Disease Profiles: Infections

Question 1

What is ersipelas?

Answer 1

Superficial form of cellulitis localised to dermis and lymphatic system

Question 2

What is the first line treatment for (non-severe) impetigo?

Answer 2

Topical fusidic acid, 7 days

Question 3

Describe the management of necrotizing fasciitis

Answer 3

Surgical debridement and antibiotics to culture

Question 4

Describe the pathophysiology of impetigo

Answer 4

Entry point is small defect in skin

Highly contagious with discharge on the face, scratching due to irritation can aid spread

Question 5

What is cellulitis?

Answer 5

Invasion of the dermis and subcutaneous fat - deeper skin infection

Question 6

What are the causative organisms in cellulitis?

Answer 6

Strep. pyogenes +/- Staph. aureus

Question 7

Describe the management of non-severe cellulitis

Answer 7

Rest, elevation, analgesia, splint

0.5 - 1g Flucloxacillin QDS, 7/7 (alternative: doxycycline 100mg BD, 7/7)

Question 8

What are the causative organisms in impetigo?

Answer 8

Staph. aurues +/- Strep. pyogenes

Question 9

What investigation would you perform in suspected cellulitis?

Answer 9

Bacterial swab

Question 10

Describe the clinical presentation of ersipelas

Answer 10

Spreading, well demarcated, erythematous plaque which most commonly affects the face

Associated symptoms: fever and systemic upset

Question 11

Describe the clinical presentation of cellulitis

Answer 11

Generalised swelling usually seen in the legs

Macular hot erythema with ill defined margins that is often spreading

Fevers, rigours and nausea

Question 12

What is the causative organism in ersipelas?

Answer 12

Strep. pyrogenes

Question 13

What are the causative organisms in necrotizing fasciitis?

Answer 13

Aerobic and anaerobic, gram-positive and gram-negative bacteria are frequently isolated

Can be monomicrobial or polymicrobial

Question 14

Describe the clinical presentation of necrotizing fasciitis

Answer 14

Systemic symptoms: fever, chills, altered mental status

Cutaneous symptoms: diffuse erythema, purple skin discolouration

Others: disproportionate pain, crepitus

Question 15

How would you manage extensive or severe impetigo?

Answer 15

Oral flucloxacillin or clarithromycin 500mg QDS + topical fusidic acid

Question 16

Describe the management of severe cellulitis

Answer 16

Rest, elevation, analgesia, splint

IV flucloxacillin (vancomycin if allergic)

Question 17

What is impetigo?

Answer 17

Highly infectious superficial (stratum corneum) skin infection that typically affects childen

Question 18

Describe the clinical presentation of impetigo

Answer 18

Well defined lesions with a honey coloured golden crust and erythematous base

Usually on the face

Question 19

What investigation would you perform in suspected impetigo?

Answer 19

Bacterial swab

Question 20

Which investigations would you perform in suspected necrotizing fasciitis?

Answer 20

Blood cultures, Gram stain and cultures from deep tissue

Question 21

Describe the management of ersipelas

Answer 21

Flucloxacillin - oral, IV if person is unable to take oral or is severely unwell

Question 22

What is necrotizing fasciitis?

Answer 22

A rapidly progressive infection resulting in extensive necrosis of superficial fascia and overlying subcutaneous fat that can develop into a life-threatening condition within hours