Emergency Soft Tissue Infections

Question 1

This covers::

Answer 1

Necrotizing Fasciitis
Toxin-Mediated Syndromes (TMS):
- Toxic Shock Syndrome
- Staphlyococcal Scalded Skin Syndrome (SSSS)
- Panton-Valentine Leucocidin Toxin (PVL)

Question 2

What are the subtypes of Necrotizing Fasciitis?

Answer 2

1 is most common
Caused by mixed aerobic/anaerobic infection
Commonly presents in Diabetic Foot Disease or Fournier’s Gangrene (NF of the genitals/perineum mainly in elderly men)

2 is monomicrobial- usually strep pyrogens

3 is rapid onset and usually associated with clostridia perfigens, septicum

Question 3

What organisms cause Necrotizing Fasciitis??

Answer 3

Type 1 can be lots of things:

• Strep
• Staph
• Enterococci
• Gram -ve Bacilli
• Clostridium

Type 2 can be Strep Pyogenes

Question 4

Risk factors for Necrotizing Fasciitis?

Answer 4

DM
Surgery
Trauma
Peripheral Vascular Disease
Skin popping (Injection drugs under skin, IVDA)

Question 5

How does NF present?

Answer 5

Rapid onset

• Initial symptoms: Systemic symptoms: fever, hypotension, tachycardia, delirium, multiorgan failure
• Anaesthesia at the site of infection
• Bullae, Skin necrosis, Crepitus may develop (gas under skin)

Question 6

NF is a medical emergency, how do we manage it?

Answer 6

Broad spectrum Abx:
- Clinidamycin + Gentamicin + Flucloxacillin

Surgery

Supportive Therapy

Question 7

What are TMSs?

Answer 7

Toxins released by bacteria trigger T cells

• > Excess T cell activation
• > Massive cytokine release
• > Endothelial leak, haemodynamic shock & multi-organ failure
• > Death

Question 8

What toxin causes TSS?

Answer 8

Staph aureus infection that secretes TSST1

Its usually caused by an offending agent e.g. tampon that allows the infection & toxin to build up

Question 9

How does TSS present?

Answer 9

Fever
Hypotension
Diffuse Macular Rash
+ 3 of the Liver, blood, kidneys, GI, CNS or muscular organs involved

Question 10

How do we confirm and treat TSS?

Answer 10

Do a blood culture, requires isolating TSST1

Also remove the offending agent, give IV fluids, Inotropes (for hypotension) and Abx
Potentially IV immunoglobulins

Question 11

What cases SSSS?

Answer 11

Staph Aureus secreting either toxin A or B

Question 12

How does SSSS present?

Answer 12

Its mostly kids and they get widespread bullae along with skin exfoliation

Question 13

How do we treat SSSS?

Answer 13

Abx

Question 14

What causes Panton-Valentine Leucocidin (PVL)?

Answer 14

Gamma haemolysin from Staph Aureus

Question 15

How does PVL present?

Answer 15

Recurrent boils

May also cause SSTI or Haemorrhagic Pneumonia

Question 16

We treat PVL with IV interferons and carbamazepine

Answer 16

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