-48 hrs later
- blanchable tiny pinkish red spots on chest,neck and axillae
- spread to whole body within 12 hrs
- sandpaper like texture
what are some complication of scarlet fever
otitis mastoiditis sinusisitis pneumonia myocarditis hepatitis meningitis rheumatic fever acute glomerulonephritis
what is necrotising fasciitis
initial dusky induration (usually of limb) followed by rapid painful necrosis of skin, connective tissue and muscle
- potentially fatal
usually synergistic: strept,,staph,enterobacteriacae and anaerobes
treatments/diagnosis for necrotising fasciitis
prompt diagnosis essential followed by broad spectrum parenteral antibiotics and surgical debridement
mri can aid diagnosis
blood and tissue cultures determine organisms and sensitivities
mortality is high
can affect scrotum - fourniers gangrene
what is atypical mycobacterial infection
important cause of infection in immunocompromised states
- mycobacterium marinum causes indolent granulomatous ulcers(fish- granuloma) in healthy people, sporotrichoid spread
- mycobacterium chelonae and abcesses - puncture wounds, tattoos, skin trauma or surgery
- mycobacterium ulcerans - important cause of limb ulceration in africa (buruli ulcer) or australia (searles ulcer)
what is borreliosis(lymes disease)
annular erythema develops at site of borrelia infected tick
bite form ixodes tick infected with borrelia burgdorferi
initial cutaneous manifestations - erythema migran - only 75%
- erythematous papule at bite site
- progression to annular erythema of >20cm
what can occur 1-30 days after infection, fever and headache in lyme disease
multiple secondary lesions develop - similar but smaller to initial lesions
- neuroborreliosis: facial palsy/other cn palsies, asesptic meningitis, polyradiculitis
- arthritis - painful and swollen large joints
- carditis
how to diagnose lyme disease
serology not sensitive and histology is non specific therefore high index of suspicion is used to make diagnosis and based of clinical features
what is tularaemia
caused by francesella tularensis
acquired through: handling infected animals,tick bites and deerfly bites
- ulceroglandular form
- primary skin lesions is small papules at innoculation site that rapidly necrosis leading to painful ulceration
+- local cellulitis
painful regional lymphadenopathy
what are the systemic features of tularaemia
fever, chills, headache and malaise
what is ecthyma gangrenosum
pseudomonas aeruginosa
usually occurs in neutropaenic patients
red macules - oedematous - haemorrhagic bullae
- may ulcerate in late stages/form eschar surrounded by erythema
what is syphilis
caused by treponema pallidum
primary infection chancre - painless ulcer with firm indurated border
painless regional lymphadenopathy one week after primary chancre
chancre appears within 10-90 days
what is secondary syphilis
begins 50 days after chancre skin manifestations: pityriasis rosea like rash allopecia mucous patches lymphademopathy residual primary chancre condylomata lata hepatosplenomegaly
symptoms of secondary syphilis
systemic symptoms
malaise fever headache pruritus loss of appetite iritis
what is lues maligna
rare manifestation of secondary syphilis
pleomorphic skin lesions with pustules,nodules and ulcers with necrotising vasculitis
more frequent in hiv maifestations