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BRS Year 2 > derm infestation + infect skin > Flashcards

derm infestation + infect skin Flashcards

1
Q

important tests for infective cause of derm tissue?

A
  • swabs
  • serum
  • tissue samples
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2
Q

how does staphyococcus attack the skin?

A
  • receptors that allow it to bind to fibrin: this is found on wound surfaces + in dermatitis
  • via panto valentine leukocidin
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3
Q

what can staph infection cause?

A

Ecthyma
Impetigo
Cellulitis

Folliculitis
- Furunculosis
- Carbuncles
Staphylococcal scalded skin syndrome (SSSS)
Superinfects other dermatoses (e.g. atopic eczema, HSV, leg ulcers)

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4
Q

how does strep attack?

A

Strepococcus pyogenes (β-haemolytic) attaches to epithelial surfaces via lipoteichoic acid portion of fimbriae

- Has M protein (anti-phagocytic) & hyaluronic acid capsule
- Produces erythrogenic exotoxins
- Produces streptolysins S and O
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5
Q

how does strep present?

low priority card

A

Ecthyma
Cellulitis
Impetigo

Erysipelas
Scarlet fever
Necrotizing fasciitis

Superinfects other dermatoses (e.g. leg ulcers)

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6
Q

what is eosinophilic (non infectious) folliculitis associated with?

A

HIV

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7
Q

treatment for folliculitis?

A

Antibiotics (usually flucloxacillin or erythromycin)

Incision and drainage is required for furunculosis.

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8
Q

folliculitis recurrent cases may arise from?

A

from nasal carriage of Staphylococcus aureus, particularly strains expressing Panton-Valentine leukocidin (PVL).

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9
Q

What is the difference between a furuncle and a carbuncle?

A

A furuncle is a deep follicular abscess
- Involvement with adjacent connected follicles = Carbuncle.

Carbuncle - more likely to lead to complications such as cellulitis and septicaemia

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10
Q

Why do some patients develop recurrent staphylococcal impetigo or recurrent furunculosis?

A

Establishment as part of the resident microbial flora:
-abundant nasal flora

Immune deficiency:

  • Hypogammaglobulinaemia
  • HyperIgE syndrome – deficiency
  • Chronic granulomatous disease
  • AIDS
  • Diabetes Mellitus
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11
Q

Where is Staphylococcus aureus most abundant?

A

nasal flora

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12
Q

Panton Valentine Leukocidin Staphylococcus Aureus features?

A

Beta pore forming exotoxin
Leukocyte destruction and tissue necrosis
Higher morbidity, mortality and transmissibility
Skin:
- Recurrent and painful abscesses
- Folliculitis
- Cellulitis
- Often painful, more than 1 site, recurrent, present in contacts

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13
Q

extracutaneous Panton Valentine Leukocidin Staphylococcus Aureus symptoms?

A
  • Necrotising pneumonia
  • Necrotising fasciitis
  • Purpura fulminans
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14
Q

Panton Valentine Leukocidin Staphylococcus Aureus : risks

A

5 Cs
Close Contact – e.g. hugging, contact sports
Contaminated items , e.g. gym equipment, towels or razors.
Crowding –crowded living conditions such as e.g. military accommodation, prisons and boarding schools.
Cleanliness (of environment)
Cuts and grazes – having a cut or graze will allow the bacteria to enter the body

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15
Q

how to treat Panton Valentine Leukocidin Staphylococcus Aureus

A

Consult local microbiologist/ guidelines
Antibiotics
Decolonisation:
* Chlorhexidine body wash for 7 days
* Nasal application of mupirocin ointment 5 days)

Treatment of close contacts

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16
Q

What is Pseudomonal Folliculitis associated with amd how does it present?

A

hot tub use, swimming pools and depilatories, wet suit

Appears 1-3 days after exposure, as a diffuse truncal eruption.
Follicular erythematous papule

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17
Q

treatment of Pseudomonal Folliculitis?

A

usually none required
Rarely can cause abscesses, lymphangitis + fever
- severe/recurrent cases treated with oral ciprofloxacin

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18
Q

What is cellulitis?

A

Infection of lower dermis and subcutaneous tissue

Tender swelling with ill-defined, blanching erythema or oedema

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19
Q

what predisposes to cellulitis and whats causes it?

A

Predisposed by oedema

Most causes caused by s.pyogenes and s. aures

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20
Q

how to treat cellulitis?

A

systemic ABs

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21
Q

Features of impetigo

A

Superficial bacterial infection
Looks like stuck-on, honey-coloured crusts overlying an erosion.
Often affects face

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22
Q

What causes impetigo?

A

Streptococci (non-bullous)
or
Staphylococci (bullous)

Caused by exfoliative toxins A & B, split epidermis by targeting desmoglein I.

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23
Q

How to treat impetigo?

A

topical +/- systemic antibiotics.

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24
Q

Impetiginisation observations?

A

Occurs in atopic dermatitis

- Gold crust
- Staphylococcus aureus
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25
Q

What is Ecthyma?

A

Severe form of streptococcal impetigo
Thick crust overlying a punch out ulceration surrounded by erythema
Usually on lower extremities

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26
Q

Who’s at risk of Staphylococcal Scalded Skin Syndrome

A

Neonates, infants or immunocompromised adults

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27
Q

What is the cause of scalded skin syndrome (not organism, but the toxin!)

A

Due to exfoliative toxin

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28
Q

Why can’t the organism be cultured from denuded skin in scalded skin syndrome?

A

Infection occurs at distant site (ie conjunctivitis or abscess)
The organism can’t be cultured from the site of skin damage

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29
Q

How does staphylococcal scaled skin syndrome affect neonates?

A

→ Diffuse tender erythema
→ Rapid progression to flaccid bullae,
→ Wrinkle and exfoliate, leaving oozing erythematous base
In neonates, kidneys cannot excrete the exfoliative toxin quickly

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30
Q

What does scalded skin syndrome look like?

A

Stevens-Johnson syndrome / toxic epidermal necrolysis

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31
Q

What causes toxic shock syndrome?

A

Group A Staphylococcus aureus strain that produces pyrogenic exotoxin TSST-1

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32
Q

signs of toxic shock syndrome

A 
Fever >38.9°C
Hypotension
Diffuse erythema
Involvement of multiple systems: 
	– Gastrointestinal 	
	– Muscular 	
	– CNS
	- Renal  
	- Hepatic 
Effects mucous membranes (erythema) 
Hematologic (platelets <100 000/mm3)
Desquamation predominantly of palms and soles 1-2 weeks after resolution of erythema
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33
Q

What causes erythasma?

A

Infection of Corynebacterium minutissimum
Well demarcated patches in intertriginous areas
(e.g. armpit)
- initially pink
- Become brown and scaly

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34
Q

Pitted Keratolysis cause + treatment

A
  1. Caused by Corynebacteria

2. Treated with topical clindamycin.

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35
Q

Erysipeloid cause?

A

Erysipelothrix rhusiopathiae

  • looks like cellulitis but slower spreading
  • Associated with handling contaminated raw fish or meat.
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36
Q

Anthrax organism?

A

Bacillus anthracis

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37
Q

How does anthrax present?

A 
Painless necrotic ulcer with surrounding oedema and regional lymphadenopathy (with pain in lymph nodes) at the site of contact with:
hides
bone meal 
wool 
or infected with Bacillus anthracis
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38
Q

Blistering Distal Dactylitis - rare- what causes it?

A

Streptococcus pyogenes or Staphylococcus aureus

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39
Q

who suffers with Blistering Distal Dactylitis

A

young children

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40
Q

signs/symptoms blistering distal dactylitis?

A

1 or more tender superficial bullae on erythematous base on the volar fat pad of a finger
Toes may rarely be affected

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41
Q

What is erysipelas and what are causes and symptoms?

A

Infection of deep dermis and subcutis
Caused by B- haemolytic streptococci or s. aures
Painful
Prodrome of malaise, fever, headache
Presents as erythematous indurated plaque with a sharp demarcated border and a cliff drop edge (+/- blistering)
May effect face or limb:
- red streak of lymphangitis and local lymphadenopathy

42
Q

how to treat Erysipelas?

A

IV ABs

43
Q

Scarlet fever cause?

A

Caused by upper respiratory tract infection with erythrogenic toxin-producing Streptococcus pyogenes

44
Q

Cause of necrotising fasciitis

A

streptococci, staphylococci, enterobacteriaceae and anaerobes.

45
Q

when Necrotising fasciitis affects the scrotum?

A

(Fournier’s gangrene).

46
Q

Which group is more vulnerable to Atypical Mycobacterial Infection

A

people in immunocompromised states

47
Q

What does Mycobacterium marinum cause

A

indolent granulomatous ulcers (fish-tank granuloma) in healthy people
- Sporotrichoid spread

48
Q

What can cause Mycobacterium chelonae?

A

puncture wounds, tattoos, skin trauma or surgery

49
Q

What Mycobacterium ulcerans lead to?

A

an important cause of limb ulceration in Africa (Buruli ulcer) or Australia (Searle’s ulcer).

50
Q

Borreliosis (Lyme Disease) manifestation?

A

Annular erythema develops at site of the bite of a Borrelia-infected tick
Bite from Ixodes tick infected with Borrelia burgdorferi
Initial cutaneous manifestation- erythema migrans (only in 70%):
- erythematous papule at bite site
-progression to annular erythema of >20cm

51
Q

What happens 1-30 days after initial bite in lyme disease?

A 
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
52
Q

How to diagnose lyme disease?

A

Serology not sensitive
Histopathology - non-specific
High index of suspicion required for diagnosis

53
Q

Cause of Tularaemia

A

Francisella tularensis

Acquired through:

- Handling infected animals (squirrels and rabbits)
- Tick bites 
- Deerfly bites
54
Q

systemic symptoms + signs of tularaemia

A

systemic: fever, chills, headache and malaise
other: Painful regional lymphadenopathy

55
Q

Ecthyma Gangrenosum cause

A

Pseudomonas aeruginosa

56
Q

Who is @ risk of Ecthyma Gangrenosum

A

neutropaenic patients

57
Q

development of Ecthyma gangrenosum

A

Red macule(s) → oedematous → haemorrhagic bullae.

May ulcerate in late stages or form an eschar surrounded by erythema

58
Q

cause of syphilis

A

Treponema pallidum

59
Q

progression of syphilis

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

60
Q

why is it hard to diagnose syphilis when looking at signs/symptoms secondary symphilis?

A

Great mimicker’ – low threshold for testing

- Rash (88-100%) -Pityriasis rosea-like rash
- Alopecia (‘moth-eaten’)
- Mucous patches
- Lymphadenopathy 
- Residual primary chancre 
- Condylomata lata 
- Hepatosplenomegaly
61
Q

secondary syphilis signs/symptoms

A

Malaise, fever, headache, pruritus, loss of appetite, iritis

62
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

63
Q

Tertiary syphilis

(5)

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)

64
Q

how to diagnose symphilis?

A

Clinical findings
Serology
Strong index of suspicion required in 2ndary syphilis

65
Q

How to treat syphilis?

A

IM benzylpenicillin or oral tetracycline

66
Q

Leprosy cause?

A

Mycobacterium leprae

67
Q

features of Lepromatous leprosy

A

Multiple lesions: macules, papules, nodules

  • Sensation and sweating normal (early on)
68
Q

features of Tuberculoid leprosy

A

Solitary or few: elevated borders – atrophic center, sometimes annular
- Hairless, anhidrotic, numb

69
Q

how can cutaneous TB be acquired?

A
  • Exogenously (primary-inoculation TB and tuberculosis verrucosa cutis)
  • Contiguous endogenous spread – (scrofuloderma )or autoinoculation – periorificial tuberculosis
  • Haematogenous/lymphatic endogenous spread –dissemination (lupus vulgaris, miliary tuberculosis, gummas)
70
Q

investigations TB

A
  • Interferon-γ release assay (Quantiferon-TB)
    • Histology – ZN stain
    • Culture / PCR
71
Q

TB cutaneous manifestations

A

Tuberculous chancre - painless, firm, reddish-brown papulonodule that forms an ulcer
Tuberculosis verrucosa cutis - wart-like papule that evolves to form redbrown plaque
Scrofuloderma – subcutaneous nodule with necrotic material - becomes fluctuant and drains, with ulceration and sinus tract formation.
Orificial TB - non-healing ulcer of the nasal mucosa that is painful
Lupus vulgaris – red brown plaque - +/- central scarring, ulceration
Miliary TB - pinhead-sized, bluish-red papules capped by minute vesicles
Tuberculous gumma – firm subcutaneous nodule - later ulcerates

72
Q

Molluscum Contagiosum common in who?

A

children + immunocomprmised

73
Q

Molluscum Contagiosum cure?

A

Usually resolve spontaneously

74
Q

Herpes Simplex Virus: HSV-1 infection?

A

direct contact with contaminated saliva / other infected secretions

75
Q

Herpes Simplex Virus: HSV-2 infection?

A

sexual contact

76
Q

how does herpes simplex travel?

A

Travels by retrograde axonal flow to dorsal root ganglia

77
Q

What type of eczma can result of herpes simplex virus?

A

Eczema herpeticum
emergency
Monomorphic, punched out erosions (excoriated vesicles)

78
Q

Herpes gladiatorum risk factor

A

Contact sports e.g. wrestling

HSV 1 involvement of cutaneous site reflecting sites of contact with another athlete’s lesions

79
Q

how to treat neonatal herpes simplex virus

A

Requires IV antivirals

Encephalitis → mortality >50% without treatment, 15% with treatment → neurological deficits

80
Q

how to treat herpes simplex virus

A

Don’t delay
Oral valacyclovir or acyclovir 200mg five times daily in immunocompetent localised infection
Intravenous 10mg/kg TDS X 7-19 days

81
Q

Hand foot and mouth disease cause

A

Coxsackie A16, Echo 71

82
Q

how to treat hand foot and mouth disease

A

don’t - usually self limiting

83
Q

Which viruses cause morbilliform (measles-like) eruptions

A

Measles, Rubella, EBV, CMV, HHV6 & HHV7 cause morbilliform (measles-like) eruptions
Leptospirosis
Rickettsia

84
Q

Erythema Infectiosum cause

A

Parvovirus B19

85
Q

causes of Roseola infantum

A

by HHV6 and HHV7 (less commonly)

86
Q

Orf causes

A

parapoxvirus

-> due to Direct exposure to sheep or goats

87
Q

important superficial fungal infections to know

A
  1. malassezia

2. Dermatophytes

88
Q

disseminated fungal infection to know

A

aspergillus

89
Q

Pityriasis versicolor treatment

A

Topical azole

90
Q

Kerion: what is it?

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

91
Q

Aspergillosis risk factors

A

: neutropaenia & corticosteroid therapy]-> primarily resp pathogen

Propensity to invade blood vessels causing thrombosis and infarction
Lesions destructive – may extend into cartilage, bone and fascial planes

92
Q

Mucormycosis cause

A

Apophysomyces, Mucor, Rhizopus, Absidia, Rhizomucor

Treatment consists of aggressive debridement and antifungal therapy
Culture positive in only 30% of cases

93
Q

Scabies cause

A

Sarcoptes species

Female mates, burrows into upper epidermis, lays her eggs and dies after one month.
Insidious onset of red to flesh-coloured pruritic papules
Affects interdigital areas of digits, volar wrists, axillary areas, genitalia

94
Q

diagnosis of scabies

A
  • diagnostic burrow of fine white scales often seen
95
Q

treatment of scabies

A

permethrin, oral ivermectin

- Two cycles of treatment are required

96
Q

treating head lice

A

malathion, permethrin, or oral ivermectin

97
Q

treating body lice

A

thorough cleaning or discarding clothes

98
Q

treating Pubic Lice

A

malathion / permethrin, oral ivermectin

99
Q

treating bed bugs

A

fumigation of homes

100
Q

What are symptoms of scarlet fever and how does it present?

A

Preceded by sore throat, headache, malaise, chills, anorexia and fever
Eruption begins 12-48 hrs later:

BRS Year 2 (110 decks)

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