Resp and Skin infections Flashcards
what is the clinical presentation of croup?
seal-like barking cough
Stridor
Voice Hoarness
respiratory distress
symptoms result from upper airway obstruction due to inflammation of the airways
typically caused by parainfluenza viruses
How is croup treated?
dexamethasone
nebulised adrenaline and o2 in severe
what virus causes bronchiolitis?
Respiratory synctyial virus
what are the S&S and InV for bronchiolitis?
cough, tachyapnoea, wheezing, grunting and nasal flaring. fever and fatigue
pulse oximetry, ELISA rapid antigen detection, CXR and RT-PCR
what is the treatment of bronchiolitis?
ribavirin
prednisolone
o2 support
what are the types of influenza and how are they subdivided?
Type A and B
Subcategorised according to H and N antigens
what are the symptoms of the flu?
fever runny/blocked nose sore throat cough headache joint pain fatigue vomiting
what are the InV for the flu? what are complications?
viral culture
immunofluorescent antibody staining
RT-PCR
Acute ottitis media sinusitis pneumonia ARDS myocarditis reye syndrome
what drugs are available to treat flu?
neuraminidase inhibitors
- oseltamivir
- zanamivir
M2 inhibitors
- amantadine
- rimantadine
IMP dehydrogenase inhibitors
- ribavirin
RNA polymerase inhibitors
- favipiravir
- baloxivir
analgesia and antipyretics
what pathogens are commonly implicated in cellulitis?
Group A streptococci e.g strep pyogenes
Staph aureus
what are the S&S of cellulitis?
acute onset of red, painful, hot, swollen skin
Well demarcated, bright red raised skin
fever and malaise
lymphangitis - red line that spreads proximally along lymphatics to the lymph nodes
what InV are done for cellulitis?
FBC, ESR and CRP
- leucocytosis and elevated CRP and ESR
Blood culture and skin swab
what is the treatment options for cellulitis?
oral/IV flucloxacillin
- clarithromycin if penicillin allergic
Supportive care
- fluids
- wound management
- mark boundaries and assess spread
- analgesia
what is necrotising fasciitis?
a life threatening subcutaneous soft tissue infection that may extend to the deep fascia but not into the underlying muscle
what is type 1 nec fasc?
polymicrobial infection of subcutaneous tissue with an anaerobe and faculative anaerobic
- bacteriodes
- E. Coli
- Klebsiella
what is type 2 nec fasc?
monomicrobial infection of subcutaneous tissue most commonly by streptococcus pyogenes
what are the S&S of nec fasc?
disproportionate pain at site or possible numbness
fever, N&V
tachycardia, tachyapnoea, hypotension
delirium
Vesicles or bullae, oedema and darkening of skin
Crepitus of skin overlying cellulitis
what InV are done in Nec Fasc?
FBC, CRP and ESR
- leucocytosis and elevated CRP/ESR
U&E’s
- hyponatraemia
- urea and creatinine markedly increased
Lactate
- elevated
blood and tissue cultures
Radiography - CT/MRI or US
- oedema extending along fascial plane
- soft tissue gas
How is Nec Fasc managed?
surgical debridement and haemodynamic support
Flucloxacillin Benzylpenicilin Gentamicin Metronidazole Clindamycin
Funny Boys Get More Cunt
what are the S&S of MRSA infection
erythematous skin lesions or pustules in single or multiple forms
- commonly mistaken for insect bites or follicutlitis
- central ulceration may be present
irritation or pain at indwelling catheter site
fever chills, malaise
abscess
nodular, abscessed or ulcerated lesion with sharp pain
which gene infers methicillin resistance in MRSA?
mecA
what InV are done for MRSA?
FBC - leucocytosis
Blood and tissue culture - MRSA
indwelling catheter tip culture
Echo - endocarditis
CXR - pneumonia
PCR - detect mecA gene
what are risk factors for MRSA?
older age
recent hospitalisation
Previous ABx
Crowded living conditions
what is the treatment of MRSA?
abscess incison and drainage
debridement
IV Vancomycin
How can herpes simplex virus infection manifest?
oral, genital or ocular ulcers
what are the InV for HSV?
viral culture
HSV PCR
Glycoprotein G-based type-specific serology
- positive antibody to HSV 1 or 2
what is the treatment of HSV?
Aciclovir
analgesia
IV foscarnet if aciclovir fails
what are the complications of HSV?
recurrence as it establishes latency in neuronal ganglia
- oesophagitis
- erythema multiforme
- meningitis
- encephalitis
- Bells palsy
