Emergency Soft Tissue Infections Flashcards
This covers::
Necrotizing Fasciitis
Toxin-Mediated Syndromes (TMS):
- Toxic Shock Syndrome
- Staphlyococcal Scalded Skin Syndrome (SSSS)
- Panton-Valentine Leucocidin Toxin (PVL)
What are the subtypes of Necrotizing Fasciitis?
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
What organisms cause Necrotizing Fasciitis??
Type 1 can be lots of things:
- Strep
- Staph
- Enterococci
- Gram -ve Bacilli
- Clostridium
Type 2 can be Strep Pyogenes
Risk factors for Necrotizing Fasciitis?
DM Surgery Trauma Peripheral Vascular Disease Skin popping (Injection drugs under skin, IVDA)
How does NF present?
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)
NF is a medical emergency, how do we manage it?
Broad spectrum Abx:
- Clinidamycin + Gentamicin + Flucloxacillin
Surgery
Supportive Therapy
What are TMSs?
Toxins released by bacteria trigger T cells
- > Excess T cell activation
- > Massive cytokine release
- > Endothelial leak, haemodynamic shock & multi-organ failure
- > Death
What toxin causes TSS?
Staph aureus infection that secretes TSST1
Its usually caused by an offending agent e.g. tampon that allows the infection & toxin to build up
How does TSS present?
Fever
Hypotension
Diffuse Macular Rash
+ 3 of the Liver, blood, kidneys, GI, CNS or muscular organs involved
How do we confirm and treat TSS?
Do a blood culture, requires isolating TSST1
Also remove the offending agent, give IV fluids, Inotropes (for hypotension) and Abx
Potentially IV immunoglobulins
What cases SSSS?
Staph Aureus secreting either toxin A or B
How does SSSS present?
Its mostly kids and they get widespread bullae along with skin exfoliation
How do we treat SSSS?
Abx
What causes Panton-Valentine Leucocidin (PVL)?
Gamma haemolysin from Staph Aureus
How does PVL present?
Recurrent boils
May also cause SSTI or Haemorrhagic Pneumonia
