Draining sinus tracts- 2 Flashcards

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1
Q

How to approach treating infectious draining sinus tracts

A

they generally affect deep skin/ subcutis
systemic treatment for min 2 weeks
ABs- based off C and S
avoid immunosuppressive drugs
consider underluing cause

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2
Q

which skin strutures are involved in deep pyodermas

A

Infection outside epidermis or hair follicle epithelium

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3
Q

What are the three most common manifestation of a deep pyoderma

A

Furunculosis
Abscess
Cellulitis

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4
Q

How does furunculosis usually develop

A

Extension of folliculitis –> rupture of hair follicle wall –> microbes + free keratin in dermis –> provokes a foreign-body reaction

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5
Q

What type of inflammation is present in furunculosis ? How will you recognise this on cytology

A

Usually pyogranulomatous reaction – see macrophages, neutrophils +/- rbcs
NB organisms may be hard to find – do not assume is sterile!

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6
Q

How do you treat bacterial furunculosis

A

Usually systemic Abs based on C and S - continue 2 weeks post-resolution
Topical chlorhexidine shampoos/foams also

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7
Q

Why does inflammation often persist, even after bacterial infection is resolved in furunculosis

A

Inflammation may persist after infection resolved due to foreign body reaction to keratin – at this stage may therefore need anti-inflammatory medication (corticosteroids/ ciclosporin/ tacrolimus)

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8
Q

List 6 specific presentations of furunculosis

A

chin/muzzle folliculitis/ furunculosis
Nasal folliculitis/furunculosis
Interdigital folliculitis/furunculosis*
Acral lick dermatitis/granuloma*
Post-grooming folliculitis/furunculosis*
German Shepherd Dog pyoderma (rare)

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9
Q

what organism is most commonly involved in deep pyodermas

A

staphylococcal infections

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10
Q

List 5 things furunculosis can occur secondary to

A

allergies
ectoparasites
infections
systemic immunosuppression/ endocrinopathy
pressure driving hair back into skin

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11
Q

Describe lesions in Interdigital folliculitis/furunculosis

A

Lesions originate on palmo-plantar surface of foot but rupture as draining sinus tracts on dorsal aspect- starts sterile then becomes infected

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12
Q

List 3 predisposing causes of interdigital folliculitis/ furunculosis

A

breed- e.g. english bull terrier
increased weight-bearing
altered weight bearing

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13
Q

how to approach clinical case of interdigital folliculitis/ furunculitis

A
  1. consider primary cause- e.g. demodicosis
  2. investigate and treat secondary inf
  3. control inflammation once infection controlled
  4. address predisposing triggers where possible
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14
Q

when do we use surgery to treat interdigital folliculitis/ furunculosis

A

For end-stage disease, refractory to medical management

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15
Q

List 4 possible underlying causes of acral lick dermatitis/ granuloma

A

pruritus
pain
neoplasia- uncommon
anxiety/ boredom

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16
Q

what is acral lick dematitis granuloma

A

– a deep pyoderma but does not present with sinus tracts - a d/d for cutaneous masses!

Localised folliculitis/furunculosis on lower limbs due to self trauma – frustrating condition!

17
Q

which dogs generally get acral lick dermatitis granuloma

A

large, middle- aged/ older dogs

18
Q

diagnosis of acral lick dermatitis granuloma

A

often visually distinctive
cytology (squeeze lesion)- deep bacterial culture ideal
biopsy- if unsure if neoplasia or deep fungal infection

19
Q

treatment of sever case of acral lick dermatisi granuloma

A

treat deep pyoderma
physical prevention of licking
control inflammation once infection controlled
behavioural modification
very frustrating cases- need to adress early

20
Q

define cellulitis

A

ill-defined deep inflammation involving deep s/c connetive tissue

21
Q

Treatment of foreign body - interdigital

A

Poultice/bathe to‘draw’, then explore carefully UGA with alligator forceps –> emove FB

Avoid antibiotics till explored!

22
Q

what is Bacterial granulomatous dermatitis caused by

A

caused by traumatic implantation of saprophytic organisms

23
Q

List the 2 causative agents of mycobacterial infections in cats

A
  1. Mycobacterium tuberculosis complex (MTBC)- need to notify APHA or UK health security agency
  2. Non-tuberculous mycobacteria (NTM)
24
Q

List the 4 subgroups of non-tuberculoous mycobacteria

A

Mycobacterium leprae complex (MLC)
M avium complex (MAC)
Slow-growing NTM
Rapid-growing NTM

25
Q

Signs seen with mycobacterium tuberculosis complex

A

Localised cutaneous nodules +/- ulcers/draining tracts, especially ‘fight and flight’ sites – face, extremities, tail base
+/- localised/generalised lymphadenopathy
+/- GI disease, lung disease, weight loss, pyrexia

26
Q

Signs seen with non-tuberculosis mycobacteria

A

Cutaneous or s/c nodules
diffuse panniculitis
variably painful
disseminated disease uncommon

27
Q

How to diagnose mycobacterial granulomas/ pyogranulomas infections in cats

A

biopsy- any non-resolving skin lesions
cytology- mixed inflammatory cells
culture
IFN- gamma-release assay
PCR

28
Q

Treatment of mycobacterial granulomas/ pyogranulomas

A

ABs- long course- based on C&S- 2 months post-resolution
Wide surgical resection where possible – likely curative for FLS

29
Q

how do subcutaneous (deep) fungal infections presented

A

cutaneous papules or s/c nodules
+/- ulceration/discharging tracts/tissue
+/- tissue granules/grains
Usually due to traumatic implantation of fungus - most commonly on feet/limbs or head

30
Q

Decsrieb systemic mycoses

A

Can affect any organ system, including skin—> granulomas/pyogranulomas/necrosis in organs affected
will be systemically ill
e.g. Cryptococcosis – zoonotic!

31
Q

A 9yo Rottweiler presents with discharging sinuses on the muzzle. Which investigations will you perform first

A

Examine an impression smear of the exudate and deep skin scrapes