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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
What should you always do with sepsis / ask in Hx
``` 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 ```
26
What is used to classify
Eron
27
How do you treat cellulitis
Fluclox till sensitivities back 2g 6 hourly OR 48 hours IV if unwell then 7 days oral
28
What else can be given
Clarithromycin if allergic Benpen Combination
29
What else do you do
Elevate leg Review Ax after 48 hours Consider oral switch for 7 days
30
When do you admit for IV
``` Systemically unwell Worried Grade 3 or 4 Sepsis Rapid deterioration Immunocompromised Age extreme Significant lymph oedema Facial or peri-orbital Worse after oral Abscess ```
31
If MRSA
Vancomycin | Decolonise
32
When is co-amox used
Dirty wounds as may have gram -ve | SSTI tend to be gram +ve
33
If recurrent what do you think
OM | Longer course of Ax
34
What is folliculitis
``` S.Aureus Circumscribed pustular infection of hair follicle Small red papule / pustule Head, back and bum May rupture ```
35
How do you Rx
No Rx | Topical Ax
36
What is furuncles (boils)
Single infected hair follicle S.Aureus Extends into dermis and subcutaneous fat May drain pus
37
Who is at risk of boils
``` DM Obesity Skin - dermatitis CKD Steroid Moist hairy friction area ```
38
How do you treat
No Rx | Topical or oral Ax
39
What is a carbuncle
``` Multiple furuncles Subcutaneous necrosis May discharge pus Multi-sepated abscess Systemically unwell Back, posterior trunk and thigh ```
40
Who is at risk of carbuncle
HIV Chemo DM
41
How do you treat
IV Ax | Surgery
42
What is necrotising fasciitis
Rapid infection of deep fascia and subcutaneous fat Causes necrosis of subcutaneous tissue Profound inflammatory response leads to sepsis, multirorgan failure and death
43
What causes type 1
``` Mixed anaerobe and aerobes Group A strep = major Clostridium perfringens = gas gangrene Staph Entero Gram -ve ```
44
What is type 1 common in and how does it present
DM Immunocompromised Usually slow onset
45
What causes type 2 and presentation
Monomicrobials Strep pyogenes / Group A beta-haemolytic Can affect fit and well Rapid and fatal
46
What are the symptoms of necrotising fasciitis
``` 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
What has high mortality strep or staph
Strep
48
What are the RF of necrotising fasciitis
``` DM Surgery Trauma PVD PWID Immunocompromised ```
49
How do you Dx
``` 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
How do you Rx and what Ax
``` URGENT SURGICAL REVIEW Broad spec IV Ax Immediate surgical debridement Inform public health Fluclox / gent Meropenem / clindamycin covers anerobes+ strep ```
51
What is pyomyositis
Purulent infection within striated muscle | Often 2 seeding from other infection
52
What causes pyomyositis and who is it common in
``` S.Aureus / TB / Fungi DM HIV IVDA Rheumatoid Malignancy Liver cirrhosis ```
53
How does pyomyositis manifest and where
``` Abscess Thigh / calf / arms / glutes / psoas Fever Pain Woody induration Septic shock ```
54
How do you Dx
CT / MRI
55
How do you treat
Drainage | Ax
56
What is septic bursitis
Infection of bursae
57
Where is bursitis common
Patella / olecranon | Pre-patellar
58
What are common organisms in bursitis
S.Aureus Gram -ve Mycobacteria Brucella
59
How does bursitis present
``` Swelling Warmth Fever Pain on movement If become septic won't be able to move ```
60
What are RF for bursitis
``` Repeated flexion / extension DM Immunsupresed CKD IVDA Alcohol ```
61
How do you Dx
Aspiration
62
How do you treat
Topical NSAID Aspiration, NSAID, steroid injection if not septic Drainage and Ax if septic
63
What should you always consider in bursitis
Septic arthritis
64
What is infection tenosynovitis
Infection of the synovial sheets around tendons
65
What causes
Penetrating trauma S.aureus Strep
66
What causes chronic
Fungi Gonorrhoea Mycobacteria
67
How does it present
Tenderness over tendon sheath Pain on extension Erythematous fusiform swelling
68
How do you Dx
Hand surgeon | Empiric antibiotics
69
What causes staph or strep toxic shock
``` 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
What do they secrete
TSST1
71
What are the symptoms
``` Fever >38.9 Hypo <90 Diffuse macular blanching rash Desquamation Multi-systemic involvement >3 ```
72
What are examples of multi-system involvement
``` D+V Renal failure Hepatitis Thrombocytopenia CNS ```
73
How do you treat
``` Urgent surgical debridement Remove offending IV fluid IV Ax IV Ig ```
74
What has higher mortality
Strep
75
What is staph scalded skin syndrome
Infection due to S.Aureus
76
What does it cause
Widespread bullae Skin exfoliation Common in children
77
How do you treat
IV fluid | IV Ax
78
What does Panton Velentine Leucocidin Toxin cause
Produced by staph SSTI Haemorrhagic pneumonia Recurrent biols
79
How do you Rx
Clindamycin
80
What causes cannula infection
S.aureus most common
81
How does it present
Area of thrombophlebitis
82
What can it lead too
``` Cellulitis Necrosis Bacteraemia Endocaridits OM ```
83
What puts you at risk of cannula infection
Infusion >24 hours In situ >72 hours LL cannula Neurosurgical problems
84
How do you Dx
Clinical | Blood culture
85
How do you treat
Remove cannula Express pus Ax 14 days
86
What should you always do after S.aureus bacteraemia
ECHO
87
How do you prevent
Do not leave unused cannula insitu Change after 72 hours Aseptic technique
88
What causes surgical wound infections
``` Own flora S.aureus S. epidermis E.coli Enterococcus Pseudomona Strep FUngi ```
89
What is class 1
Clean wound | Resp. /GI / genital not entered
90
What is class 2
Clean contaminated Above tracts entered No unusual contamination Own organisms
91
What is class 3
Contamined | Open, fresh wound or spillage from GI
92
What is class 4
Infected wound Existing before op Most severe
93
What is personal RF
``` DM Smoking Obesity Steroid Malnutrition S.aureus colonisation ```
94
What is healthcare RF
``` Delayed prophylactic Ax Shaving prior Improper prophylaxis Break in sterile Inadequate theatre ventilation Hypoxia Non-iodine drape ```
95
How do you Dx
Send tissue for culture
96
How do you Rx
Ax
97
How do you prevent
``` No shaving Prophylactic Ax Infection screen before Laminar air flow Alcohol on skin Wound and tissue dressing over surgical site ```
98
Who gets prophylactic Ax
``` Prosthesis Valve Clean contaminated surgery Contaminated Surgery on dirty or infected wound See local formulary ```
99
What is most common organism causing gangree
C.perfrinigens
100
Examples of procedures needing AX
Appendicetomy | THR

Infection (14 decks)

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