Infection Flashcards
What is Mastitis?
Painful inflammatory condition of breast
Can lead to formation of breast abscess which is a complication
What are the causes of Mastitis?
Infectious Causes :
- Lactational or duct ectasia (milk stasis)
- MC cause is Staph. aureus
Non-infectious causes :
- Idiopathic granulomatous Inflammation
- Foreign body reaction
H&E of Mastitis
- Coryzal symptoms (common cold symptoms)
- Nipple discharge
- Redness
- Tenderness
- Abscess
Severe signs:
- Infected nipple fissure
- Not improving
- Positive breast milk culture
Investigations for Mastitis
Breast milk culture and clinical diagnosis
Management of Mastitis
Lactational / Non-severe :
- Continue breastfeeding
- Warm compress
- Analgesia
Severe or not improving after milk removal :
- Oral flucloxacillin for 10-14 days
Non-lactational :
- Co-amoxiclav 3x a day for 10-14 days
Management of breast abscess
- Incision and drainage (+culture)
- IV/PO antibiotics (typically doxycycline)
- Analgesia
What is Sepsis?
Life-threatening organ dysfunction caused by dysregulated host response to infection
What is septic shock?
A more severe form of sepsis, technically defined as ‘in which circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone’
How is the quickSOFA score used in sepsis?
qSOFA score
RR > 22/min
Altered mentation
Systolic BP < 100mmHg
Adults with suspected infection with qSOFA score >= 2 at heightened risk of mortality
Within ICU for SOFA score is used
Red Flags for Sepsis
- Responds only to voice or pain/unresponsive
- Acute confusional state
- Systolic BP <= 90mmHg or drop >40 from normal
- HR > 130
- RR > 25
- Needs oxygen to keep SpO2 >= 92%
- Non-blanching rash, mottled/ashen/cyanotic
- Not passed urine in last 18h/ UO < 0.5ml/kg/hr
- Lactate >= 2mmol/L
- Recent Chemo
Management of Sepsis
If any of the red flags are present the ‘sepsis six’ should be started straight away:
- Administer oxygen : keep above 94% or 88-92% if at risk of CO2 retention
- Take blood cultures
- Give broad spectrum antibiotics
- Give IV fluid challenges
- Measure Serum Lactate
- Measure accurate hourly urine output
What is a Breast Abscess?
- Lobules fill with fluid
- Oestrogen causes fluid production
- Post-menopause, Oestrogen falls, less fluid, fewer cysts
- HRT can lead to cysts
- More common > 35
H&E of Breast Abscess
- Well circumscribed mass
- Sudden enlargement
- Fluctuant
- No systemic symptoms
Investigations for Breast Abscess
- <40 : USS
- > 40 : USS + MMG
Management of Breast Abscess
If large and painful
- USS-guided aspiration
If solid lesion is seen after - biopsy
What is Candidiasis?
- Thrush
- Overgrowth of Candida species (C. albicans)
RF for Candidiasis
- Young
- Dentures
- Abx
- Steroids
- Chemo
- COCP
- DM
- Malnutrition
- Xerostomia
- HIV/AIDS
- Pregnancy
H&E of Candidiasis
Pseudomembranous plaques
- Whitish plaques, can be scraped off
- Asymptomatic
- Cotton feeling, pain/tenderness, odynophagia, decreased taste, angular chelitis
Atrophic with dentures
- red lesions with no plaques
Hyperplastic
- Non-scrapable plaques
H&E of Vulvovaginal Candidiasis
- Thick white discharge “cottage cheese”
- Vulvar itching and burning
- Dyspareunia
- Dysuria
Investigations for Candidiasis
Microscopy
- Branched pseudohyphae
KOH
- Hyphae
Management of Candidiasis
Oral
- Topical antifungal - nystatin
- Systemic antifungal - fluconazole (NOT IN PREGNANCY)
Management of Vulvovaginal Candidiasis
Uncomplicated
- 150mg oral fluconazole
- Pessaries
- Vaginal creams/ointment
Complicated
- 150mg oluconazole in 2/3 doses
- Intravaginal boric acid OR flucytosine cream
H&E of Chicken Pox
- Fever, sore throat
- Rash - crusts over
Severe
- Congenital varicella syndrome - blueberry muffin rash
- Meningitis, encephalitis, varicella pneumonitis
H&E of Shingles
- Dermatomal erythmatous maculopapular rash
Severe
- Ramsey-Hunt syndrome - unilateral paralysis, hearing problems, rash in hair
- Post-hepatic neuralgia
- Herpes zoster opthalmicus
