Rashes and Infection (Med 1 ILOs) Flashcards
What is this condition?
Chicken Pox
What is this condition?
Meningococcal Sepsis
What is this condition?
Erythema Multiforme
What is this condition?
Impetigo
What is this condition?
Lyme Disease
What is this condition?
Eczema Herpeticum
What is this condition?
Cellulitis
What is this condition?
Necrotising Fasciitis
What is chicken pox? (clinical features, how transmitted, complications, treatmenty
What is it?
Chickenpox is an acute disease, predominantly occurring in childhood. It is caused by varicella-zoster virus. Following acute infection, the virus persists in sensory nerve ganglia of the dorsal root. It can reactivate and cause shingles.
The _clinical features_ of chickenpox include:
- Prodromalsymptomssuchasnausea,myalgia,headache,generalmalaise,andlossofappetite.
- Small,erythematousmaculeswhichappearonthescalp,face,trunk,andproximallimbs,andprogressover12–14 hours to papules, clear vesicles (which are intensely itchy), and pustules.
- Vesicles can also occur on the palms and soles, and mucous membranes, with painful and shallow oral or genital ulcers. Vesicles appear in crops. Crusting occurs within 5 days, and crusts fall off after 1–2 weeks.
Transmission
By personal contact or droplet spread, with an incubation of 1–3 weeks. Chickenpox is infectious from 1–2 days before the rash appears until the vesicles are dry or have crusted over, usually about 5 days after the onset of the rash. Chickenpox is usually a self-limiting disease in healthy children.
Complications include:
- Bacterial skin infection, most common in young children.
- Lung involvement, more common in adults (Varicella Pneumonia).
o In pregnancy, severe maternal chickenpox and foetal varicella syndrome. - In immunocompromised people, severe disseminated chickenpox with varicella pneumonia, encephalitis, hepatitis, and haemorrhagic complications.
Treatment
For treatment of symptoms, the following can be considered:
- Paracetamol.
- Topical calamine lotion.
- Aciclovir can be considered for an immunocompetent adult/adolescent who presents within 24 hours of rash onset, particularly for people with severe chickenpox or those at risk of complications.
What is bacterial meningitis? (clinical features, factors that affect prognosis, treatment)
Bacterial meningitis is a life-threatening condition that is most common in babies and children. The overall annual incidence of acute bacterial meningitis in the UK is 1 per 100,000. The fatality rates for bacterial meningitis are 4–10% (children) and 25% (adults). Transmission is through close contact, droplets, or direct contact with secretions.
Clinical features
of acute bacterial meningitis include:
- Non-specific symptoms: fever, nausea and vomiting, lethargy, irritable or unsettled mood, refusal of food and drink, headache, muscle ache or joint pain, and respiratory symptoms such as a cough.
- More specific symptoms and signs: stiff neck, altered mental state (confusion, delirium and drowsiness, impaired consciousness), non-blanching rash, back rigidity, bulging fontanelle (in children younger than 2 years of age), photophobia, Kernig’s sign, Brudzinski’s sign, coma, paresis, focal neurological deficit, and seizures.
Complications are more common following pneumococcal meningitis and occur in about 30% of people compared with 7% with meningococcal meningitis.
Factors that affect the prognosis of bacterial meningitis include:
- Age — fatality rates are higher at extremes of age.
- The causative organism.
- Presence of comorbidities.
- Severity at presentation.
Treatment
With prompt and adequate antimicrobial treatment and supportive therapy, the outcome of acute bacterial meningitis is excellent. All suspected cases of meningitis are medical emergencies requiring hospital admission. For suspected meningococcal disease (meningitis with non-blanching rash or meningococcal septicaemia):
- Parenteral antibiotics (usually IM benzylpenicillin) should be given at the earliest opportunity (i.e. GP).
- Benzylpenicillin should be withheld only in people who have a clear history of anaphylaxis.
What is erythema multiforme?(causes, clinical features, treatment)
Erythema multiforme, a cutaneous hypersensitivity reaction, is usually caused by infection (herpes simplex virus or Mycoplasma pneumoniae) and less commonly by drug sensitivity (sulphonamides, barbiturates, antibiotics).
Clinical features
The rash can appear as macules, papules, plaques, vesicles, or bullae, but always has a targetoid or iris appearance. They usually on the skin, often with an acral distribution (extremities). Erythema multiforme can also occur on mucosal surfaces. Prodromal symptoms are uncommon. Erythema multiforme is self-limited and usually resolves in 2-4 weeks.
Treatment
Treatment of the rash itself is not usually required. Treatment of the underlying cause will allow resolution of the rash.
What is impetigo? (types, risk factors, management)
Impetigo is a common superficial bacterial infection of the skin. The two main clinical forms are non-bullous impetigo and bullous impetigo. Impetigo is usually mild, complications (e.g. glomerulonephritis and cellulitis) are rare.
Types
o Non-bullous impetigo is caused by Staphylococcus aureus,Streptococcus pyogenes or a combination of both and accounts for the majority of cases (about 70%). Presents with rapidly rupturing vesicles which release exudate forming a golden/brown crust. Usually asymptomatic, may be slightly itchy. The areas around the mouth and nose are most commonly affected.
o Bullous impetigo is caused by Staphylococcus aureus — bullae are fluid filled lesions which are usually more than 5mm in diameter. This most commonly affects infants. This causes flaccid fluid filled vesicles and blisters (often with a diameter of 1-2cm) which can persist for 2-3 days. These blisters rupture leaving a thin flat yellow/brown crust. Lesions most often occur on the flexures, face, trunk and limbs and can be particularly widespread
Risk factors
Impetigo affects all age groups but is most common in young children. The annual incidence is around 2.8% in children up to 4 years of age, and 1.6% in children 5–15 years of age.
Diagnosis of impetigo is usually clinical but swabs (of exudate from a moist lesion or de-roofed blister) for culture and sensitivities should be considered in cases which are persistent despite treatment.
Management
The management of impetigo in primary care includes:
- Advising the person on hygiene measures to aid healing and stop infection spreading.
- Advising children and adults to stay away from school or work until the lesions are dry and scabbed over or, if the lesions are still crusted or weeping, for 48 hours after antibiotic treatment has started.
- Ensuring pre-existing skin conditions (such as eczema) are optimally treated.
- Treating localized non-bullous infection with topical hydrogen peroxide for five days, or a topical antibiotic if this is not suitable. More extensive severe or bullies infections mat require oral antibiotics e.g. flucloxacillin
What is lyme disease? (complications)
Lyme disease is an infection caused by a group of bacteria called Borrelia burgdorferi, which are transmitted to humans following a bite from an infected tick. It is estimated that there are 2,000–3,000 new confirmed cases of Lyme disease each year in England and Wales.
Complications
- Severe neurological symptoms.
- Lyme arthritis.
A diagnosis of Lyme disease should be made in people with erythema migrans rash, as it only occurs in Lyme disease. This is a target-like rash appearance which usually starts around 4-5cm in diameter and gradually expands. The rash appears around the site of the initial bite (usually 7-10 days after the bite).
People with erythema migrans and no focal symptoms should be prescribed oral antibiotics. People with focal symptoms (e.g. neurological complications) should also be referred to the appropriate specialist, but treatment should not be delayed.
People diagnosed with Lyme disease should be prescribed oral antibiotics:
Adults and children aged 12 years or older — Doxycycline 100 mg twice daily (or 200 mg once daily) for 21 days.
What is herpes simplex? (clinical features, risk factors, management)
Herpes simplex may complicate eczema by creating a super-added infection. This appears as grouped vesicles and punched-out erosions within areas of particularly flared eczema. Disseminated herpes simplex virus infection (eczema herpeticum) presents with widespread lesions that may coalesce into large, denuded, bleeding areas that can extend over the entire body, occasionally complicated by secondary infection with staphylococcal or streptococcal species.
Clinical Features:
- Fever, lymphadenopathy, and malaise are common with eczema herpeticum.
- It is a medical emergency, especially in children under two years of age, and requires urgent referral for diagnosis and management. It can have serious sequelae, such as eye or meningeal involvement.
Risk factors
- Early-onset and severe atopic eczema.
- Marked elevations in total immunoglobulin E (IgE).
Management
It should be managed with immediate hospital admission.
What is cellulitis? (clinical features, management, Causative agents)
Cellulitis is an acute bacterial infection of the dermis and subcutaneous tissue.
Clinical features
The infected area, most commonly the lower limb, is characterized by pain, warmth, swelling, and erythema. Blisters and bullae may form. Fever, malaise, nausea, and rigors may accompany or precede the skin changes.
Causative agents
Cellulitis develops when microorganisms (most commonly Streptococcus pyogenes and Staphylococcus aureus) gain entry to the dermal and subcutaneous tissues via disruptions in the cutaneous barrier. Risk factors include skin trauma, ulceration, and obesity.
The diagnosis of cellulitis can usually be made on history and examination alone. Investigations may be considered in certain cases, for example, a swab for culture if there is an open wound, drainage, or an obvious portal for microbial entry.
Patients who have severe cellulitis with systemic symptoms (e.g. fever, low BP) should be managed in hospital. People who are more vulnerable to life-threatening infection, for example, the very young and frail, and people with comorbidities should also be considered for admission.
Management
Primary care management of uncomplicated cellulitis includes:
- Prescribing appropriate antibiotics (usually Flucloxacillin first-line unless Penicillin allergy).
- Advising on the use of analgesia to treat pain, adequate fluid intake, elevating the leg for comfort and to relieve oedema (where applicable), and when to seek immediate medical review (for example if antibiotics are not tolerated or systemic symptoms develop or worsen).
- Managing any underlying risk factors (such as breaks in the skin).
- Identifying and managing comorbidities (such as diabetes mellitus) that may cause the cellulitis to spread rapidly, or delay healing.
