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Infection > Skin and Soft Tissue Infection > Flashcards

Skin and Soft Tissue Infection Flashcards

1
Q

Impetigo refers to

A

infection of the epidermis

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2
Q

Erisypelas refers to

A

infection of the epidermis/upper dermis

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3
Q

Cellulitis refers to

A

infection of the subcutaneous layer

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4
Q

Necrotising fasciitis refers to

A

infection of the fascia

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5
Q

What factors should be considered when assessing a soft tissue infection?

A 
Site 
Organism
Host
Predisposing factors 
Environment
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6
Q

Important predisposing factors for soft tissue infections

A 
Diabetes mellitus
Immunosuppression
Renal failure 
Milord's disease 
Predisposing skin conditions
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7
Q

Most common causative organism of impetigo

A

Staph aureus

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8
Q

Presentation of impetigo

A

Multiple vesicular lesions on an erythematous base
Golden crusting characteristic
Tends to occur on exposed areas of body

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9
Q

Second most common causative organism of impetigo

A

Strep pyogenes

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10
Q

Predisposing factors of impetigo

A 
Skin abrasions 
Minor trauma 
Burns
Poor hygiene 
Insect bites
Chickenpox
Eczema 
Atopic dermatitis
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11
Q

Treatment of impetigo

A

Small areas treated with topical antibiotics alone, targeting mainly gram positive
Large areas treated with topical and oral antibiotics e.g. flucloxacillin

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12
Q

Presentation of erysipelas

A 
Raised erythematous areas 
Commonly affect face and limbs 
Painful red area
Associated fever
Regional lymphadenopathy and lymphangitis 
Distinct elevated borders
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13
Q

Most common causative organism of erysipelas

A

Strep pyogenes

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14
Q

Predisposing factors to erysipelas

A 
Pre-exsting lymphoedema 
Venous stasis 
Obesity 
Paraparesis 
Diabetes mellitus
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15
Q

Recurrence rate of erysipelas

A

30% within 3 years

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16
Q

What percentage of erysipelas affects the lower limbs and face?

A

70-80% lower limbs

5-25% face

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17
Q

Presentation of cellulitis

A

Diffuse skin infections involving deep dermis and subcutaneous fat
Spreading erythematous area with no distinct borders
Fever
Systemically unwell

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18
Q

Causative organisms of cellulitis

A

Staph aureus

Strep pyogenes

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19
Q

When should gram negative organisms be considered as a cause of cellulitis?

A

Diabetic patients
Febrile neutropenic patients

Particularly if not improving

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20
Q

Predisposing factors of cellulitis

A 
Diabetes mellitus 
Tinea pedis 
Lymphoedema 
Lymphangitis 
Lymphadenitis
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21
Q

Treatment of erysipelas and cellulitis

A

Combination of anti-staph and anti-strep antibiotics
Usually penicillin or vancomycin and doxycycline

Admission for IV antibiotics and rest if extensive disease

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22
Q

Follicular infections

A

Folliculitis
Furunculosis
Carbuncle

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23
Q

Presentation of folliculitis

A

Well circumscribed pustular infection of a single hair follicle
Small red papules
May occur in clusters, typically on head, back, buttocks and extremities
Central area of purulence

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24
Q

Most common causative organism of folliculitis

A

Staph aureus

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25
Q

What is furunculosis?

A

Inflammatory infection of a single hair follicle that extends deep into the dermis and subcutaneous tissue

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26
Q

Areas affected by furunculosis

A

Moist, hairy, friction prone areas

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27
Q

Most common causative organism of furunculosis

A

Staph aureus

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28
Q

Risk factors of furunculosis

A 
Obesity 
Diabetes mellitus 
Atopic dermatitis 
Chronic kidney disease 
Corticosteroid use
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29
Q

What is a carbuncle?

A

Infection which has extended to involve multiple furuncles

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30
Q

Presentation of carbuncle

A

Large abscess involving multiple adjacent hair follicles
Multiseptated abscesses
Purulent material expressed from multiple sites
May drain spontaneously

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31
Q

Areas commonly affected by carbuncles

A

Back of neck
Posterior trunk
Thighs

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32
Q

Major predisposing factor for carbuncles

A

Diabetes mellitus

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33
Q

Treatment of folliculitis

A

No treatment or topical antibiotics

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34
Q

Treatment of furunculosis

A

No treatment or topical antibiotics

Oral antibiotics if failure to improve with topical

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35
Q

Treatment of carbuncle

A

Admission
Surgery
IV antibiotics

36
Q

Presentation of necrotising fasciitis

A 
Rapid onset
Sequential development of erythema, extensive oedema and severe unremitting pain 
Haemorrhagic bullae 
Skin necrosis 
Crepitus 
Anaesthesia at site of infection
37
Q

Systemic features of necrotising fasciitis

A 
Fever 
Hypotension 
Tachycardia 
Delirium 
Multi-organ failure
38
Q

Causative organism of type 1 necrotising fasciitis

A 
Mixed aerobic and anaerobic infections
Strep
Staph 
Enterococci
Gram negative bacilli 
Clostridium
39
Q

Treatment of type 1 necrotising fasciitis

A 
Broad spectrum 
Benzapenicillin for strep
Flucloxacillin for staph 
Gentamicin for gram negatives 
Clindamycin to aid action of benza and fluclox
Metronidazole for anaerobes
40
Q

Causative organism of type 2 necrotising fasciitis

A

Monomicrobial

Usually associated with strep pyogenes

41
Q

Predisposing factors of type 2 necrotising fasciitis

A 
Diabetes mellitus 
Surgery 
Trauma 
Peripheral vascular disease 
Skin popping
42
Q

Presentation of type 2 necrotising fasciitis

A 
Rapid onset
Redness followed by oedema and severe pain 
Hypotension
Systemic features 
Multi-organ failure
43
Q

Treatment of type 2 necrotising fasciitis

A 
Cannula 
Fluids to raise BP 
Antibiotics - flucloxacillin, gentamicin, clindamycin
Surgery - removal of dead tissue 
Surgical review
44
Q

Overall mortality of type 2 necrotising fasciitis

A

17-40%

45
Q

What is pyomyositis?

A

Purulent infection deep within striated muscles, often manifesting as an abscess

46
Q

Sites affected by pyomyositis

A

Multiple sites involved in 15%

Thigh, calf, arms, gluteal region, chest wall, psoas muscle

47
Q

Presentation of pyomyositis

A

Pain
Fever
Woody induration of affected muscle

48
Q

Predisposing factors of pyomyositis

A 
Diabetes mellitus 
HIV
Immunocompromised 
IVDA
Rheumatological disease 
Malignancy 
Liver cirrhosis
49
Q

Commonest cause of pyomyositis

A

Staph aureus

Other organisms may be involved, including gram positive, gram negative, TB bacteria and fungi

50
Q

Treatment of pyomyositis

A

Drainage and antibiotics depending on gram stain and culture results

51
Q

Presentation of septic bursitis

A

Commonly affects olecranon and patellar bursae
Infection normally spread to bursae from adjacent skin infection
Peribursal cellulitis, swelling and warmth
Fever and pain on movement

52
Q

Common causative organism of septic bursitis

A

Staph aureus

more rarely caused by mycobacteria and brucella

53
Q

Diagnosis of septic bursitis

A

Based on aspiration of the fluid

54
Q

Predisposing factors of septic bursitis

A 
Rheumatoid arthritis 
Alcoholism
Diabetes mellitus
IVDA 
Immunosuppression 
Renal insufficiency
55
Q

What needs to be excluded in the differential diagnosis of septic bursitis?

A

Septic arteritis - this requires immediate treatment

56
Q

What is infectious tenosynovitis?

A

Infection of the synovial sheets that surround tendons

57
Q

Area most commonly affected by infectious tenosynovitis

A

Flexor synovial sheets around tendons in the hand

58
Q

Most common inciting event of infectious tenosynovitis

A

Penetrating trauma

59
Q

Most common causative organism of infectious tenosynovitis

A

Staph aureus

Strep pyogenes

60
Q

Causative organism of chronic infectious tenosynovitis

A

Mycobacteria or fungi

61
Q

Presentation of infectious tenosynovitis

A

Erythematous fusiform swelling of the finger
Finger held in semi-flexed position
Tenderness over length of tendon sheet

62
Q

Treatment of infectious tenosynovitis

A

Urgent review by hand surgeon
Surgery to relieve pressure
Empiric antibiotics

63
Q

Toxin-mediated cutaneous infections are often due to

A

super antigens

64
Q

How do pyogenic exotoxins work?

A

They don’t activate the immune system via normal contact between antigen presenting cells and T cells, they bypass this and attach directly to T cell receptors causing huge cytokine release

65
Q

Most common cause of toxin-mediated cutaneous infections

A

Staph aureus TSST1, ETA and ETB

Strep pyogenes TSST1

66
Q

What does toxic shock syndrome toxin 1 cause (TSST1) and how does it present?

A

Toxic shock syndrome

Presents as fever, rash, hypotension and organ failure

67
Q

What do exfoliative toxins A and B cause and how does it present?

A

Staphylococcal scalded skin syndrome

Widespread bullae and skin exfoliation

68
Q

What does Panton-Valentine leukocidin toxin cause?

A

Recurrent boils and haemorrhagic pneumonia in children and young adults

69
Q

Diagnostic criteria for staphylococcal toxic shock syndrome

A

Fever
Hypotension
Diffuse macular rash
Three of the following involved; liver, blood, kidneys, GI, CNS, muscular
Isolation of staph aureus from mucosal or normally sterile sites
Production of TSST1 by isolate
Development of antibody to toxin during convalescence

70
Q

What is streptococcal toxic shock syndrome almost always associated with?

A

Presence of strep in a deep-seated infection e.g. erysipelas or necrotising fasciitis

71
Q

Mortality rate of staph TSS vs strep TSS

A

Streptococcal TSS 50% mortality

Staphylococcal TSS 5% mortality

72
Q

Treatment of toxic shock syndrome

A 
Remove offending agents 
IV fluids
Inotropes
Antibiotics
IV immunoglobulins
73
Q

Risk factors of venflon-associated infections

A

Continuous IV infusion > 24 hours
Cannula in situ > 72 hours
Cannula in lower extremity
Neurological and neurosurgical problems

74
Q

Causative organisms of venflon-associated infections

A

MMSA

MRSA

75
Q

What can bacteraemia associated with venflon-associated infections cause?

A

Endocarditis

Osteomyelitis

76
Q

Treatment of venflon-associated infections

A

Prevention
Removal of cannula
Antibiotics

77
Q

Presentation of IV catheter associated infections

A

Normally starts as local STT inflammation, progressing to cellulitis and tissue necrosis
Associated bacteraemia

78
Q

Treatment of IV catheter associated infections

A

Remove cannula
Express any pus from thrombophlebitis
Antibiotics 14 days
Echo

79
Q

Prevention of infections in patients with peripheral venous cannulae

A 
Do not leave an unused cannula 
Do not insert a cannula unless it is being used 
Change cannula every 72 hours 
Monitor for thrombophlebitis 
Practice aseptic technique
80
Q

Risk factors of surgical site infections

A

Diabetes
Smoking
Obesity
Malnutrition

81
Q

Procedural risk factors for surgical site infection

A 
Shaving site of surgery the night prior to procedure 
Improper pre-operative skin preparation 
Improper antimicrobial prophylaxis 
Break in sterile technique 
Inadequate theatre ventilation 
Perioperative hypoxia
82
Q

Causative organism of surgical site infection

A

Can be caused by any organism

83
Q

Description of class 1 surgical site infection

A

Clean wound infection

  • Respiratory, alimentary, genital and urinary systems not entered
  • Infection in a surgical site that is sterile e.g. joint operations
  • Normally due to invasive organisms e.g. staph aureus
84
Q

Description of class 2 surgical site infection

A

Clean contaminated wound

- respiratory, alimentary, genital or urinary system entered but no unusual contamination

85
Q

Description of class 3 surgical site infection

A

Contaminated wound
- infections at a surgical site that is either already contaminated at the start of surgery or is contaminated during surgery e.g. due to perforation in abdominal surgery

86
Q

Description of class 4 surgical site infection

A

Infected wound

- existing clinical infection

87
Q

Diagnosis of surgical site infection

A

Send pus/infected tissue for culture
Avoid superficial swabs
Consider unlikely pathogen if obtained from sterile site
Target likely organisms

Infection (14 decks)

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