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A13AMC @ UoN > L18 - Infections of the Skin, Soft Tissues, Bones & Joints > Flashcards

L18 - Infections of the Skin, Soft Tissues, Bones & Joints Flashcards

1
Q

Define colonisation

A

The presence of bacteria on the skin, a mucous membrane or a wound without any symptoms or signs of infection

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2
Q

Describe the microbiology of normal skin - permanent residents

A

Staphylococci
Corynebacteria (diptheroids)
Propionibacteria (acne)
Acinetobacter

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3
Q

What bacterium can be described as a temporary resident on normal skin?

A

S. aureus

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4
Q

What comprises the transient flora of skin?

A

Coliforms

Pseudomonas

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5
Q

What effect does damaged skin have on colonisation?

A

Makes skin prone to colonisation with more pathogenic bacteria

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6
Q

Give three examples of pathogenic bacteria that colonise damaged skin

A

S. aureus
Streptococci
Pseudomonas

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7
Q

What must happen for colonisation to become infection?

A

Breaching of the normal skin barrier

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8
Q

What are the two main pathogens of skin/soft tissue?

A

Staph. aureus

Strep. pyogenes

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9
Q

Give examples of pathogens affecting the skin/soft tissue - Bacterial

A

Haemolytic streptococci
Pseudomonas
Coliforms
Anaerobes

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10
Q

Give examples of pathogens affecting the skin/soft tissue - Viral

A

Herpes (HSV, VZV)

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11
Q

Give examples of pathogens affecting the skin/soft tissue - Fungal

A

Dermatophytosis (Tinea)

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12
Q

Describe the skin/soft tissue infections caused by S. aureus

A 
Pustular lesions
Impetigo
Cellulitis
Infected wounds
Cannula infections
Toxin-mediated (scalded skin syndrome)
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13
Q

Describe the skin/soft tissue infections caused by S. pyogenes

A 
Impetigo
Erysipelas
Cellulitis
Necrotising fasciitis
Toxin-mediated (scarlet fever)
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14
Q

Describe a carbuncle

A

A cluster of boils draining pus onto the skin

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15
Q

How are carbuncles treated?

A

Draining of pus and antibiotic therapy

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16
Q

Describe cellulitis

A

Infection of the upper layers of skin
Erythrema, swelling, painful
Often turns white on pressure
Can cause blisters/ulcers

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17
Q

Describe erysipelas

A

Infection of the upper skin and lymphatics that causes a skin rash on the face/limbs

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18
Q

How is erysipelas different from cellulitis?

A

More superficial

More raised/demarcated

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19
Q

Describe impetigo

A

Yellow, crusting lesions present on the skin
Often heals w/o scarring
Often a mix of S. aureus/S. pyogenes
Very contagious

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20
Q

Describe scalded skin syndrome

A

Due to S. aureus infection (often at distant site) releasing scalded skin syndrome toxin
Layers of skin split, can slough off easily

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21
Q

Describe Herpes Simplex - Whitlow

A

An abscess in the soft tissue near fingernails/toenails

V. painful

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22
Q

Describe Shingles (VZV)

A

Reactivation of dormant Varicella Zozter Virus

Characterised by painful skin rash w/ blisters in a localised area

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23
Q

Describe Thrush

A

Infection w/ Candida

Itching, burning, white discharge

24
Q

Describe Tinea Pedis (Dermatophyte)

A

Athletes Foot

Fungal infection causing itching, redness and scaling

25
Q

Describe Anthrax

A

Infection caused by bacillus anthracis
Skin form presents as a small blister w/ surrounding swelling that develops into an ulcer w/ black centre
Relatively painless

26
Q

Describe necrotising fasciitis

A

Infection resulting in soft tissue death
Sudden onset and rapid spread
Red/purple skin, fever, vomiting
SEVERE PAIN

27
Q

What is the surgical treatment for necrotising fasciitis?

A

Debridement, cutting away of soft tissue

28
Q

Describe a central line infection

A

Infection of inserted central line
Can give rise to soft tissue infection
Can be v. serious

29
Q

What is the antibiotic therapy for S. aureus?

A

Flucloxacillin

Co-amoxiclav

30
Q

Define MRSA

A

Methicillin Resistant Staph Aureus

31
Q

What is the antibiotic therapy for S. pyogenes?

A

Penicillins

Flucloxacillin

32
Q

What antibiotics are available for treating MRSA/resistant S. pyogenes?

A

Erythromycin
Clindamycin
Cefuroxime
Vancomycin

33
Q

By what mechanism does resistance arise in MRSA?

A

PBP2 is the main target site for penicillins in S. aureus
MRSA has a mutated PBP2a
Cross-resistant to all Beta-lactams
Usually resistant to macrolides

34
Q

What proportion of hospital-acquired skin/soft tissue infections are caused by MRSA?

A

1-2%

35
Q

Define disinfectant

A

Chemical w/ ability to destroy or inactivate potentially pathogenic micro-organisms

36
Q

Define antiseptic

A

Disinfectant that can be applied to skin or mucous membranes

37
Q

Define topical antibiotic

A

Natural/synthetic drug w/ antimicrobial activity applied directly to the skin

38
Q

What are the advantages of topical antibiotics?

A

High conc at site of infection
Can use agents too toxic for systemic use
Cheap
Combination preparations w/ steroids available

39
Q

What are the disadvantages of topical antibiotics?

A

May not penetrate to site of infection
Can get systemic absorption
Resistance

40
Q

Where are topical antibiotics most commonly used?

A 
Skin
Mucous membranes
Mouth
Eyes
Nose
Skin
Vagina
41
Q

What topical antibiotics are used around the mouth? - What are they treating?

A

Nystatin (candida)

42
Q

What topical antibiotics are used around the eyes? - What are they treating?

A

Chloramphenicol/Tetracycline (conjunctivitis)

43
Q

What topical antibiotics are used around the nose? - What are they treating?

A

Mupirocin (S. aureus/MRSA)

44
Q

What topical antibiotics are used on the skin? - What are they treating?

A

Fucidin (impetigo)
Aciclovir (cold sores)
Azoles (fungal infections)

45
Q

Describe septic arthritis

A

Acute bacterial infection of a joint, often metastatic

46
Q

What are the principle pathogens for SA?

A

S. aureus
S. pyogenes
Pneumococcus

47
Q

What are the clinical features of SA?

A 
Pain, inflammation
Joint effusion
Restricted movement
Pyrexia
Systemic sepsis
48
Q

How is SA diagnosed?

A

Mc&C on Joint aspirate

Blood culture

49
Q

What is the treatment for Septic Arthritis?

A

High dose of i.v. antibiotics >2wks

Followed by 4wks oral antibiotics

50
Q

Define osteomyelitis

A

Acute/chronic infection of bone, usually metastatic spread

51
Q

What are the principle pathogens for osteomyelitis?

A

S. aureus
Streptococci
M. tuberculosis

52
Q

What are the clinical features of osteomyelitis?

A

Pain, swelling, fever
Systemic sepssis
Deformity, collapse (vertebra), fracture

53
Q

How is osteomyelitis diagnosed?

A

X-ray, bone scan, MRI
Blood cultures
Bone biopsy

54
Q

What is the treatment for osteomyelitis - Acute

A

High dose i.v. antibiotics >6wks

+/- surgical drainage

55
Q

What is the treatment for osteomyelitis - Chronic

A

Formation of sequestrum (dead bone w/i tissue)
Months of antibiotics + surgery
Often relapses

A13AMC @ UoN (20 decks)

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