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Week 7 - microbiology > Skin and soft tissue infection > Flashcards

Skin and soft tissue infection Flashcards

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1
Q

Name two superficial skin infections

A
  • Impetigo

* Tinea

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2
Q

Name two viral skin infections

A
  • Herpes simplex virus

* Varicella zoster virus

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3
Q

Name 2 bugs part of the normal skin flora in areas of skin with less acidic pH

A
  • Staphylococcus aureus

* Streptococcus pyogenes

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4
Q

Which bugs are less likely to be part of the normal skin flora?

A
  • Gram negative bacteria

* Anaerobic organsims

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5
Q

Which bacteria lives in the sweat and sebaceous glands?

A

Anaerobe P.acnes

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6
Q

What is impetigo?

A

Golden encrusted skin lesions with inflammation localised to the dermis. It is most common in children and may occur in small outbreaks

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7
Q

What causes impetigo?

A

Staphylococcus aureus

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8
Q

What is the treatment of impetigo?

A
  • Usually self limiting
  • topical fusidic acid
  • Systemic antibiotics if required
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9
Q

What is tinea?

A

Superficial fungal infection of the skin or nails, very common especially on the feet

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10
Q

What are the most common causes of tinea?

A
  • Microsporum
  • Epidermophyton
  • Trichophyton
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11
Q

How can tinea be diagnosed?

A

On skin scraping

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12
Q

What is the treatment of tinea?

A
  • In non severe cases involving skin alone: clorimazole cream, terbinafine cream etc.
  • Systemic therapy in severe cases and those involving hair/nails: terbinafine or itraconazole (oral antifungals)
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13
Q

What is soft tissue abscess?

A

Infection within the dermis or fat layers with development of walled off infection and pooled pus

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14
Q

What is the treatment of soft tissue abscess?

A
  • There is limited antibiotic penetration into the abscess
  • Best treatment for abscess is always surgical drainage
  • Antibiotics are usually not required if the abscess is fully drained and there is no surrounding cellulitis
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15
Q

What is cellulitis?

A

Infection involving the dermis, most commonly beginning on the lower limbs.
Can track through the lymphatic system and may involve localised lymph nodes.
It may be associated with systemic upset although bacteraemia is relatively uncommon

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16
Q

What are the most common causes of cellulitis?

A

•B-haemolytic streptococci and Staphylococcus aureus

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17
Q

What is class I cellulitis according to the Eron classification?

A

There are no signs of systemic toxicity or uncontrolled comorbidities

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18
Q

What is class II cellulitis according to the Eron classification?

A

The person is either systemically unwell or systemically well but with a comorbidity which may complicate or delay resolution of infection

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19
Q

What is class III cellulitis according to the Eron classification?

A

The person has significant systemic upset or unstable comorbidities that may interfere with a response to treatment, or limb treating infection, due to vascular compromise

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20
Q

What is class IV cellulitis according to the Eron classification?

A

The person has sepsis or a severe life threatening infection, such as necrotising fasciitis

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21
Q

How are people with class I cellulitis treated?

A

In primary care with oral antibiotics

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22
Q

How are people with class II cellulitis managed?

A

Suitable for short term (up to 48 hours) hospitalisation and discharge on outpatient parenteral antibiotic therapy where this service is available

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23
Q

Which patients with cellulitis should have urgent hospitalisation arranged?

A
  • those with class III or class IV
  • People more vulnerable to life threatening infection e.g. the very young and frail and people with comorbidities
  • People with facial cellulitis (unless mild) or suspected orbital or peri-orbital cellulitis
24
Q

What is the oral therapy treatment for cellulitis

A

•give treatment to cover S. aureus and S. pyogenes:
- 1st line: flucloxacillin
- 2nd line: doxycycline, clarithromycin, clindamycin
•7 day course

25
Q

What is the Iv therapy for the treatment of cellulitis?

A
  • 1st line: flucloxacillin 2g 6 hourly
  • 2nds line: vancomycin based on dosing calculation
  • Usually able to be switched to oral therapy after 48 to 72 hours
26
Q

What is the normal OPAT ambulatory care for cellulitis?

A
  • Once daily antibiotics

* usually IV ceftriaxone 2g once daily unless MRSA+

27
Q

What are the complications of cellulitis?

A
  • local: severe tissue destruction

* Distant: septic shock

28
Q

What is the cause of streptococcal toxic shock?

A

Toxin produced by group A streptococcus

29
Q

Where is the typical primary infection of Streptococcal toxic shock?

A

In the throat or skin/soft tissue

30
Q

What are the symptoms of toxic shock?

A
  • Localised infection
  • Fever
  • Shock
  • often have diffuse, faint rash over body/limbs
31
Q

What is the treatment of streptococcal toxic shock?

A
  • Surgery - aggressively seek out abscesses for drainage
  • Antibiotics - penicillin may be ineffective, add clindamycin to reduce toxin production
  • Consider pooled human immunoglobulin in severe cases
32
Q

What is necrotising Fasciitis?

A

Immediately life threatening soft tissue infection with deep tissue involvement

33
Q

What is the treatment of necrotising fasciitis?

A

It is a surgical emergency, surgical debridement is required

34
Q

What are the symptoms of necrotising fasciitis?

A
  • Rapidly progressing
  • Pain out of proportion to clinical signs
  • Severe systemic upset
  • Presence of visible necrotic tissue
35
Q

What may be seen in imaging of necrotising fasciitis?

A

Fascial oedema and gas in soft tissues, it is a late sign

36
Q

Describe type 1 necrotising fasciitis

A
  • Polymicrobial
  • usually complicates existing wounds, including surgical wounds
  • Microbiology usually a mix of gram positive gram negatives and anaerobes
37
Q

What is type 2 necrotising fasciitis?

A
  • group A streptococcus
  • usually occurs in previously healthy tissue, typically on the limbs
  • May follow a minor injury such as a sprain or a scratch
  • Microbiology usually mono bacterial infection with streptococcus pyogenes only
38
Q

What is the treatment of necrotising fasciitis?

A

•Broad spectrum antibiotic therapy is required
- flucloxacillin
- benzypenicillin
- gentamicin
- clindamycin
- metronidazole
•Experienced surgeon should review the patient without delay

39
Q

What is the antibiotic treatment of bite injuries?

A
  • 1st line: co-amoxiclav

* 2nd: Doxyxycline and metronidazole

40
Q

What is the surgical treatment of bit injuries?

A

Need to consider the early exploration and debridement of complications i.e. tendon sheath infection

41
Q

Describe the prophylactic treatment of bite injuries

A
  • Antibiotics for high risk injuries
  • Consideration of tentanus prophylaxis
  • Rabies prophylaxis if rabies cannot be excluded - bat scratches/bites only in the UK
42
Q

For a hospital acquired infection with known MRSA which antibiotic should be used?

A

Vancomycin

43
Q

Describe PVL staphylococcus

A

•Virulence factor carried by some staph aureus
•Association with recurrent soft tissue boils and abscesses often over months or even years
•

44
Q

How can you diagnose PVL staphylococcus?

A

Obtain cultures and ask lab to do PVL genotyping

45
Q

What is the treatment of PVL staphylococcus?

A

•Surgical treatment of abscesses
•Antibiotics if required according to sensitivities
•Decolonisation therpay should be given to patient and to household contacts
- topical chlorhexididne for skin/hair
- nasal mupirocin ointment
- simultaneous washing of sheets/towels

46
Q

What are the types of herpes simplex virus?

A
  • type 1: stomatitis (cold sore)

* type 2 genital herpes

47
Q

What is the diagnosis of herpes?

A
  • Can be clinical
  • Blood or vesicle fluid for PCR
  • Serology can sometimes be helpful
48
Q

What is the treatment of herpes?

A

Acyclovir (topical, oral, IV)

49
Q

Why is herpes recurrent?

A

the virus is latent in sensory nerve ganglia

50
Q

How is chickenpox diagnosed?

A

PCR of vesicle fluid (or serology)

51
Q

What may happen if chickenpox is acquired during pregnancy?

A

Congenital abnormalities

52
Q

What is a complication of chicken pox in adults?

A

Pnemonitis

53
Q

What is the treatment of chicken pox?

A
  • It is often self limiting in children

* Treat at risk adults within 48 hours of symptoms (pregnant, immunocompromised, pneumonitis) with acyclovir PO or IV

54
Q

What is shingles?

A

Reactivation of the dormant Varicella Zoster virus in the dorsal root ganglia

55
Q

What is the treatment of shingles?

A
  • Treat only high risk patients with acyclovir

* Pain management - NSAIDs, gabapentin

56
Q

What are the 3 zones of burns?

A
  • Zone of coagulation
  • Zone of stasis
  • Hyperaema
57
Q

What is the treatment of burn wound infections?

A
  • Debridement of dead or severely infected tissue
  • topical antiseptics/antimicrobial
  • Systemic antimicrobials

Week 7 - microbiology (12 decks)

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