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
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
The tissue becomes red, swells and painful, potentially with anaesthesia.
It will develop haemorrhagic bullae, skin necrosis and crepitus.
Also comes with severe systemic features such as:
- Fever
- Hypotension
- Tachycardia
- Delirium
- Multiorgan Failure
- Septic Shock
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)?
Staph Aureus
How does PVL present?
Recurrent boils
May also cause SSTI or Haemorrhagic Pneumonia
