Skin and soft tissue Flashcards
Define cellulitis.
- Soft tissue infection of the skin and subcutaneous tissue
List the most common organisms in:
Dog bite
- Capnocytophagia
- Pasturella
- Brucella
Cat bite
- Bartonella
- Pasturella
- Capnocytophagia
- Tularemia
Cat scratch disease
Battonella henselae
Human bite
- Aerobic (staph, strep)
- Anaerobic (Eikenella, peptostreptococcus)
- Average 4 bugs / bite
Diabetic foot
Staph, strep
-Anaerobes
-Gram negative (pseudomonas)
What are your choices for treatment of suspected CA-MRSA?
- PO o Clindamycin monotherapy o Doxycycline + Keflex o Septra + Keflex o (Note: doxy and septra don’t cover strep on their own)
V o Vancomycin o Linezolid o Tigecycline o Daptomycin Clindamycin
List clinical features of periorbital cellulitis.
- Swelling of the lid
- Discolouration or orbital skin
- Redness
- Warmth
- Conjunctival injection
- +/- Discharge
- Fever
- Leukocytosis
- Normal vision, EOMS, pupillary findings, and optometric exam
List clinical features that suggest orbital cellulitis.
- Proptosis
- Decreased ocular mobility
- Ocular pain
- Tenderness with eye movement
- Altered vision
- Sharp margin of erythema
What are the treatments for periorbital and orbital cellulites?
- Periorbital cellulitis – o cefotaxime x 2 days then switch to po - Orbital cellulitis- admit – IV antibiotics and admit o Broad spectrum cefotaxime + clox +/- flagyl (?vanco)
What is impetigo?
- Superficial infection of the skin caused by GAS > staphylococcus aureus
- Most common cutaneous infection of childhood
Communicable à person to person and fomites
List treatments for impetigo:
- Non-bullous: Mupirocin ointment 2% (MRSA activity)
- Bullous, extensive non-bullous, impractical location for topicals:
o Clindamycin
o septra + keflex
Outline your approach to the management of necrotizing fasciitis:
o Pip-tazo + Vanco
o Clindamycin 900mg IV q8h
o PCN allergic: cipro+flagyl (or tigecycline) + clinda
- IVIG: neutralizing effects on strep superantigens and clostridial toxins
o 2g/kg
o Not the best evidence, but small studies show benefit
What are the two toxic shock syndromes.
- Toxic shock syndrome (toxin producing staphylococcus aureus)
- Streptococcal toxic shock syndrome (toxin producing GAS)
List 5 risk factors for TSS (Box 129-8)
tampons nasal packing post partum post op wound infections cancer common bacterial infections ethanol abuse DM influenza VZV HIV chronic pulm and cardiac dz
Provide the case definitions for Staph TSS (Box 129-6):
- Clinical Case Definition:
a. Fever: Temp > 38.9C (102F)
b. Skin Rash: diffuse macular erythema (may be mistaken for fever rash)
c. Skin Desquamation 1-2 weeks after onset
d. Hypotension: SBP 5 WBC/hpf)
v. Hepatic: bili,AST,ALT doubled
vi. Hem: platelets
Provide the case definitions for Strep TSS (Box 129-7):
- Clinical Case definition:
a. Hypotension: SBP 2 of):
i. Renal: creat >117 or >2x normal or 2x baseline
ii. Hem: plts
Provide a differential for TSS: fever and rash with hypotension
- SSS (although early desquamation)
- Scarlet fever
- Drug reaction: SJS, TEN
- RMSF
- Clostridial gas gangrene
- Kawasaki
- Leptospirosis
- Meningoccemia
- Gram –ve sepsis
- Atypical measles
Viral illness
Outline the management of TSS:
esuscitate, ETT, EGDT, supportive care for AKI, ARDS,
- Source control:
o Remove tampons, nasal packs, FB
o Surgical wound debridement if needed
- BS Antibiotics: piptazo, vanco
- Reduce toxin production:
o Clindamycin - protein synthesis inhibition and toxin inhibition
o Give clindamycin FIRST as it decreases toxin formation and thus when you give a bactericidal agent less toxin is released
o 900mg IV q8h (40mg/kg peds)
- IVIG: 2g/kg over several hours, then 500mg/kg/day for up to 5 days
