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Disease and Defense III > Inflammation and Infection > Flashcards

Inflammation and Infection Flashcards

1
Q

Most common bacterial infection in children?

A

impetigo

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2
Q

how is impetigo usually contracted?

A

person to person

less commonly through fomites

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3
Q

predisposing factors to impetigo?

A

high humidity
cutaneous carriage
poor hygiene

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4
Q

causative agent

non bullous impetigo of childhood?

A

Streptococcus pyogenes

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5
Q

causative agent

non-bullous and bullous impetigo (most common cause of both types of impetigo)

A

Staphylococcus aureus

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6
Q

70-80% of all impetigo is which kind?

A

non-bullous impetigo

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7
Q

non-bullous impetigo

most commonly affects?

A

face followed by extremities

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8
Q

non-bullous impetigo - typical beginnings?

A

typically begins as single lesion - autoinoculation frequently produces multiple adjacent lesions

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9
Q

non-bullous impetigo - early primary lesion – appearance?

A

erythematous macule with superficial blister (rarely appreciated)

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10
Q

non bullous impetgio - developed lesion?

A

honey colored yellow crust

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11
Q

do we see lymphadenopathy in non-bullous impetigo?

A

mild / variably present

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12
Q

complication to have on your radar with non-bullous impetigo from streptococcal ?

A

up to 5% are associated with post-streptococcal glomerulonephritis

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13
Q

bullous impetigo (percent)

A

20-30

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14
Q

bullous impetigo body area

A

any area

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15
Q

Bullous impetigo beginning?

A

typically begins as single lesion - autoinocculation frequently produces multiple adjacent lesion

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16
Q

bullous impetigo - primary lesion

A

superficial, flaccid blister that may occasionally demonstrate layered pus

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17
Q

bullous impetigo - older lesion

A

demonstrate collapsed blister that are often described as having a varnished like appearance

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18
Q

Stapphylococcal scalded skin syndrome/

A

primarily seen in children less than six - produced by pahge group II strains that produce exoliative toxins - that produce diffuse superficial blisters over large areas of the body

listed under bullous impetigo

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19
Q

Diagnosis of impetigo?

A

clinical
culture
biopsy (Rarely done)

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20
Q

Impetigo with short chains of gram positive cocci amongst numerous neutrophils?

A

S pygogenes =

non-bullous impetigo of children

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21
Q

treatment of impetigo?

A

soak and remove crust
topical antibiotics (limited cases)
systemic antibiotics

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22
Q

topical antibiotic used to treat impetigo?

A

mupirocin 2% ointment

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23
Q

do systemic antibiotics used to treat impetigo alter post-streptococcal glomerulonephritis risk?

A

no

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24
Q

common systemic antibiotics

A

cephalexin
dicloxacillin
azithromycin
clarithromycin

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25
Q

impetigo fucks with what layer of skin

A

epidermis

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26
Q

cellulitis fucks with which layer of skin

A

dermis

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27
Q

epidemiology of cellulitis

A

more common in very young, elderly, immunocompromised, IV drug users, chronic ulcers

post-surgical

increased summer

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28
Q

where do celluitis infections occur through?

A

breaks in skin - breaks can be microscopic and not clinically noticeable

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29
Q

bacteriology of cellulitis

most commonly associated with (3)

A

b-hemolytic streptococci (streptococcus pyogenes), staphylococcus aureus, Haemophilus influenza (kids)

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30
Q

What is erysipelas

A

clinical variant of celluitis in children -

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31
Q

eryspielas - most common bacteriology

A

b-hemolytic streptococci (streptococcus pyogenes)

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32
Q

What is erysipelas?

A

St. Elmo’s fire

Cellulitis

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33
Q

Erysipelas common presentation?

A

most commonly confined to face, less commonly extremities

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34
Q

erysipelas incubation period

A

2-5 days

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35
Q

erysipelas systemic symptoms

A

variable

chills, fevers, malaise

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36
Q

erysipelas - primary lesion

A

sharply demarcated area of erythema (cliff drop border) that demonstrates non-pitting edema (lesions are often painful)

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37
Q

erysipelas - lymphadenopathy?

A

regional

strictly present

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38
Q

erysipelas infrequent epidermal presentation?

A

rarely the overlying epidermis may demonstrate bullae, pustules, or hemorrhagic necrosis

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39
Q

cellulitis

most common location

A

extremities

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40
Q

cellulitis

incubation period

A

2-5 days

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41
Q

cellulitis

primary lesion

A

ill defined non-palpable or subtly palpable area of painful erythema that is warm to the touch

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42
Q

cellulitis

older lesion

A

may demonstrate variable hemorrhage

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43
Q

cellulitis

lymph involvement?

A

lymphatic streaking commonly present

regional lymphadenopathy frequently present

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44
Q

cellulitis

patients may progress to?

A

septicemia

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45
Q

cellulitis

diagnosis?

A 
clinical 
CBC may demonstrate luekocytosis 
biopsy - may be conistent though organisms are rarely IDd
Culture more specific (use leading edge)
blood culture - positive in up to 10%
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46
Q

treatment of cellulitis?
correct against?

mild

severe

A

streptococcal or staphylococcal organisms

mild cases

  • oral cephalexin
  • oral dicloxacillin
  • oral clarithromycin
  • oral azithromycin
  • oral fluoquinolone antibiotic
severe cases (require hospitalization)
- intravenous antibiotics with broad spectrum coverage (e.g. piperacillin/tazobactam or metronidazole plus ciprofloxacin)
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47
Q

true or false

severe cases of cellulitis require hospitalization

A

true

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48
Q

dermatophyte infection

-

A

superficial fungal infection - because dermatophytes eat keratin

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49
Q

dermatophyte infection acquired?

A

human
animal
fomite
soil

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50
Q

dermatophyte food source

A

keratin (top layer of skin / hair / nails)

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51
Q

socks and jocks dermatophyte?

A

epidermophyton - tinea cruris

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52
Q

most common dermatophyte?

A

trichophyton - tinea capitis / corporus

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53
Q

fluorescent dermatophyte in tinea capitis?

A

microsporum

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54
Q

most common cutaneous dermatophyte

A

trichophyton rubrun

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55
Q

most common tinea pedis

A

trichophyton metagrophytes

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56
Q

most common tinea capitis

A

trichophyton tonsurans

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57
Q

most common fluorescent tinea capitis

A

microsporum canis

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58
Q

most common tinea cruris

A

epidermophyton floccosum

59
Q

dermatophyte infection of the scalp hair?

A

tinea capitis

60
Q

dermatophyte infection of the scalp hair - variant with abscess formaiton

61
Q

dermatophyte infection of the face

A

tinea faciei

62
Q

dermatophyte infection of the beard

A

tinea barbae

63
Q

dermatophyte infection of the glabrous skin (hair bearing)

A

tinea corporis

64
Q

dermatophyte infection of the glabrous skin - variant characterized by follicular pustules and granulomas

A

majocchi’s granuloma

65
Q

dermatophyte infection of the genital region

A

tinea cruris

66
Q

dermatophyte infection of the hands

A

tinea manuum

67
Q

dermatophyte infection of teh feet

A

tinea pedis

68
Q

dermatophyte infection of the nail

A

onychomycosis

69
Q

how to diagnose dermatophyte infection

A

clinical

Potassium hydroxide (KOH) - organisms appear as hypahe or as athrospores

Culture on DTM

Biopsy with GMS stain

70
Q

Treatment of dermatophyte infection?

A

topical antifungal agents

systemic antifungal agents

71
Q

do we use topical antifungals on nails?

A

not usually

72
Q

common topical antifungals

A

imidazoles
allylamines
hydroxypyridones

73
Q

common systemic antfungal agents

A

griseofulvin (tinea capitis)
fluconazole
itraconazole
terbinafine (tinea uniquium)

74
Q

Candidiasis - what do they eat

A

glucose - so deeper in skin

75
Q

candidiasis effects what?

A

mucous membranes and skin

76
Q

candidiasis infections are more common in which populations (4)

A

diabetes
occlusion
corticosteroid users
broad spectrum antibiotics

77
Q

which species is most common cause of candidiasis?

A

candida albicans - found as normal microflor in the GI tract of greater than 80% of individuals

78
Q

oral candidiasis =

79
Q

angular cheilitis =

A

candida infection

perleche

80
Q

diaper dermatitis
erosio interdigitalis

two common types of?

A

cutaneous candidiasis

81
Q

candida infection of v

A

vulvovaginitis

82
Q

balanitis

A

glans penis candida

83
Q

rare candida variant characterized by absence of normal immunity

A

chronic mucoctaneous candidiasis

84
Q

dx of candidiasis

A

clinical presentation

KOH - pseudohyphae - fatter than dermatopytes and less branches / septate

culture - (saboraud’s agar / nickerson’s medium) –> looks like mucoid white substance

biopsy

85
Q

treatment of candidiasis

A

topical antifungals - not usually on nails

systemic antifungals

86
Q

systemic antifungal (candida) treatment of choice for mucosal disease?

A

fluconazole

87
Q

Tinea (Pityriasis) Versicolor

A

fungal infection

88
Q

Tinea (Pityriasis) Versicolor
distribution
increased incidence
demographic

A

worldwide distribution

more common in humid and warm climates

confined to post-pubertal

89
Q

Tinea (Pityriasis) Versicolor

food?

A

follicular lipids

90
Q

Tinea (Pityriasis) Versicolor

mycology

A

Malassezia furfur

Pityrosporum oribulare

91
Q

Tinea (Pityriasis) Versicolor

cutaneous distribution

A

primarily truncal

92
Q

Tinea (Pityriasis) Versicolor

primary lesion

A

asymptomatic - tan colored / subtle scaly macules that may develop into large patches

93
Q

Tinea (Pityriasis) Versicolor

hypopigmented variant?

A

due to production of azelaic acid that inhibts the function of tyrosinase produced by melanocytes

94
Q

Tinea (Pityriasis) Versicolor

pityrosporum folliculitis variant?

A

characterized by follicular papules in pustules on the trunk, arms, and occasionally face

95
Q

Tinea (Pityriasis) Versicolor

diagnosis

A

clinical

KOH - spaghettic and meatballs hyphae /yeast

96
Q

Tinea (Pityriasis) Versicolor

treatment

A

selenium sulfide shampoo applied topically

topical imidazoles

oral itraconazole / ketoconazole

97
Q

Scabies

epidemiology

A

everyone
higher prevelance in sexually active
spread is primairly person to person rarely fomites

98
Q

scabies

parasitology

A

sarcoptes scabiei - hominis

i.e. only humans

99
Q

scabies life cycle

A

30 days in epidermis before the female lays 60 to 90 eggs that mature in 10 days

100
Q

scabies size

101
Q

scabies #

A

usually less than 100

102
Q

scabies

clinical distribution

A

symmetric with characteristic areas of involvement being the interdigital webspace of the hands, flexural portion of the wrist, waist, around the axillary araes, genitalia, and butt

103
Q

scabies typically spares (body parts)

A

head
palms
soles

104
Q

scabies - symptoms accentuated ?

A

at night or by hot baths and showers

105
Q

scabies

primary lesion?

A

erythematous papules
wavy threadlike grayish white to slightly erythematous burrows - pathognomonic finding
distinctive erythematous nodules on male genitalia

106
Q

scabies secondary lesion

A

excoriations and secondary infections

107
Q

norwegian scabies?

A

crusted scabies - extenisve infestations associated with massive hyperkeratosis - typically seen in immunocompromised individuals and patients with diminished sensory function

108
Q

scabies

dx - clinical

A

id of characteristic burrows or genital nodules

109
Q

scabies dx

mineral oil?

A

small drop of mineral oils is placed on the skin in gently scraped and examined under microscope for infestation evidence –> mite / egg / skybala

110
Q

scabies dx

skin biopsy

A

occasionally needed - can be diagnostic if mites, eggs, or feces are id’d on epidermis

111
Q

scabies

treatment cream?

A

permethrin 5% cream - treamtent of choice in most cases (tolerance but not true resistance has been seen in some strains)

112
Q

scabies

treatment lotion?

A

lindane 1% - use limited by increasing resistance

113
Q

scabies

treatment of choice in extensive cases or cases that fail topica?

A

ivermectin

114
Q

lice

epidemiology

A

worldwide

12 million / yr in US (head)

115
Q

Crab lice

epidemiology

A

highest in homosexual males and men 15-40

116
Q

Lice parasitology

scalp infector?

A

pediculus humanus var. capitis - bloodsucking, wingless insect that preferentially infects scalp

117
Q

Lice parasitology

trunk infector?

A

pediculus humanus - var corpus

most common in indigent

118
Q

Lice parasitology

genital infector?

A

phthirus pubis

119
Q

Head lice

area?

A

limited to scalp with the area behind the ears in teh nape of the neck being the area most commonly affected

120
Q

Head lice

symptoms

121
Q

Head lice

skin presentation?

A

erythema, scale, and secondary infection commonly present

122
Q

head lice

what they look like?

A

nit are tan-brown oval eggs attached to hair shafts (Relatively easy to find) once the eggs hatch they are white in color

lice demonstrate a brown-tan color with 6 legs and are more difficult to find

123
Q

body lice

look like and local

A

lice and eggs are morphologically identical to head lice but are found only on clothes except during feeding

124
Q

body lice

clinical findings

A

intense pruritus

erythematous papules and macules that are most commonly located on the trunk

125
Q

crab lice

local?

A

limited to the hair of the genital area and less commonly eyelashes, beard, or axilla

126
Q

crab lice

symptoms

A

pruritus of genitals

127
Q

crab lice

appearance

A

nits are usually similar to those in head lice, the adult louse is usually easily found attached to base of hairs

128
Q

crab lice

dx?

A

clinical presentation

demonstration of either nit or louse

129
Q

treatment

head lice

A 
pyrethrin (otc)
permethrin 1% cream rinse (otc)
lindane 1% shampp
malathion 0.5% - most efficacious
ivermectin - very good efficacy
130
Q

body lice

treatment

A

deinfestation of clothing and bedding by fumigation / heating to 65C

topical treatments that are effective against scabies are also used

131
Q

crab lice

treatment

A

permethrn
pyrethrin
lindane 1% shampoo
ivermectin

132
Q

what should dandruff in a school age child tip you off to?

A

ring worm (tinea capitis)

we do not normally see dandruff in school age children so you should be considering tinea capitis (dermatophyte) - ring worm - with central clearing

133
Q

bacterial skin diseases (2 types we went over)

A

impetigo - surface

cellulitis - deeper

134
Q

impetigo contagiosa =

A

streptococcal non-bullous impetigo

most commonly children face

135
Q

post-streptococcal glomerulonephritis - worry about with

A

streptococcal non-bullous impetigo - (impetigo contagiosa)

136
Q

impetigo with gram stain demonstrating short chains of gram-positive cocci amongst numerous neutrophils - think?

A

Strep pyogenes

137
Q

impetigo with biopsy showing clusters of bacteria inside blister cavity - think?

A

staphylococcus bullous impetigo

138
Q

cliff drop border facial reddening - clue you to?

could also look for ___ as clinical pearl

A

erysipelas = facial cellulitis (strep)

lymphadenopathy - preauricular

139
Q

fungal infections of the skin (2) surface and deep

A

dermatophyte - eat keratin

candidiasis - eat glucose

140
Q

variant of tinea corporis characterized by follicular pustules and granulomas

A

majocchi’s granuloma

141
Q

long hollow septate branching hyphae on KOH?

A

Dermatophyte

142
Q

if your test medium changes color from amber to red this is positive sign of ?

A

dermatophyte infection

143
Q

tinea pedis

topical treatment with

Disease and Defense III (11 decks)

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