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Block G -- Infection > Dr. Al-Muhsaini -- Infectious Skin Diseases and Rashes > Flashcards

Dr. Al-Muhsaini -- Infectious Skin Diseases and Rashes Flashcards

1
Q

2 ways bacterial infection can happen in the skin

A
  • Direct infection of skin and adjacent tissues
  • Cutaneous disease due to effect of bacterial toxin
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2
Q

2 examples of cutaneous diseases due to effect of bacterial toxin

A
  • Staphylococcal scalded skin sydrome
  • Toxic shock syndrome
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3
Q

3 kinds of *S. aureus *toxins

A
  • Toxic shock syndomre toxin-1 (TSST-1)
  • Exfoliative toxin (ET-A, ET-B)
  • Panton-Valentine leukocidin (PVL)
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4
Q

Define TSST-1

A

Superantigen involved in toxic shock syndrome (TSS)

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5
Q

2 effects of ET-A and ET-B

A
  • Protease activity
  • Splits epidermal desmoglein 1
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6
Q

2 conditions that exfoliative toxins of S. aureus are involved in

A
  • Styphylococcal scalded skin syndrome (SSSS)
  • Bullous impetigo
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7
Q

Specific S. aureus type that can secrete PVL toxin

A

Community-acquired MRSA strains

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8
Q

Effects of S. aureus PVL

A
  • Associated with increased virulence (leukocyte destructon, necrosis)
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9
Q

Define impetigo and its two types

A

Highly contagious infection seen primarily in children (bullous vs. nonbullous)

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10
Q

2 most common causes of nonbullous impetigo

A
  1. S. aureus
  2. GAS
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11
Q

Clinical presentation of nonbullous impetigo

A

Erythematous macule –> erosion with golden (honey color) crust

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12
Q

Diagnosis of nonbullous impetigo

A

Positive culture from exudate under crust

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13
Q

Treatment for nonbullous impetigo

A
  • Topical mupirocin
  • If extensive, can use oral ABX (i.e. cephalexin, dicloxacillin)
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14
Q

ONLY cause of bullous impetigo

A

S. aureus

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15
Q

Clinical presentation of bullous impetigo

A

Flaccid, transparent bullae –> rupture leaving shiny, dry erosion with no surrounding erythema

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16
Q

Pathogenesis of bullous impetigo

A

Cleavage at granular layer due to Exfoliative toxin (ET-A, ET-B) binding to desmoglein 1

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17
Q

Treatment for bullous impetigo

A
  • Topical mupirocin AND
  • Oral antibiotic (i.e. cephalexin, dicloxacillin)
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18
Q

Define bacterial folliculitis

A

Superficial infection of hair follicle usually due to S. aureus

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19
Q

Clinical presentation of bacterial folliculitis

A

Pustules in follicular distribution associated with hairs

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20
Q

3 treatments for bacterial folliculitis

A
  • Antibacterial wash (chlorhexidine or triclosan)
  • Antibacterial ointments (mupirocin)
  • If widespread, can use oral antibiotic
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21
Q

Typical cause of frunucle, carbuncle and abscess

A

S. aureus

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22
Q

Define furuncle

A

Deep-seated tender nodule of hair follicle

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23
Q

Define carbuncle

A

Coalescing of adjacent furuncles with multiple draining sinuses (typically involves nape of neck or back of thighs)

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24
Q

Define abscess

A

Inflamed walled-off collection of pus

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25
Q

Treatment for simple furuncle (no fluctuance)

A

Warm compresses and topical antibiotics

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26
Q

Treatment for fluctuant furuncle or abscess

A

Incision and drainage

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27
Q

When to give oral antibiotic in the event of furuncle, carbuncle or abscess

A
  • Location near midface (due to concern for cavernous sinus thrombosis) or external auditory canal
  • Recurrent or recalcitrant
  • Very large or with surrounding cellulitis
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28
Q

Body parts in which streptococcal bacteria can reside

A
  • Aerodigestive tract
  • Vagina
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29
Q

Type of streptococcus that is most pathogenic

A
  • Group A beta-hemolytic streptococci
    • S. pyogenes
    • GAS
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30
Q

3 positive antibodies found after infection with GAS

A
  • Antistreptolysin O (ASO)
  • Antihyaluronidase
  • Anti-DNase-B
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31
Q

Streptococcal strain that has erythrogenic toxins and list the 3 produced

A

*S. pyogenes *exotoxins (SPE-A, SPE-B, SPE-C)

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32
Q

Define ecthyma

A

Deeper form of nonbullous impetigo with ulceration

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33
Q

Cause of ecthyma

A

GAS, but quickly contaminated by S. aureus

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34
Q

Clinical presentation of ecthyma

A

“Punched out” shallow ulcer with thick, yellow-gray crust commonly in lower legs of children

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35
Q

Ecthyma treatment

A

Dicloxacillin or first generation cephalosporin

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36
Q

Define erysipelas

A

Superficial type of cellulitis with significant dermal lymphatic involvement

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37
Q

Typical cause of erysipelas

A

GAS

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38
Q

Clinical presentation of erysipelas

A

Well-defined, bright red indurated plaque with sharp, raised borders commonlu on the face or legs, with or without constitutional symptoms

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39
Q

Treatment for erysipelas

A

PCN (if PCN allergic, can use macrolide)

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40
Q

Define cellulitis

A

Infection of the deep dermis and subcutaneous tissue

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41
Q

2 causes of cellulitis and the proportion of cases that they are involved in

A
  • GAS (2/3)
  • S. aureus (1/3)
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42
Q

9 rare causes of cellulitis

A
  • P. aeruginosa
  • H. influenzae
  • Anaerobes
  • Eikenella
  • Streptococcus viridans
  • Pasteurella multocida
  • Vibrio vulnificus
  • Aeromonas
  • *Erysipelothrix *(erysipeloid)
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43
Q

Source of *P. aeruginosa *leading to cellulitis

A

Puncture wound involving foot or hand

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44
Q

Type of patient affected by H. influenzae causing cellulitis

A

Children with facial cellulitis

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45
Q

Source of anaerobes, *Eikenella *and *Streptococcus viridans *causing cellulitis

A

Human bite

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46
Q

source of Pasteurella multocida causing cellulitis

A

Cat or dog bites

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47
Q

Source of *Vibrio vulnificus *causing cellulitis

A

Salt water (i.e. following coral injury)

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48
Q

Source of *Aeromonas *causing cellulitis

A

Fresh water (i.e. following leech bites)

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49
Q

Type of patient who can get cellulitis from Erysipelothrix

A

Butcher

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50
Q

Clinical presentation of cellulitis

A

Ill-defined area with erythema, swelling and tenderness +/- fever, chills

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51
Q

Treatment for cellulitis

A

Oral/IV antibiotic with good gram positive coverage

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52
Q

Define necrotizing fasciitis

A

Rapidly progressive necrosis of subcutaneous tissue and fascia

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53
Q

Cause of necrotizing fasciitis

A

GAS, but typically mixed infection with 30% mortality

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54
Q

4 risk factors for necrotizing fasciitis

A
  • Advanced age
  • Diabetes
  • Peripheral vascular disease
  • History of alcohol abuse
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55
Q

Clinical presentation of necrotizing fasciitis

A

Tender, erythematous tense plaques recalcitrant to antibiotics

Progresses at an alarming rate –> necrosis of fascia and fat

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56
Q

Treatment of necrotizing fasciitis

A

Extensive surgical debridement

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57
Q

6 skin infections by level of depth

A
  1. Impetigo (epidermis; keratinized layer)
  2. Ecthyma (deeper epidermis)
  3. Erysipelas (Papillary dermis)
  4. Cellulitis (Reticular dermis)
  5. Panniculitis (subcutaneous tissue)
  6. Necrotizing fasciitis (Fascia and fat)
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58
Q

Typical age of patients affected by perianal streptococcal disease

A

Preschool children

59
Q

Strain causing perianal streptococcal disease

60
Q

Clinical presentation of perianal streptococcal disease

A

Circular band of erythema around anus +/- painful defecation, blood streaked stool and anal leakage

61
Q

Diagnosis of perianal streptococcal disease

A

Throat and perianal culture

62
Q

Treatment for perianal streptococcal disease

A

PCN or erythromycin x 10 - 14 days

63
Q

Type of bacteria: croynebacteria

A

Gram positive rod-shapped bacteria

64
Q

Cause of erythrasma

A

Corynebacteria

65
Q

Define erythrasma

A

Superficial infection in occluded intertriginous areas (i.e. armpit)

66
Q

Clinical presentation of erythrasma

A

Well-demarcated red-brown macules/patches with fine scale and wrinkling in intertriginous areas

Interdigital maceration and scaling between toes

67
Q

One diagnostic test for erythrasma

A

Wood’s lamp = bright coral-red fluorescence due to perphyrn production

68
Q

Treatment for erythrasma

A

Topical antibiotic clindamycin, erythromycin

69
Q

2 general characteristics about pseudomonas and its cutaneous manifestations

A
  • Grows well in aqueous environment
  • Has ability to produce variety of pigments
70
Q

2 pseudomonal infections

A

Green nail syndrome

Pseudomonal folliculitis (hot tub folliculitis)

71
Q

Define green nail syndrome

A

Subungual pseudomonal infection causing green discoloration of nail and onycholysis

72
Q

Treatment for green nail syndrome (3)

A
  • Trim nail
  • Acetic acid soaks
  • Topical ciprofloxacin
73
Q

Presentation of pseudomonal foliculitis

A

Erythematous follicular papules and pustules at sites of exposure to water (i.e. via whirlpool, hot tub, rarely swimming pool) with sparing of face and neck

NOTE: Self-limited in immunocompromised person

74
Q

Define acute meningococcemia

A

Acute and potentially life-threatening infection of the blood vessels

75
Q

Cause of acute meningococcemia

A

Neisseria menigitidis

76
Q

Neisseria meningitidis: type of bacteria

A

Encapsulated gram negative diplococcus

77
Q

Presentation of acute meningococcemia

A

Erythematous macules/papules –> evolve to stellate purpuric pathces/plaques with ischemic necrosis and/or hemorrhage, accompanied by high fever and toxic appearance

78
Q

Treatment of acute meningococcemia

A

High dose IV PCN

NOTE: If resistant, use third generation cephalosporin

79
Q

Type of patients affected by SSSS (3)

A
  • Neonates
  • Young children
  • Adults with renal insufficiency or if immunocompromised
80
Q

Location of pathogen (name it) and how this affects culture in SSSS

A

*S. aureus *at a distant site (extralesional) = negative bullae culture

81
Q

SSSS presentation

A
  • Fever
  • Initial tenderness of skin and erythema over body folds –> generalized wrinkled appearance with subsequent exfoliation, perioral crusting/fissuring
    • Nikolsky sign
82
Q

Nikolsky sign

A

Slight rubbing of the skin results in exfoliation of the skin’s outermost layer

83
Q

Treatment for SSSS (3)

A
  • Penicillinase resistant penicillin (i.e. diclocacillin)
  • First generation cephalosporin
  • IV fluid support
84
Q

Define toxic shock syndrome (tSS)

A

Rapidly progressie multiorgan illness (high mortality; 30 - 60%)

85
Q

2 pathogens of TSS

A
  • Staphylococcus aureus
  • GAS (strep. TSS)
86
Q

5 causes of TSS

A
  • Women who use superabsorbent tampons (rare nowadays)
  • Infections with wounds
  • Catheters
  • Deep abscesses
  • Nasal packing
87
Q

2 toxins involved in TSS

A
  • *S. aureus *= TSST-1
  • GAS = *S. pyogenes *exotoxins (SPE-A)
88
Q

4 presenting manifestatinos of TSS

A
  • Fever
  • Hypotension
  • Macular exanthem
  • Involvement of 3 or more organ systems
89
Q

Describe exanthem in TSS (4)

A
  • Diffuse scarlatiniform exanthem on trunk spreading outwards
  • Palmoplantar edema
  • Erythema (with desquamation 1 - 3 weeks later)
  • Hyperemia of conjunctiva
90
Q

Describe the difference between STSS vs. TSS

A
  • Generalized exanthem less common in STSS
  • STSS more likely in an otherwise healthy adult
91
Q

3 treatments for TSS

A
  • Remove any nidus of infection
  • Intensive supportive therapy, fluid support
  • IV antibiotics
92
Q

Describe exanthem in scarlet fever and its cause

A

Diffuse exanthem from GAS pharyngitis with erythrogenic toxin (SPE-A, B, C)

93
Q

Main age group affected by scarlet fever

94
Q

8 manifestations of scarlet fever

A
  • Sore throat
  • Headache
  • Fever
  • Tiny pink papules on erythematous background (sandpaper like)
  • Strawberry tongue,
  • Palatal petechiae
  • Circumoral pallor
  • Linear petechiael streaks along bod folds (Pastia’s lines)
95
Q

Treatment for scarlet fever

A

PCN or erythromycin x 10 - 14 days

96
Q

Define HSV

A

Neurotropic virus which hides in the dorsal root ganglion until reactivation

97
Q

2 primary HSV infections

A
  • Primary herpetic gingivostomatitis
  • Primary genital infection
98
Q

Typical age group affected by primary herpetic gingivostomatitis

99
Q

9 manifestations of primary herpetic gingivostomatitis

A
  • Abrupt onset of erythematous, friable gingiva
  • Painful vasicles clusteres on oral mucosa, tongue, lips and/or perioral
  • Skin –> vasicles rupture, leaving small ulcers with characteristic gray base
  • May have:
    • Pharyngitis
    • Tonsillitis
    • Difficulty eating or swallowing
    • Enlarged lymph nodes
    • Fever
    • Anorexia
100
Q

6 Manifestations of primary genital herpes infection

A
  • Constitutional symptoms
  • Painful grouped vesicles in genitalia –> progress to pustules, crusting and exquisitely tender ulcers
  • May have:
    • Painful lymphadenopathy
    • Cervicitis
    • Urethritis
    • Proctitis
101
Q

4 treatments for primary HSV infection

A
  • Hydration, pain control, hospitalization
  • Acyclovir 200 mg 5 times/day x 7 - 10 days or 400 mg TID (15/mg/kg five/day)
  • Valacyclovir 1 g BID for 7 - 10 days
  • Famciclovir 250 mg TID for 7 - 10 days
102
Q

2 recurrent herpes infections

A
  • Herpes labialis
  • Genital herpes
103
Q

Most common HSV-1 manifestation

A

Herpes labialis

104
Q

4 triggers of herpes labialis

A
  • Pyrexia
  • Stress
  • Sunburn
  • Trauma
105
Q

2 Manifestations of herpes labialis

A
  • Prodrome (pain, burning, tingling) may precede eruption
  • Grouped vesicles on erythematous base which typically evolve into pusules and then apinful ulcers
106
Q

Manifestation of genital herpes

A

+/- prodrome followed by grouped vesicles –> pustules –> ulceration

107
Q

5 other herpes infections aside from gingivostomatitis, labial and genital forms

A
  • Eczema herpeticum
  • Herpetic whitlow
  • Herpes gladiatorum
  • Chronic ulcerative HSV
  • Keratoconjuncivitis
108
Q

Define eczema herpeticum

A

Disseminaed form of HSV mainly seen wit atopic dermatitis that can also occur when there are other reasons for breakdown of the skin barrier

109
Q

Presentation of eczema herpeticum

A

Monomorphic umbilicated vesiculopustules or punched out ulcrations with hemorrhagic crust

110
Q

Common complication of eczema herpeticum

A

Seconday bacterial infection

NOTE: may progress to life-threatning infection

111
Q

Define herpetic whitlow

A

Painful primary herpetic infection of hand (typically distal phalanx) more common in healthcare workers or caregivers

112
Q

Presentation of herpetic whitlow

A

Exquisite pain and swelling of finger with characteristic vesicular lesions

113
Q

Define herpes gladiatorum

A

HSV primary infection primarily, noted in wrestlers, involving extramucosal sites typically over face, neck, or arms

114
Q

Which kinds of patients are most likely to be affect by chronic ulcerative HSV

A

Immunocompromised

115
Q

Presentation and complications of keratoconjunctivitis

A

Branching dendritic corneal ulcerations (seen with fluorescein stain)

Can lead to scarring and blindness

116
Q

5 diagnostic methods for HSV

A
  • Taznck smear shows multinucleated epithelial giant cells (does not differentiate from VZV)
  • Viral culture
  • Direct fluorescent anibody (DFA)
  • Viral PCR
  • Histology skin Bx
117
Q

Transmission of VZV

A

Airborne respiratory droplets

118
Q

Presentation of VZV (6)

A
  • Itchy red papules –> vesicles (blisters) on the trunk and face, and then sprading to other parts of the body
  • High fever
  • Headache
  • Respiratory signs
  • Vomiting
  • Diarrhea
119
Q

Describe the natural history of VZV (4)

A
  • Usually more severe in adults or immunocompromised patients
  • May be life-threatening in complicated cases
  • Typically clears up within 1 - 3 weeks, but may leave scars
  • After initial infection (chickenpox), virus lies dormant in spinal dorsal root ganglion until reactivation –> herpes zoster
120
Q

Presentation of herpes zoster (4)

A
  1. Prodromal pain/paresthesias
  2. Grouped, painful erythematous macules/papules along single sensory dermatome
  3. Vesicles/bullae
  4. Hemorrhagic crust and dry over 7 - 10 days

NOTE: Lesions are infectious until dry

121
Q

6 complications of zoster

A
  • Post-herpetic neuralgia (PHN)
  • Scarring
  • Secondary bacterial infection
  • Meningoencephalitis
  • Ramsay-Hunt syndrome
  • Ocular blindness
122
Q

Define Ramsay-Hunt syndrome

A

Ear canal/auricle/tympanic membrane involvement with painful vesicles, facial paralysis/paresis, ipsilateral hearing loss

123
Q

Pathogenesis of ocular blindness due to zoster

A
  1. Lesions on tip of nose
  2. Possible ocular infection
  3. Nasociliary nerve involvement (branch of the ophthalmic nerve)
124
Q

Transmission of HPV

A

Mainly via direct skin contact

Less likely via fomites

125
Q

2 divisions of HPV

A
  • Genital vs. nongenital
  • Benign or low risk (HPV 6/11) vs. high risk (HPV 16/18) (risk malignant transformation)
126
Q

3 clinical manifestations of HPV infection

A
  • Common, plantar, flat warts
  • Filiform warts
  • Condyloma acuminata (lesions without significant scale in genital area)
127
Q

5 treatment options for HPV

A
  • Watchfl waiting
  • Cryotherapy with liquid nitrogen
  • Salicylic acid
  • Other topical treatments (depending on locaiton of warts)
  • Surgical excision
128
Q

2 vaccines against HPV and the types they cover

A
  • Gardasil (6, 11, 16, 18)
  • Cervarix (16 and 18)
129
Q

Clinical presentation of molluscum contagiosum (poxvirus)

A

Umbilicated pink, firm, waxy papules

NOTE: Usually self-limited

130
Q

Describe the types of patients that may be affected by poxvirus and what this means about the infection itself (3)

A
  • Usual = children
  • If adult, transmission is likely sexual
  • AIDS = larger lesions
131
Q

3 treatments for molluscum contagiosum

A
  • Cartharidin
  • Cryosurgery
  • Curettage

Among others

132
Q

4 classic childhoos viral exanthems

A
  • Rubella (German measles)
  • Measles (Rubeola)
  • Erythema infectiosum
  • Roseola infantum (exanthem subitum)
133
Q

Describe the exanthem and enanthem of measles

A
  • Erythematous macules and papules begin on the face and spread cephalocaudally
  • Koplik sports (grey papules on buccal mucosa)
134
Q

4 complications of measles

A
  • Encephalitis
  • Otitis media
  • Pneumonia
  • Myocarditis
135
Q

Describe the exanthem and enanthem of rubella

A
  • Pruritic, pink to red macules and papules which begin on the face and spread to neck, turnk, and extremities over 24 hours
  • Tender lymphadenopathy (occipital, postauricular, cervical)
136
Q

4 complications of rubells

A
  • Arthralgia/arthritis
  • Hepatitis
  • Myocarditis
  • Pneumonia
137
Q

Describe the exanthem and enanthem of erythema infectiosum

A
  1. Bright red macular erythema over cheeks
  2. Lacy eruption mainly on the extremitis

NOTE: school-age children affected, self-limited milk prodrome and 10%with arthralgias

138
Q

Etiology of erythema infectiosum

A

Parvovirus B19 (also causes hydrops fetalis during pregnancy)

139
Q

Describe the exanthem and enanthem of roseola infantum

A

Pink macules and papules surrounded by white halos beginning on trunk and spreading to neck and proximal extremities

140
Q

Etiology of roseola infantum

A

Human herpesvirus 6 (HHV6)

141
Q

Cause of tinea versicolor (pityriasis versicolor)

A

*Malassezia furfur *(yeast form = pityrosporum ovale or P. orbuiculare)

Yeast part of normal cutaneous flora

142
Q

Presentation of tinea versicolor and where/when it occurs

A
  • Hyper/hypopigmented (pink, coppery brown or paler) macules and patches with fine scale
  • Lipid-rich areas of skin
  • Common in summer
143
Q

Treatment for tinea versicolor

A

Topical antifungal

If extensive, use oral antifungal

Block G -- Infection (23 decks)

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