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Infection > Skin and soft tissue infection > Flashcards

Skin and soft tissue infection Flashcards

1
Q

What is impitigo?

A

Superficial skin infection

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2
Q

Impetigo is caused by what?

A

Most commonly due to Staph aureus

Less commonly Strep pyogenes

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3
Q

Features of impetigo?

A
  • Multiple vesicular lesions on an erythematous base
  • Golden crust is highly suggestive of this diagnosisa
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4
Q

Who is impetigo common in?

A
  • Common in children 2-5 years of age
  • Highly infectious
  • Usually occurs on exposed parts of the body including face, extremities and scalp
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5
Q

Predisposing factors for impetigo?

A
  • Skin abrasions
  • Minor trauma
  • Burns
  • Poor hygiene
  • Insect bites
  • Chickenpox
  • Eczema
  • Atopic dermatitis
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6
Q

What is the treatment for impetigo?

A
  • Small areas can be treated with topical antibiotics alone
  • Large areas need topical treatment and oral antibiotics (ex flucloxacillin)
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7
Q

What is erysipelas?

A
  • Infection of the upper dermis
  • Painful, red area (no central clearing)
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8
Q

Common features of erysipelas?

A
  • Painful, red area (no central clearing)
  • Associated fever
  • Regional lymphadenopathy and lymphangitis
  • Typically has distinct elevated borders
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9
Q

Erysipelas is caused by what?

A
  • Most commonly due to Strep pyogenes
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10
Q

Erysipelas affects where?

A
  • 70-80% of cases involves the lower limbs
  • 5-20% affect the face
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11
Q

RF for erysipelas?

A
  • Tends to occur in areas of pre-existing lymphoedema, venous stasis, obesity, paraparesis, diabetes mellitus
  • May involve intact skin
  • High recurrence rate (30% within 3 years)
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12
Q

What is cellulitis?

A
  • Diffuse skin infection involving deep dermis and subcutaneous fat
  • Presents as a spreading erythematous area with no distinct borders
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13
Q

Causative organisms for cellulits?

A
  • Most likely organisms are Strep pyogenes and Staph aureus
  • Remember role of Gram negatives in diabetics and febrile neutropaenics
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14
Q

What are the common features of cellulitis?

A
  • Fever is common
  • Regional lymphadenopathy and lymphangitis
  • Possible source of bacteraemia
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15
Q

What are the predisposing factors for cellulitis?

A
  • Diabetes mellitus
  • Tinea pedis
  • Lymphoedema
  • Patients can have lymphangitis and/or lymphadenitis
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16
Q

What are the treatments for erysipelas and cellulitis?

A
  • A combination of anti-staphylococcal and anti-streptococcal antibiotics
  • In extensive disease, admission for intravenous antibiotics and rest
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17
Q

What are the hair associated infections?

A
  • Folliculitis
  • Furunculosis
  • Carbuncles
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18
Q

What organism causes folliculitis?

A
  • Most common organism is Staph aureus
  • Benign condition
  • Constitutional symptoms not often seen
19
Q

What are furuncles commonly known as?

A
  • boils
  • Single hair follicle-associated inflammatory nodule
  • Extending into dermis and subcuta
20
Q

Causative organism for furunculosis?

A
  • Staph aureus most common organism
  • Systemic symptoms uncommon
21
Q

What are carbuncles?

A
  • Occurs when infection extends to involve multiple furuncles
  • Often located back of neck, posterior trunk or thigh
  • Multiseptated abscesses
  • Purulent material may be expressed from multiple sites
  • Constitutional symptoms common
22
Q

Which hair associated infection requires admission?

A

Carbuncles

  • Carbuncles often require admission to hospital, surgery and intravenous antibiotics
23
Q

What is necrotising?

A
  • One of the infectious diseases emergencies
  • Any site may be affected
24
Q

RF for necrotising fasciitis?

A
  • Diabetes mellitus
  • Surgery
  • Trauma
  • Peripheral vascular disease
  • Skin popping
25
Q

What are type 1 and type 2 necrotising fasciitis?

A
  • Type I refers to a mixed aerobic and anaerobic infection (diabetic foot infection, Fournier’s gangrene)
  • Type II is monomicrobial
26
Q

What are the organisms for type 1 and 2 necrotising fasciitis?

A

Type 1

  • Streptococci
  • Staphylococci
  • Enterococci
  • Gram negative bacilli
  • Clostridium

Type 2

  • Type II is monomicrobial
  • Normally associated with Strep pyogenes
27
Q

Clinical features of necrotising fasciitis?

A
  • Rapid onset
  • Sequential development of erythema, extensive oedema and severe, unremitting pain
  • Haemorrhagic bullae, skin necrosis and crepitus may develop
  • Systemic features include fever, hypotension, tachycardia, delirium and multiorgan failure
  • Anaesthesia at site of infection is highly suggestive of this disease
28
Q

Management of necrotising fasciitis?

A
  • Surgical review is mandatory
  • Imaging may help but could delay treatment
  • Antibiotics should be broad spectrum
    • Flucloxacillin
    • Gentamicin
    • Clindamycin
  • Overall mortality ranges between 17-40%
29
Q

What is pyomyositis?

A
  • Purulent infection deep within striated muscle, often manifesting as an abscess
  • Infection is often secondary to seeding into damaged muscle
30
Q

What are presentations of pyomyositis?

Predisposing factors

A
  • Can present with fever, pain and woody induration of affected muscle
  • If untreated can lead to septic shock and death
  • Predisposing factors include
    • Diabetes mellitus
    • HIV/immunocompromised
    • Intravenous drug use
    • Rheumatological diseases
    • Malignancya
31
Q

Causative organism of pyomyositis?

A

•Commonest cause is Staph aureus

32
Q

What is septic bursitis?

A

•Infection is often from adjacent skin infection

33
Q

Dx for septic bursitis?

A
  • Peribursal cellulitis, swelling and warmth are common
  • Fever and pain on movement also seen
  • Diagnosis is based on aspiration of the fluid
  • Most common cause is Staph aureus
34
Q

What is infectious tenosynovitis?

A
  • Infection of the synovial sheats that surround tendons
  • Staph aureus and streptococci
35
Q

What is TSS?

A
  • Toxic Shock Syndrome
  • Known since 1927 but interest increased in 1980s due to association with the use of high-absorbency tampons during menses
  • Can also be due to small skin infections due to Staph aureus secreting TSST1
  • Mostly due to some strains of Staphylococcus aureus and Streptococcus pyogenes
36
Q

Dx criteria for staphylococcoal TSS?

A
  • Fever
  • Hypotension
  • Diffuse macular rash
  • Three of the following organs involved
    • Liver, blood, renal, gatrointestinal, CNS, muscular
37
Q

Treatment of TSS?

A
  • Remove offending agent (ex tampon)
  • Intravenous fluids
  • Inotropes
  • Antibiotics
  • Intravenous immunoglobulins
38
Q

Notable features of IV catheter associated infections?

A
  • Nosocomial infection
  • Normally starts as local SST inflammation progressing to cellulitis and even tissue necrosis
  • Common to have an associated bacteraemia
  • Risk factors for infections
    • Continuous infusion >24 hours
    • Cannula in situ >72 hours
    • Cannula in lower limb
    • Patients with neurological/neurosurgical problems
39
Q

What are the most common causative organisms for IV cath associated infections?

A
  • Most common organism is Staph aureus (MSSA and MRSA)
40
Q

How do we treat IV cath associated infections?

A
  • Treatment is to remove cannula
  • Express any pus from the thrombophlebitis
  • Antibiotics for 14 days
  • Echocardiogram
41
Q

Common causes of surgical site infections?

A
  • Staph aureus (incl MSSA and MRSA)
  • Coagulase negative Staphylococci
  • Enterococcus
  • Escherichia coli
  • Pseudomonas aeruginosa
  • Enterobacter
  • Streptococci
  • Fungi
  • Anaerobes
42
Q

RF for surgical site infections?

A

Patient associated:

  • Diabetes
  • Smoking
  • Obesity
  • Malnutrition
  • Concurrent steroid use
  • Colonisation with Staph aureus

Procedural factors:

  • Shaving of site the night prior to procedure
  • Improper preoperative skin preparation
  • Improper antimicrobial prophylaxis
  • Break in sterile technique
  • Inadequate theatre ventilation
  • Perioperative hypoxia
43
Q

Dx for surgical site infections?

A
  • Importance of sending pus/infected tissue for cultures especially with clean wound infections
  • Avoid superficial swabs – aim for deep structures
  • Consider an unlikely pathogen as a cause if obtained from a sterile site (ex bone infection)
  • Antibiotics to target likely organisms

Infection (12 decks)

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