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Infectious Diseases Flashcards

1
Q

What is Cellulitis

A

It’s spreading inflammation of subcutaneous and fascial planes

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2
Q

Causative agents of Cellulitis

A

Streptococcus pyogenes and other Gram +ve bacteria.

Often Gram -ve bacteria like klebsiella, pseudomonas, E.coli.
Gram -ve causes secondary infections

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3
Q

Sequelae of cellulitis

A

Infection localised to form pyogenic abscess.
Infections to spread and cause bacteremia, septicemia, pyemia
Can also lead to local gangrene

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4
Q

Clinical features of Cellulitis

A

Fever, toxicity.
Swelling is diffused and spreading in nature
Cellulitis progresses rapidly in diabetic and immunosuppressed patients

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5
Q

Management of cellulitis

A

Elevation of limb or parts to reduce edema
Antibiotics
Dressing using glycerine to reduce edema because of hygroscopic action

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6
Q

Types of cellulitis

A

Orbital cellulitis
Ludwig’s Angina

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7
Q

Orbital cellulitis

A

It causes proptosis leading to impairment of ocular movements and blindness.
Can spread through ophthalmic veins into cavernous sinus causing cavernous sinus thrombosis.

Management through higher generation Antibiotics

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8
Q

What’s ludwig’s Angina

A

Cellulitis of upper part of neck involving submandibular region and floor of mouth along fascial planes

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9
Q

Clinical features of Ludwig’s Angina

A

Diffuse swelling, redness, tenderness, induration in floor of mouth and submandibular region.

Difficulty in mouth opening (trismus), dysphagia.
Fever, tachycardia and tachypnea.

Severe laryngeal edema.may require emergency tracheostomy.

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10
Q

Complications of Ludwig’s angina

A

Septicemia

Spread of infection into the parapharyngeal space leads to the thrombosis of the inter jugular vein which may extend above into sigmoid sinus which may be fatal

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11
Q

Treatment of Ludwig’s Angina

A

Antibiotics

Early surgical intervention under general anaesthesia.
Horizontal incision placed in submandibular region extending both side deepen to include deep fascia.
Myloid muscles are cut on both side to release tension, this prevents laryngeal edema and futher prevents spread of infection

When infection is controlled the incised wound is closed by secondary suture.
Occasionally loose sutures are placed with placement of drain into the wound

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12
Q

What is Erysipelas

A

It’s spreading inflammation of skin and subcutaneous tissues due to Streptococcus pyogenes.

There’s always cutaneous lymphangitis with rose pink rash and cutaneous lymphatic edema.

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13
Q

Sites of Erysipelas

A

Orbit
Face
Scrotum

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14
Q

Clinical features of Erysipelas

A

Toxemia
Rash is fast spreading
Discharge is serious
Milian’s ear sign

Common among individuals with poor hygiene

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15
Q

What is milian’s ear sign

A

A clinical sign.
Skin of ear mobile is adherent to subcutaneous tissue and so cellulitis cannot occur
Erysipelas being a cutaneous condition can spread into ear lobule

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16
Q

Treatment of Erysipelas

A

Penicillin
Amoxicillin
Cloxacillin

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17
Q

What’s pyogenic abscess

A

Localised collection of ous in a cavity lined by granulation tissue, covered by pyogenic membrane

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18
Q

Modes of infection of pyogenic abscess

A

Direct
Hematogenous
Lymphatics
Extension from adjacent tissues

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19
Q

Bacteria causing Pyogenic abscess

A

Staphylococcus aureus
Streptococcus pyogenes
Gram -ve bacteria
Anaerobes

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20
Q

Factors precipitating pyogenic abscess formation

A

General condition:- nutrition,age, anemia
Associated diseases:- diabetes, HIV, immunosuppressed patients
Types and virulence of organism
Trauma, hematoma, road traffic accidents

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21
Q

Clinical features of pyogenic abscess

A

Fever with chills and rigor
Localised swelling which is smooth, soft and fluctuant.
Visible pus
Throbbing pain and pointing tenderness
Brawny induration
Redness and warmth.

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22
Q

Site of pyogenic abscess

A

External:-
Finger and hands
Neck
Axilla
Breast
Foot, thigh
Ischiorectal and perianal
Abdominal wall
Dental abscess, tonsillar abscess

Internal:-
Abdominal
Perinephric
Retroperitoneal
Lung
Brain
Retropharyngeal

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23
Q

Investigations for abscess

A

Total count is raised.

Urine and blood sugar to rule out diabetes

Ultrasound sonography of abdomen and other region when required.

Xray in case of lung abscess

Gallium isotope

CT scan or MRI in case of brain and thoracic absess

Liver function test, PO2 and PCO2 tests, blood culture estimations

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24
Q

Complications of abscess

A

Bacteremia, Septicemia, pyemia
Multiple abscess formation
Destruction of tissues
Antibioma (common in breast abscess)
Large abscess may erode into adjacent vessels and can cause haemorrhage
Abscess in head and neck region can cause laryngeal edema, stridor and dysphagia.

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25
Specific complications of internal abscess
Brain abscess can cause intracranial hypertension, epilepsy and neurological deficit. Liver abscess can cause hepatic failure, rupture and jaundice. Lung abscess can lead onto bronchopleural fistula or septicemia or respiratory failure or ARDS
26
Hilton's method of draining abscess
Initially, broad spectrum antibiotics is started. Under general anaesthesia or regional block anaesthesia, after cleansing and draping ,abscess is aspirated and presence of pus is confirmed . Skin is incised in the line parallel to neurovascular bundle. Pyogenic membrane is open using sinus forceps and all loculi are broken up. Pus is cleared and washed away with saline. A drain(guaze or corrugated rubber drain) is placed Wound Is not closed and allowed to granulate and heal. Sometimes secondary suturing or skin grafting is required. Antibiotics are continued Pus is sent for culture and sensitivity.
27
Problems in drainage of Abscess
Improper drainage Bleeding Residual abscess or sinus formation
28
Differential diagnosis of an abscess
Aneurysm, especially in femoral and popliteal and axillary region. Aspirating with needle and confirming the pus is important. Soft tissue tumors, Sarcomas maybe smooth and warmer
29
What is Boil
Also called Furuncle. It's an acute staphylococcal infection of hair follicle with perifolliculitis which proceeds to suppuration and Central necrosis
30
Treatment of boil
Antibiotics Drainage of boil
31
Complications of boil
Cellulitis Lymphadenitis Hydradenitis (infection of a group of hair follicles)
32
Carbuncle
Word meaning is charcoal. It's an infective gangrene of skin and subcutaneous tissues
33
Main causative organism for carbuncle
Staphylococcus
34
Common site of carbuncle
Back and nape of neck
35
Carbuncle is common in
Diabetes and after 40 years of age . In males Patients will be toxic and in diabetic they will be ketotic
36
Investigations for carbuncle
Urine sugar and ketone bodies Blood sugar Discharge for culture and sensitivity
37
Treatment of carbuncle
Proper control of diabetes. antibiotics Drainage done by cruciate incision and debridement of all dead tissues. Excision is done later Once wounds granulate, skin grafting may be required
38
What's Pott's puffy tumor
Formation of diffuse external swelling in the scalp due to subperiosteal pus formation and scalp edema. Originates in the frontal region and may extend into other
39
Causes of potts puffy tumor
Chronic frontal sinusitis. Trauma causing frontal subperiosteal hematoma. Chronic otitis nedia
40
Clinical features of potts puffy tumor
Pain and swelling in frontal region which is warm and tender Toxicity and drowsiness
41
Complications of potts puffy tumor
Osteomyelitis of frontal bone. Spread of infection into the intracranial cavity leading to intracranial abscess.
42
Investigations for Potts puffy tumor
Total leukocytes count Erythrocytes sedimentation rate {ESR} XRAY of skull CT scan
43
Differential diagnosis of Potts puffy tumor
Secondaries in brain or skull
44
Treatment of Pott's puffy tumor
Antibiotics and drainage under general anaesthesia before it spreads into cranial cavity. Once it extends into cranial cavity, it's treated by neurosurgical decompression using Dandy's brain cannula. Osteomyelitic brain often needs radical removal with proper reconstruction.
45
Pyogenic granuloma
Common in face, scalp, fingers and toes. Maybe due to minor trauma or minor infection. Infection leads to unhealthy granulation tissue which protrudes through wound
46
Clinical features of pyogenic granuloma
Single, well localised, red, firm, nodule which bleeds on touch. May or May not be tender
47
Sites for pyogenic granuloma
Face Scalp Fingers Toes
48
Differential diagnosis for pyogenic granuloma
Hemangioma Papilloma Skin adnexal tumours
49
Treatment
Excision Tissue sent for histopathological study
50
Pyemia
Presence of multiplying bacteria in blood as emboli, spreads and lodge through different organs causing metastatic abscess. Which may lead to multiple organ dysfunction syndrome.
51
Clinical features of pyemia
Fever with chills and rigor Jaundice, oliguria, drowsiness Hypotension, peripheral circulatory collapse and later coma with MODS
52
Common causes of Pyemia
Urinary infection Biliary tract infection Lower respiratory tract infection Abdominal sepsis Sepsis in diabetic and immunosuppressed individuals like HIV, steroids therapy
53
Investigations for Pyemia
Total leukocytes count Pus culture Blood culture Urine culture Blood urea and serum creatinine LFT
54
Treatment of Pyemia
Monitoring of vital parameters Antibiotics (ceftazidime, ceftoperazone, ceftriaxone sodium) IV fluids, maintenance of urine output.. Hydrocortisone Blood and plasma transfusion Nasal oxygen, ventilator support, monitoring of pulmonary function
55
What is Gonorrhea
Sexually transmitted disease caused by Niesseria Gonorrheae. It's a gram -ve Intracellular diplococcus.
56
Where does gonorrhea affect and what's its incubation period
It affects the epithelium of urogenital tract, rectum, pharynx, conjuntivae and anterior urethra (in male) Incubation period:- 2-14 days
57
Features of Gonorrhea
Dysuria and urethral discharge. In females, vaginal discharge, dysuria, bilateral salpingitis and infertility. After chronic infection,gonococcal urethritis causes urethral strictures usually in bulbar urethra. It also causes epididymoorchitis, prostatitis and proctitis
58
Diagnosis of Gonorrhea
Patient is asked to pass urine in two cups. Haziness in first cup signifies infection with pus the second cup is clear. Gram staining and culture of urine is diagnostic
59
Treatment of Gonorrhea
Penicillin is DOC. Ampicillin, ciprofloxacin, ceftriaxone , cefixime and spectinomycin are used. In complicated Gonorrhea, prostatic massage, local irrigation, treatment for stricture urethra, Doxycycline and Gentamicin therapy are indicated.
60
Acute pyomyositis
Infection and suppuration with destruction of skeletal muscles .
61
Causative organism of acute pyomyositis
Staphylococcus aureus Streptococcus pyogenes And gram -ve bacteria
62
Common site for acute pyomyositis
Thigh Gluteal region Shoulder and arm
63
Clinical features for Acute pyomyositis
Creatine phosphokinase will be high and signifies acute phase. Renal failure is common. MRI is useful
64
Treatment of acute pyomyositis
Antibiotics Wound excision and compartment release often with hemodialysis.
65
Anthrax
Caused by Bacillus anthracis which is gram +ve bacteria, spore forming, capsulated, non motile, non Acid fast bacillus. Resistant to heat and antisepsis. Common in cattle and seen in humans who handle carcasses,wool and hairs.
66
Types of Anthrax
Cutaneous type- common. Occurs after 3-4 days after infection. Indurated papular with black Slough and rounded by vesicles --malignant pustules. Regional lymph nodes are involved. Toxemia common. Woolsorter's disease is respiratory type. Due to inhalation of spores causing pneumonia. More dangerous and life threatening. Alimentary type- due to ingestion of spores
67
Diagnosis of Anthrax
Culture shows Medusa head appearance. Positive for M'Fadyean reaction and Positive for Acoli's thermoprecipitation test
68
Treatment of Anthrax
Penicillins Ciprofloxacin
69
Tetanus
It's an infective condition caused by clostridium tetani leading to relex muscle spasm often associated with tonic clinic seizures
70
How is tenatus caused
Caused by clostridium tetani which is gram positive bacteria, anaerobic, mobile, non capsulated with petrichous flagella with terminal spores. Spores are infective agent. Found in soil, manure, dust etc. They gain entry into wound, prick injuries, accidents, foreign bodies, anaerobic conditions etc.
71
Clinical features of tetanus:- Symptoms
Jaw stiffness, pain and stiffness in neck and back muscles Anxiousness and sweating Headache, delirium, sleeplessness Dysphagia Dyspnea
72
Clinical features of tetanus Signs:-
Trismus, due to spasm of masseter and ptreygoids Risus sardonicus (smiling face) due to spasm of zygomaticus major Neck rigidity Spasm and rigidity of all muscles Hyperreflexia Respiratory changes
73
Which toxins are released in tetanus
Exotoxins:- Tetanospasmin and tetanolysin.
74
Tetanospasmin
Enters through the perineurial sheath into the CNS BLocks Cholinesterase enzymes at anterior horn cells Which causes hyperexcitability and reflex spasm of muscles with TONIC CLONIC CONVULSIONS Once toxin is fixed in nerve tissue it can no longer be neutralized by antitoxin.
75
Tetanospasmin another pathway
Circulation Causes Toxemia through blood Blocks the NMJ by acting on Cholinesterase Aggrevates muscle spasm
76
Tetanolysin
Causes hemolysin
77
Pathogenesis of Tetanus
Tonic clonic convulsions Abdominal wall rigidity and hematoma formation Severe convulsions may often lead to fractures, joint dislocation and tendon ruptures. Fever, Tachycardia Retention of urine, constipation. Rarely features of Carditis. Symptoms will be aggrevated by stimuli like light, noise.
78
Incubation period of tetanus
Time between entry of spore and appearance of first symptom. 7-10 days
79
Period of Onset of Tetanus
Time between first symptom and first sign.
80
Types of tetanus
1. Early tetanus 2. Latent tetanus 3. Late tetanus 4. Ascending tetanus 5. Descending tetanus 6. Cephalic tetanus 7. Localised tetanus 8. Bulbar tetanus 9. Tetanus neonatorum 10. Urban tetanus
81
Different postures in tetanus
1. Opisthotonus- backward bending. 2. Orthotonus - straight posture 3. Emprosthotonus - forward bending 4. Pleurosthotonus- lateral bending.
82
Staging of tetanus
Mildly I'll - rigidity,spasm, trismus and different postures Seriously ill- spasm, rigidity,severe respiratory infections Dangerously ill- cyanosis with respiratory failure and tonic clonic convulsions
83
Differential diagnosis of tetanus
Strychnine poisoning Trismus due to dental oral, tonsillar sepsis, oral malignancy. Meningitis Hydrophobic Convulsion disorders
84
Treatment of Tetanus
Patient admitted in isolated, dark, quiet room. Antitetanus globulin (ATG) 300 /units IM stat. ATS when ATG is not available After IV test dose (1000 units of ATS),full dose of ATS i.e, 1,00,000 units half by IM and half by IV is given Wound debridement, drainage of pus, injection of ATG 250-500 units locally reduce toxin effect. Ryle's tube is passed to decompress and so as to prevent aspiration but later for feeding purpose. Catheterization IV fluids and electrolyte balance to be maintained Tetanus toxoid to be given as disease will not give immunity against further infections IV diazepam 20mg 4/6th hourly IV phenobarbitone 30mg 6th hourly IV chlorpromazine 25 mg 6th hourly Injection crystallize penicillin 20lacs 6th hrly, Inj. Gentamicin and metronidazole to prevent secondary infection. Nasal oxygen In severe cases, patient is curarised and placed in ventilators Endotracheal intubation or tracheostomy are often life saving Steroids to be given when Carditis is suspected
85
Gas Gangrene in earlier days was called
Malignant Edema
86
Organisms that cause Gas Gangrene
Clostridium purfringens. (welchii) Clostridium oedematiens Clostridium septicum Clostridium histolyticus
87
Which exotoxins are released in Gas Gangrene
Lecithinase (imp toxin- hemolytic, membranolytix and necrotic causing extensive myositis) Hemolysin Hyaluronidase (rapid spread of gas) Proteinase
88
Effects of Gas Gangrene
Extensive necrosis of muscle with production of H2S gas Foaming liver- when it affects the liver causes necrosis with frothy blood.
89
Incubation period of gas Gangrene
1-2 days
90
Clinical features of Gas Gangrene
Toxemia, fever, tachycardia Wound under tension with foul smelling discharge Khaki coloured skin due to hemolysis. Crepitus can be felt Jaundice-maybe fatal
91
Clinical types of Gas Gangrene
Fulminant type Massive type Group type Single muscle type Subcutaneous type
92
Fulminant type of gas Gangrene
Causes rapid Progress and Often death Due to Toxemia, renal failure of liver failure or MODS
93
Massive type
Infection involving the whole of one limb containing fully dark coloured gas filled areas.
94
Group type gas Gangrene
Involving one group of muscles
95
Single muscle type of gas Gangrene
Affecting one single muscle
96
Subcutaneous type of gas Gangrene
Involves only subcutaneous tissues
97
Investigations for gas Gangrene
X ray shows gas in muscle plane or under the skin. LFTs, blood urea, serum creatinine, total count, PO2, PCO2
98
Treatment of gas Gangrene
Inj. Benzyl penicillin 20lacs 4th hourly + Inj. Metronidazole 500mg 8th hourly + Inj. Aminoglycoside (if blood urea is normal) Fresh blood transfusion Polyvalent antiserum 25000/unit after a test dose and repeat 6th hours. Hyperbaric oxygen Liberal incisions, all dead tissues and debridement is done until healthy tissues bleeds. Rehydration and maintaining optimum urine output 30ml/hr. Electrolyte management In severe cases, amputation.
99
Precautions after operating on a gas Gangrene patients in OR
They should be fumigated 24-48 hours properly to prevent risk of spread of infection to other patients.

General surgery (1 decks)

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