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Infection > Skin and soft tissue infection > Flashcards

Skin and soft tissue infection Flashcards

1
Q

What is impetigo

A

Highly infectious infection of superficial dermis

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2
Q

What causes impetigo

A

S.Aureus = most common

Strep pyogenes

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3
Q

What are the symptoms of impetigo

A

Multiple vesicular lesions
Erythematous base
Goldren crust
Face, extremities and scalp

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4
Q

Who is at risk of impetigo

A 
Young children
Trauma
Burns 
Poor hygiene
Bites
Chicken pox 
Atopic dermatitis
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5
Q

How do you treat impetigo

A

Hygiene advice
Fusidic acid
Topical antibiotics
Oral fluclox if large

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6
Q

What is erysipelas

A

Infection of upper dermis

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7
Q

What causes erysipelas

A

Strep pyogenes (A)

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8
Q

What are the symptoms of erysipelas

A 
Painful red area
Elevated distinct border
No central clearing 
Fever 
Lymphadenopathy 
70% lower limb and face
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9
Q

What are the Rf for erysipelas

A 
Lymph oedema
Venous stasis
Obesity 
DM
Trauma
Immunocompromised
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10
Q

How do you diagnose erysipelas

A

High ASO titre

High WCC

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11
Q

How do you treat erysipelas

A

Same as cellulitis
Anti-staph (fluclox)
Anti-strep (benzylpen)
IV and rest if extensive

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12
Q

What are differential of erysipelas

A

GCA - if headache
Shingles - pain in face
Watch vision

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13
Q

What is cellulitis

A

Infection of deep dermis AND subcutaneous fat

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14
Q

What causes cellulitis

A

S.aureus = most common
Strep A
MRSA can cause

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15
Q

How does cellulitis present

A 
Spreading erythema
No border and less defined
Painful
Swollen, oedematous leg 
Warm 
Fever
Lymphadenopathy 
Lymphaginitis 
Systemic upset
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16
Q

What are localised lesions likely to form

A

Abscess

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17
Q

What do you do for peri-orbital cellulitis and how do you differentiate from conjunctivitis

A

Risk of vision los so IV
Swab
Conjunctivitis - usually bilateral

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18
Q

What are the stages of cellulitis

A 
Eron 
1 = no systemic or co-morbid
2 = systemically unwell or well + co-morbid 
3 = significant upset
4 = sepsis syndome / necrosis
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19
Q

What can cellulitis cause

A

Sepsis

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20
Q

What are co-morbid conditions that increase likelihood of cellulitis progressing

A 
Obesity
Venous insufficiency
PAD
DM
Break in skin - trauma / eczema / ulcer
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21
Q

What are the RF of cellulitis

A 
DM
Lymph oedema
Venous stasis 
Obesity
Neutropenia 
Skin conditions 
CKD
Chronic liver 
Immunosuppresed
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22
Q

What are neutropenic patients more prone too

A

Gram -ve

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23
Q

What makes you immunosuppressed

A 
DM
Age extreme
Long term steroid
Post transplant
Chronic renal
Anti-rheumatic - TNFa / DMARD / biologic
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24
Q

How do you Dx cellulitis

A 
Bloods - FBC, U+E, CRP
Blood culture for anyone with infection 
Swab
VBG - Lactate if sepsis 
Aspirate abscess
X-ray to look for foreign body
Do D-dimer to rule out DVT
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25
Q

What should you always do with sepsis / ask in Hx

A 
Draw round cellulitis to mark
Systemic Sx - nausea / appetite / fatigue / rigors
Spread
How fast
Immunosuppression
Ask about water exposure
Human or animal bite 
Trauma - when, where, Rx, any break, any foreign body
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26
Q

What is used to classify

A

Eron

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27
Q

How do you treat cellulitis

A

Fluclox till sensitivities back
2g 6 hourly OR
48 hours IV if unwell then 7 days oral

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28
Q

What else can be given

A

Clarithromycin if allergic
Benpen
Combination

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29
Q

What else do you do

A

Elevate leg
Review Ax after 48 hours
Consider oral switch for 7 days

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30
Q

When do you admit for IV

A 
Systemically unwell
Worried
Grade 3 or 4
Sepsis
Rapid deterioration
Immunocompromised
Age extreme
Significant lymph oedema
Facial or peri-orbital 
Worse after oral
Abscess
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31
Q

If MRSA

A

Vancomycin

Decolonise

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32
Q

When is co-amox used

A

Dirty wounds as may have gram -ve

SSTI tend to be gram +ve

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33
Q

If recurrent what do you think

A

OM

Longer course of Ax

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34
Q

What is folliculitis

A 
S.Aureus 
Circumscribed pustular infection of hair follicle 
Small red papule / pustule
Head, back and bum 
May rupture
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35
Q

How do you Rx

A

No Rx

Topical Ax

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36
Q

What is furuncles (boils)

A

Single infected hair follicle
S.Aureus
Extends into dermis and subcutaneous fat
May drain pus

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37
Q

Who is at risk of boils

A 
DM
Obesity
Skin - dermatitis
CKD
Steroid
Moist hairy friction area
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38
Q

How do you treat

A

No Rx

Topical or oral Ax

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39
Q

What is a carbuncle

A 
Multiple furuncles
Subcutaneous necrosis
May discharge pus
Multi-sepated abscess 
Systemically unwell 
Back, posterior trunk and thigh
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40
Q

Who is at risk of carbuncle

A

HIV
Chemo
DM

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41
Q

How do you treat

A

IV Ax

Surgery

42
Q

What is necrotising fasciitis

A

Rapid infection of deep fascia and subcutaneous fat
Causes necrosis of subcutaneous tissue

Profound inflammatory response leads to sepsis, multirorgan failure and death

43
Q

What causes type 1

A 
Mixed anaerobe and aerobes
Group A strep = major
Clostridium perfringens = gas gangrene 
Staph
Entero
Gram -ve
44
Q

What is type 1 common in and how does it present

A

DM
Immunocompromised

Usually slow onset

45
Q

What causes type 2 and presentation

A

Monomicrobials
Strep pyogenes / Group A beta-haemolytic
Can affect fit and well
Rapid and fatal

46
Q

What are the symptoms of necrotising fasciitis

A 
Rapid onset
Erythema
Oedema
Severe pain over skin and muscle out of context
- Can query DVT
Signs of sepsis - fever/ hypo / tachy
Haemorrhagic bullae - if Q says this 
Necrosis
Crepitus due to subcut emphysema
- Only in type 1 due to closdtirum
Delerium
Anaesthesia 
Organ failure
47
Q

What has high mortality strep or staph

48
Q

What are the RF of necrotising fasciitis

A 
DM
Surgery
Trauma
PVD
PWID 
Immunocompromised
49
Q

How do you Dx

A 
Bloods - FBC, U+E, CRP, lactate, glucose
G+S if op 
ABG as well as VBG
X-ray to rule out underlying bone
CT can show deep collection

URGENT SURGICAL REVIEW
Broad spec IV Ax
IMMEDIATE Surgical debridement
Inform public health

50
Q

How do you Rx and what Ax

A 
URGENT SURGICAL REVIEW
Broad spec IV Ax
Immediate surgical debridement
Inform public health 
Fluclox / gent
Meropenem / clindamycin covers anerobes+ strep
51
Q

What is pyomyositis

A

Purulent infection within striated muscle

Often 2 seeding from other infection

52
Q

What causes pyomyositis and who is it common in

A 
S.Aureus / TB / Fungi 
DM
HIV
IVDA
Rheumatoid
Malignancy 
Liver cirrhosis
53
Q

How does pyomyositis manifest and where

A 
Abscess
Thigh / calf / arms / glutes / psoas
Fever 
Pain
Woody induration
Septic shock
54
Q

How do you Dx

55
Q

How do you treat

A

Drainage

Ax

56
Q

What is septic bursitis

A

Infection of bursae

57
Q

Where is bursitis common

A

Patella / olecranon

Pre-patellar

58
Q

What are common organisms in bursitis

A

S.Aureus
Gram -ve
Mycobacteria
Brucella

59
Q

How does bursitis present

A 
Swelling
Warmth
Fever
Pain on movement
If become septic won't be able to move
60
Q

What are RF for bursitis

A 
Repeated flexion / extension
DM
Immunsupresed
CKD 
IVDA
Alcohol
61
Q

How do you Dx

A

Aspiration

62
Q

How do you treat

A

Topical NSAID
Aspiration, NSAID, steroid injection if not septic
Drainage and Ax if septic

63
Q

What should you always consider in bursitis

A

Septic arthritis

64
Q

What is infection tenosynovitis

A

Infection of the synovial sheets around tendons

65
Q

What causes

A

Penetrating trauma
S.aureus
Strep

66
Q

What causes chronic

A

Fungi
Gonorrhoea
Mycobacteria

67
Q

How does it present

A

Tenderness over tendon sheath
Pain on extension
Erythematous fusiform swelling

68
Q

How do you Dx

A

Hand surgeon

Empiric antibiotics

69
Q

What causes staph or strep toxic shock

A 
Super-antigen or pyogenic exotoxins
Bypass normal immune
Attach directly to T cell receptors 
Massive cytokine release
Endothelial leakage
Haemodynamic shock
Multi-organ failure
70
Q

What do they secrete

71
Q

What are the symptoms

A 
Fever >38.9
Hypo <90
Diffuse macular blanching rash 
Desquamation 
Multi-systemic involvement >3
72
Q

What are examples of multi-system involvement

A 
D+V
Renal failure
Hepatitis
Thrombocytopenia 
CNS
73
Q

How do you treat

A 
Urgent surgical debridement
Remove offending
IV fluid
IV Ax
IV Ig
74
Q

What has higher mortality

75
Q

What is staph scalded skin syndrome

A

Infection due to S.Aureus

76
Q

What does it cause

A

Widespread bullae
Skin exfoliation
Common in children

77
Q

How do you treat

A

IV fluid

IV Ax

78
Q

What does Panton Velentine Leucocidin Toxin cause

A

Produced by staph
SSTI
Haemorrhagic pneumonia
Recurrent biols

79
Q

How do you Rx

A

Clindamycin

80
Q

What causes cannula infection

A

S.aureus most common

81
Q

How does it present

A

Area of thrombophlebitis

82
Q

What can it lead too

A 
Cellulitis
Necrosis
Bacteraemia
Endocaridits
OM
83
Q

What puts you at risk of cannula infection

A

Infusion >24 hours
In situ >72 hours
LL cannula
Neurosurgical problems

84
Q

How do you Dx

A

Clinical

Blood culture

85
Q

How do you treat

A

Remove cannula
Express pus
Ax 14 days

86
Q

What should you always do after S.aureus bacteraemia

87
Q

How do you prevent

A

Do not leave unused cannula insitu
Change after 72 hours
Aseptic technique

88
Q

What causes surgical wound infections

A 
Own flora
S.aureus 
S. epidermis
E.coli
Enterococcus
Pseudomona
Strep
FUngi
89
Q

What is class 1

A

Clean wound

Resp. /GI / genital not entered

90
Q

What is class 2

A

Clean contaminated
Above tracts entered
No unusual contamination
Own organisms

91
Q

What is class 3

A

Contamined

Open, fresh wound or spillage from GI

92
Q

What is class 4

A

Infected wound
Existing before op
Most severe

93
Q

What is personal RF

A 
DM
Smoking
Obesity
Steroid
Malnutrition
S.aureus colonisation
94
Q

What is healthcare RF

A 
Delayed prophylactic Ax
Shaving prior
Improper prophylaxis
Break in sterile
Inadequate theatre ventilation
Hypoxia
Non-iodine drape
95
Q

How do you Dx

A

Send tissue for culture

96
Q

How do you Rx

97
Q

How do you prevent

A 
No shaving
Prophylactic Ax
Infection screen before
Laminar air flow
Alcohol on skin
Wound and tissue dressing over surgical site
98
Q

Who gets prophylactic Ax

A 
Prosthesis
Valve
Clean contaminated surgery 
Contaminated
Surgery on dirty or infected wound 
See local formulary
99
Q

What is most common organism causing gangree

A

C.perfrinigens

100
Q

Examples of procedures needing AX

A

Appendicetomy

THR

Infection (14 decks)

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