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Conditions + definitions > Infection - Immunisations + skin infections > Flashcards

Infection - Immunisations + skin infections Flashcards

1
Q

What are the different types of vaccines?

A

Live attenuated
Inactivated
Detoxified exotoxin
Subunit of micro-organism

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2
Q

How are detoxified vaccines detoxified?

A

Toxin treated with formalin to form toxois

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3
Q

How are recombinant vaccines formed?

A

DNA segment coding for antigen mixed with plasmids, removed and purified
Inserted into yeasts + fermeneted to form more antigen

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4
Q

What is immunological memory?

A

Where cells remember the antigen and produce the antibody much quicker, instead of having to “develop” it first

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5
Q

What is the disadvantage of killed vaccines over live vaccines?

A

Multiple doses required to get same response

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6
Q

Who is vaccinated against TB?

A

Healthcare workenrs
New immigants
Areas of high prevelance
Anyone below 35 who had contact with TB patient

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7
Q

What is passive immunisation?

A

Use of immunoglobulins to give immunity to disease

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8
Q

What are common immunisations for travellers?

A 
Tetanus
Polio
Typhoid
Hep A
Yellow fever
Cholera
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9
Q

What drugs offer prophylaxis to malaria?

A

Malaron (proquanil + atovaquone_ daily
Doxycycline daily (photosensiticity)
Mefloquine (weekly)
Choloquine weekly + proqunail daily

Choice depends on country

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10
Q

What is impetigo?

A

Superficial skin infection + multiple vesicular lesions on erythematous base
Golden crust highly suggestive of diagnosis

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11
Q

What organisms cause impetigo?

A

Most commonly - staph A

Less commonly - Strep pyogenes

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12
Q

Who is most likely to get impetigo?

A

Children 2-5 in age

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13
Q

Where does impetigo occur?

A

Highly infectious - occurs on exposed parts of body

Face + scalp

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14
Q

What are predisposing factors of impetigo?

A 
Skin abrasions 
Minor Trauma / Burns 
Poor Hygiene 
Insect bites 
Chicken Pox 
Eczema / Atopic Dermatitis
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15
Q

How do you treat impetigo?

A

Small - topical antibiotics

Large areas - topical treatment + oral antibiotics

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16
Q

What is erysipelas?

A

Infection of upper dermis

Painful red area with elevated borders

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17
Q

What are the symptoms of erysipelas?

A

Painful red area with no central clearing
Associated fever
Regional lymphadenopathy
Regional lymphangitis

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18
Q

What is the most common causative agent of erysipelas?

A

Strep pyogenes

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19
Q

What is the recurrance rate of erysipelas?

A

30% in 3 yrs

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20
Q

Where does erysipelas occur?

A

70-80% on lower limb
5-20% face

Often in pre-exisiting lymphodema, obesity, DM

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21
Q

What is the treatment for erysipelas?

A

Combination of anti-staphylococcal + anti-streptococcal agents

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22
Q

What is cellultitis?

A

Diffuse skin infection involving deep dermis + subcut fat

Erythematous area with no distinct borders

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23
Q

What organisms are most likely to cause cellultitis?

A

Strep pyogenes
Staph aureus

Rare - H.influenzae

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24
Q

What are the predisposing factors for cellultitis?

A

Diabetes
Tinea pedis
Lymphoedema

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25
Q

What are the symptoms of cellultitis?

A

Erythematous area with no distinct border
Fever common
Regional lymphadenopathy + lympangitis

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26
Q

What is the treatment for cellultitis?

A

Combination of anti-staphylococcal + anti-streptococcal agents
Severe - IV agents

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27
Q

What are the ahir related inections?

A

Folliculitis
Furunculosis
Carbuncles

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28
Q

What is superficial follulitis?

A

Erythema and pustule in a single follicle

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29
Q

What is follultitis?

A

Circumscribed pustulat infection of hair follicle
Present as small red papules
Central area that may rupture/drain

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30
Q

What is the most common causative agent for folliculitis?

A

Stap A

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31
Q

Where is folliculitis commonly found?

A

Head
Back
Buttocks
Extremities

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32
Q

What is Furunculosis?

A

AKA boils
Single hair follicle inflammatory nodule
Extends into dermis + Sub cut tissue
May sponateously drain

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33
Q

What are the common areas for furunculosis?

A 
Moist, hiary areas (with no friction)
Face
Axilla
Neck
Buttocks
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34
Q

What is the most common causative organism of furnculosis?

A

Staph A

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35
Q

What are the risk factors for furunculosis?

A 
Obesity
Diabetes Mellitus
Atopic dermatitis
Chronic kidney disease
Corticosteroid use
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36
Q

What is a carbuncle?

A

Deep follicular abscess of several follciles and draining points (multisepated abscesses)
When infection has extended to involve multiple follicles (furuncles)

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37
Q

What locations are common sites for carbuncles?

A

Back of neck
Posterior trunk
Thigh

38
Q

How do you treat hair-associated infections?

A

No treatment or topical antibiotics if needed for folliculitis + furnculosis
Can administer oral antibiotics for furunculosis if no improvement

Carbuncles require admission + surgery + IV antibiotics

39
Q

What is necrotising fascitis?

A

Infectious disease emergency

Infection where bacteria consumes soft tissue/flesh

40
Q

What are the predisposing factors to necrotising fascitis?

A 
Diabetes mellitus
Surgery
Trauma
Peripheral vascular disease
Skin popping
41
Q

What are the types of necroitisng fascitis?

A 
Type 1 (mixed aerobi/anarebic)
Type 2 - monomicrobial (oten strep pyogenes)
42
Q

What organisms are associated with type 1 necrotising fascitis?

A 
Streptococci
Stapylococci
Enterococci
Gram negative bacilli
Clostridium
43
Q

What are the symptoms for necroitisng fascitis?

A

Rapid onset with sequential development of:
Erythema, extensive oedema + severe, unremitting pain

Haemorrhagic bullae, skin necrosis and crepitus may develop

Systemic features: fever, hypotension, tachycardia, delerium + multiorgan failure

44
Q

How do you manage necrotising fascititis?

A 
Surgical review is mandatory
Broadspectrum antibiotics 
Fluclocacilling
Gentamicin
Clindamycin
45
Q

What is the mortality rate of necrotising fascitis?

A

17-40%

46
Q

What is pyomyositis?

A

Deep purulent straited muscle infection
Often abscess
Infection secondary to damaged muscle

47
Q

What are the common sites for pyomyositis?

A 
Thigh
Calf
Arms
Gluteal region
Chest wall
Psoas muscle
48
Q

What are the predisposing factors of pyomyositis?

A 
Diabetes mellitus
Immunocomprimised
IV drug use
Rheumatological disease
Malignancy
Liver cirrhosis
49
Q

What is the presentation of pyomyositis?

A

Fever, pain and woody induration of affected muscle

Can lead to septic shock

50
Q

What is the most common causative organism of pymyositis?

A

Staph A

51
Q

What other organisms can be involved in pyomyositis?

A

Gram positives/negatives
TB
Fungi

52
Q

How do you treat pyomyositis?

A

Antibiotics based on investigations (culture results)

53
Q

How do you investigate pyomyositis?

A

Gram stain + culture

CT/MRI

54
Q

What is septic bursitis?

A

Bursae that have been infected from adjacent skin infection

55
Q

What are the predisposing factor to septic bursitis?

A 
Rheumatoid arthritis
Alcoholism
Diabetes mellitus
IV drug use
Immunosupression
Renal insufficiency
56
Q

How do you diagnose septic bursitis?

A

Aspiration of synovial fluid

57
Q

What are the common sites of septic bursitis?

A

Elbow

Knee

58
Q

How do you treat septic burisitis?

A

Antibiotics

59
Q

What is infectious tenosynovitis?

A

Infection of tendon sheathes

60
Q

Which sheathes are most commonly affected in infectious tenosynovitis?

A

Flexor muscle tendons of hand

61
Q

What is the most common causative agent of infectious tenosynovitis?

A

Staph A

Streptococci

62
Q

How does infectious tenosynovitis present?

A

Erythematous fusiform swelling around tendons
Fingers in flexed position
Tenderness on tendon sheath
Pain on extension of finger

63
Q

How do you treat infectious tenosynovisitis?

A

Empiric antiobiotics

Hand surgeon to review

64
Q

What causes toxin-mediated syndromes?

A

Superantigens - a group of pyrogenic exotoxins

65
Q

How are these superantigens different?

A

The antigens bypass normal measures and activate the T cell receptors directly (~2000% times more)
Massive burst in cytokine release

66
Q

What does this burst in cytokine release lead to?

A

Leads to endothelial leackage, multi-organ failure and death

Also haemodynamic shock

67
Q

What are the most likely agents to cause toxin-mediated syndromes? (what antigens do they release?)

A 
Staph A (TSST1 + ETA/ETB)
Strep pyogenes TSST1
68
Q

How do you diagnose staphyloccoal toxic shock syndrome?

A 
Fever
Hypotension
Macular rash (diffuse)
Multiple organs involved 
Isolation of staph a from sterile sites
69
Q

What is stretococcal TSS associated with?

A

Streorocci in deep seated infections - erysipelas/necrotising fascitis

70
Q

How do you treat TSS?

A 
Remove offending agent
IV fluids
Inotropes
Antiobiotics
IV immunoglobulins
71
Q

What is staphyloccoal scaled skin syndrome?

A

Infection via staph A releaseing ETa/B (exfoliative toxin)

More common in children

72
Q

How does staphyloccoal syndorme present?

A

Widespread bullae and skin exfoliation

73
Q

How do you treat staphyloccoal scalded skin syndrome?

A

IV fluids + antimicrobials

74
Q

What is panton-valentine leuconcidin toxin?

A

Gamma haemolysin

Often staph A

75
Q

How do patients present with panton valentine leucoidin toxin?

A

Skin + soft tissue infection
Haemorrhagic pneumonia
Recurrent boils

76
Q

How do you treat panton-valentine leucocidin toxin?

A

Antiobiotics that reduce toxin production

77
Q

What type of infection is an IV catheter infection?

A

Nosocmial

78
Q

What is the presentation of an IV catheter infection?

A

Local skin and soft tissue inflammation –> cellultitis
Sometimes tissue necoris

Associated bacteraemia

79
Q

What are the risk factors for IV cather assocaited infection?

A

24hr + continuous infection
72+ canula in situ
Lower limb cannula

80
Q

What are the common causative agents in IV catheter infections?

A

Staph A

81
Q

What is the normal pathway for an IV catheter infection?

A

Biofilm which spills into bloodstream

Can seed other places (endocarditis etc)

82
Q

How do you diagnose IV catheter infection?

A

Clinically or blood cultures

83
Q

How do you treat an IV catheter infection?

A

Remove cannula
Excise any pus
Antibiotcs for 14 days
Echocardiogram

PREVENTION first

84
Q

What are the classifications for surgical site wounds?

A 
4 classes
Clean wound
Clean contaminated wound
Contaminated wound
Infected wound
85
Q

What is a class 1 (clean wound) surgical infection?

A

Respiratory, alimentary, genital or urinary system not been entered

86
Q

What is a class 2 (clean contaminated wound) surgical infection?

A

Respiratory, alimentary, genital or urinary system entered, but no unusual contamination

87
Q

What is a class 3 (contaminated wound) surgical infection?

A

Open, fresh accidental wounds or gross spillage from intestinal tract

88
Q

What is a class 4 (infected wound) surgical infection?

A

Exisitng clinical infection (before operation)

89
Q

What are the main causes of a surgical site infection?

A 
Staph A
Coagulase negative staphylococci
Enterococcus
E coli
Pseudomonas Aeruginosa 
Enterobacter 
Streptococci 
Fungi 
Anaerobes
90
Q

What are the risk factors of surgical site infections? (patient associated)

A 
Diabetes
Smoking
Obesity
Malnutrition
Steroid use
Colonisation of staph A
91
Q

What are the procederal risk factors for a surgical site infection?

A 
Site shaved night before operation
Improper preop skin prep
Improper antimicrobial prphylaxis/sterile technique
Insufficient theatre ventillation
Perioperative hypoxia
92
Q

How do you diagnose surgical site infections?

A

Avoid superficial swabs - aim deep
Antibiotics
Send pus/tissue for cultures!

Conditions + definitions (68 decks)

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