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Skin and Soft Tissue Infection Flashcards

1
Q

Which bacteria make up the normal skin flora?

A

Gram positives such as diptheroids, corynebacteria, anaerobes, staphylococci and streptococci

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2
Q

On what areas of the skin is s.aureus most commonly found?

A

Nose and moist areas of the skin

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3
Q

In which areas of the body is s.pyogenes commonly found as a commensal?

A

Respiratory or vaginal tract

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4
Q

What are general predisposing factors to cellulitis?

A

Pregnancy
Caucasian
Venous insufficiency
Lymphoedema

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5
Q

What are local factors which can predispose to cellulitis?

A

Trauma, animal/insect bites, tattoos, ulcers, eczema, athlete’s foot, burns and surgery

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6
Q

What factors are important to assess when classifying skin and soft tissue infection?

A

Severity
Anatomical site
Comorbidity
Hospital acquired infection

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7
Q

What classes of skin and soft tissue infection are admitted to hospital?

A 
Class two (if no outpatient parenteral antimicrobial therapy facilities are available)
Classes three and four
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8
Q

Which classes of skin and soft tissue infection require management with IV antibiotics?

A

Classes 2, 3 and 4

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9
Q

In addition to IV antibiotics, which classes of skin and soft tissue infection require surgical management?

A

Class 4

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10
Q

Describe class one skin and soft tissue infection

A

No signs of systemic toxicity
No comorbidities
Treated as outpatient with oral antibiotics

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11
Q

Describe class two skin and soft tissue infection

A

Possible signs of systemic illness
Possible comorbidities of: obesity, venous insufficiency and peripheral vascular disease
Treated as inpatient with IV antibiotics unless outpatient parenetaral antimicrobial therapy facilities are available.

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12
Q

Describe class three skin and soft tissue infection

A

Signs of significant systemic illness
Unstable
Treated as inpatient with IV antibiotics

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13
Q

Describe class four skin and soft tissue infection

A

Signs of sepsis or necrotising fasciitis
Unstable
Treated as inpatient with IV antibiotics and surgery

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14
Q

What specific groups of patients should always be admitted to hospital for treatment of skin and soft tissue infections?

A

Immuocompromised patients

Very young children (<1 year)

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15
Q

Cellulitis at which sites should always be admitted to hospital for treatment?

A

Facial cellulitis

Suspected orbital or periorbital cellulitis (referred to ophthalmology)

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16
Q

Typical cellulitis is caused by s.pyogenes. What antibiotics are used to treat this?

A

Amplicillin or flucloxacillin

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17
Q

Typical pus forming cellulitis is caused by which organisms?

A

S.aureus

MRSA

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18
Q

Typical pus forming cellulitis is caused by s.aureus (possibly MRSA). How is this treated?

A

Flucloxacillin

Vancomycin

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19
Q

How should skin and soft tissue infection be treated when there is a penicillin allergy?

A

Doxycycline
Clindamicin
Vancomycin

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20
Q

What organism commonly causes skin/soft tissue infection as a result of a dog or cat bite?

A

Pasturella multocida

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21
Q

Pasturella multocida commonly causes skin/soft tissue infection as a result of a dog or cat bite. How is this treated?

A

Co-amoxiclav

Doxycycline + metronidazole

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22
Q

What organism commonly causes skin/soft tissue infection as a result of a freshwater exposure?

A

Aeromonas hydrophila

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23
Q

Aeromonas hydrophila commonly causes skin/soft tissue infection as a result of a freshwater exposure. How is this treated?

A

Ciprofloxacin

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24
Q

What organism commonly causes skin/soft tissue infection as a result of a salt water exposure?

A

Vibrio vulnificus

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25
Vibrio vulnificus commonly causes skin/soft tissue infection as a result of a salt water exposure. How is this treated?
Doxycycline
26
What organism commonly causes necrotising fasciitis?
Clostridium perfringes | S.pyogenes
27
Which antibiotics are commonly used to treat necrotising fasciitis?
``` Penicillin Flucloxacillin Clindamycin Gentamicin Metronidazole ```
28
What organism commonly causes skin/soft tissue infection in butchers and fish handlers?
Erysipelothrix
29
Erysipelothrix commonly causes skin/soft tissue infection in butchers and fish handlers. How is this treated?
Ciprofloxacin
30
List differential diagnoses of skin and soft tissue infection?
``` Stasis dermatitis Acute arthritis Pyoderma gangrenosum Hypersensitivity or drug reaction DVT Necrotising fasciitis ```
31
Explain how stasis dermatitis can be distinguished from skin and soft tissue infection?
Absence of pain and fever Circumferential Bilateral
32
Explain how acute arthritis can be distinguished from skin and soft tissue infection?
Joint involvement | Pain on movement
33
Explain how pyoderma gangrenosum can be distinguished from skin and soft tissue infection?
Ulcerations on legs | History of inflammatory bowel disease
34
Explain how hypersensitivity/drug reactions can be distinguished from skin and soft tissue infection?
Exposure to allergens/drug Pruritis Absence of fever and pain
35
Explain how DVT can be distinguished from skin and soft tissue infection?
Absence of skin changes or fever
36
Explain how necrotising fasciitis can be distinguished from skin and soft tissue infection?
``` Severe pain out of proportion Swelling Fever Rapid progression Systemic toxicity ```
37
What is necrotising fasciitis?
Rapidly spreading infection of the subcutaneous fascia
38
Necrotising fasciitis is toxin mediated. T/F?
True
39
Describe the clinical manifestation of necrotising fasciitis?
Remarkably rapid progression Most common on extremities e.g. legs Initially erythema and swelling without sharp mergins Exquisite pain and tenderness Lymphatic involvement is rare Colour changes from red-purple to blue-grey Skin breakdown and bullae with development of anaesthesia Probing of lesion reveals easy passage through tissues
40
How is necrotising fasciitis treated?
Surgical debridement | IV antibiotics: penicillin, flucloxacillin, clindamycin, gentamicin and metronidazole
41
Which organisms cause erysipelas?
Group A strep | Rarely group B, S and G s.aureus
42
Describe the appearance of erysipelas?
Skin/soft tissue infection Raised lesion with a clear line of demarcation Classical butterfly involvement
43
What age groups are particularly susceptible to erysipelas?
Infants | Elderly
44
What is impetigo?
Staphylococcal infection of the epidermis which forms a honey coloured crust and is often peri oral
45
What groups of people are most commonly affected by impetigo?
Children | Sports persons
46
How is impetigo managed?
Gently removing crust Flucloxacillin Management of secondary infection
47
S.aureus strains produce an exfoliative exotoxin which causes widespread bullae and exfoliation. What is this known as in the neonate?
Ritter's disease or Pemphigus neonatorum
48
S.aureus strains produce an exfoliative exotoxin which causes widespread bullae and exfoliation. What are the symptoms of this?
Fever Tenderness Scarlatiniform rash
49
S.aureus can produce the toxin PVL. What is the action of this toxin?
Destroys white blood cells
50
What conditions is PVL producing s.aureus associated with?
Necrotising pyogenic skin infections Septic arthritis Fulminant pneumonia
51
Community isolates of s.aureus are more likely to carry to PVL toxin than hospital isolates. T/F?
True
52
When should PVL producing s.aureus be suspected?
Patients with recurrent or multiple boils especially those in close contact situations
53
How is PVL producing s.aureus skin/soft tissue infection managed?
Drainage Treatment according to sensitivity patterns Nose, throat, axilla, perineum and skin lesions screened for carriage
54
What is scarlet fever caused by?
Infection with a streptococcal strain which has pyrogenic exotoxins or erythrogenic toxins
55
Scarlet fever usually occurs post pharyngitis. T/F?
True
56
Scarlet fever can complicate wound infections and post partum infections. T/F?
True
57
Describe the appearance of scarlet fever?
Diffuse red blush which appears on the second day of infection with a point of deeper rich blanche on pressure Starts on upper chest the spreads to trunk, neck and extremities Occlusion of sweat glands gives skin a sandpapery touch
58
Which sites are usually spared in scarlet fever?
Palms Soles Face
59
Describe the appearance of the tongue in scarlet fever?
White strawberry tongue then ed strawberry tongue
60
When is prophylaxis following a bite recommended?
Deep bites Hand bites Splenectomised or immunocompromised patients Crush injuries
61
How are infected bones treated?
Aggressive debridement Abscess drainagae Antibiotics
62
Cat bites are more likely to become infected than dog bites. T/F?
True
63
Which pathogen is most commonly isolated from bites?
Pasturella
64
How is pasturella infection as a result of a bite treated?
``` Penicllins Cephalosporins Tetrayclines Quinolones Macrolides ```
65
Which organism can commonly infect puncture wounds from crabs?
Erysipelothrix rhusiopathiae
66
Aeromonas infection from fresh water exposure results in skin/soft tissue infection with the following features...?
Rapidly developing infection associated with fever and sepsis
67
Edwardsiella trade infection from fresh water exposure results in skin/soft tissue infection with the following features...?
Cellulitis | Occasionally fulminant infection with bacteraemia
68
Describe the clinical syndrome which results from erysipelothrix rhusiopathiae infection of puncture wounds from crabs?
Indolent localised cutaneous eruption | Erypsipeloid
69
Describe the clinical syndrome which results from vibrio velnificus skin/soft tissue infection from salt or brackish waters?
Rapidly progressive necrotising infection, bullies cellulitis, sepsis
70
Describe the clinical syndrome which results from mycobacterium marine skin/soft tissue infection from fresh or salt water exposure?
Indolent infection Papules to ulcers Ascending lesions may resemble sporotrichosis
71
Define 'burns'
Damage to the skin caused bay heat/chemicals/radiation which results in protein denaturing
72
Describe the classification of a superficial (1st degree) burn
Dry, red, glances on pressure, painful, heals in a week
73
Describe the classification of a partial thickness (2nd degree) burn
``` Superficial or deep Blisters Pain Heals in less than 3 weeks Treated with antibiotics, surgery and grafting ```
74
Describe the classification of a full thickness (3rd degree) burn
Painless Non-blanching Treated with surgery
75
What are the possible complications of burns?
Infection Hypothermia Acid-base abnormalities Dehydration
76
How are infected burns managed?
``` Cleaning Dressings Topical antimicrobials (silver salfadiazine, bismuth compounds, chlorhexidine) Topical antibiotics Systemic antibiotics ```
77
What are the major features of cutaneous anthrax?
Extensive oedema Painless Non-tender
78
What are the minor features of cutaneous anthrax?
``` Black eschar Progresses over 2-6 days through papular, vesicular and ulcerated stages before eschar appears Affects hands, forearms, face and neck Discharge of serous fluid Local erythema and induration Local lymphadenopathy Systemic malaise - headache, chills, sort throat Afebrile ```
79
What are the risk factors for cutaneous anthrax?
Working with animals or animal hides Making/owning or playing animal hide drums Drug use (heroin) Travel Working in postal sorting offices Handling large volumes of mail Receiving threatening letters or packages containing white powder
80
How is cutaneous anthrax treated?
``` Penicllin Flucloxacillin Clindamycin Ciprofloxacin Metronidazole ```
81
What is tinea?
A superficial dermatophyte infection characterised by scaly, inflammatory or non-inflammatory patches
82
How is tinea spread?
Direct skin to skin contact
83
In what pattern does tinea expand?
Centrifugal pattern
84
What is the common name for tinea pedis?
Athlete's foot
85
What pathogens most commonly cause tinea?
Trichophyton Microsporum Epidermophyton
86
How is tinea diagnosed?
Potassium hydroxide preparation form a skin scraping
87
What causes erythema infectiosum?
Human parvovirus virus B19
88
How is human parvovirus B19 (causing erythema infectiosum) spread?
Blood or blood products
89
What are the symptoms fo erythema infectiosum?
Fever Headache Runny nose Pruritic rash on the face, torso and extremities
90
Erythema infectiosum is self limiting and reoslves without complications. T/F?
It is self limiting and IN CHILDREN resolves without complications
91
Erythema infectiosum can cause an acute cessation of red blood cell production. What problems can this cause?
Transient aplastic crisis Chronic red cell aplasia Hydrops foetals Congenital anaemia
92
What virus causes hand foot and mouth disease?
Coxsackle virus A16
93
What age groups are commonly affected by hand foot and mouth disease?
Children and infants
94
What are the symptoms of hand foot and mouth disease?
``` Fever Rash Headache Sore throat Oropharyngeal ulcers Loss of appetite ```
95
What are the symptoms of measles?
``` Fever Cough Coryza Conjunctivitis Koplik spots Maculoppaular red rash on face and hairline then spreading to the neck, trunk, arms and legs ```
96
What are the possible complications of measles?
Hospitalisation Pneumonia Encephalitis (can cause deafness and intellectual disability) Death due to respiratory and neurological complications
97
At what site can herpes simplex virus lie latent?
Sensory nerve ganglia
98
How is herpes simplex virus treated?
Topical/oral/IV acyclovir
99
At what days in infection is varicella zoster virus contagious?
days 8-21
100
Varicella zoster virus can cause congenital abnormalities if it is acquired during pregnancy. T/F?
True
101
High risk adults with varicella. zoster virus infection should be. treatment with acyclovir. Which adults are classified as high risk?
Pregnant Immunocompromised Pneumonitis
102
Reactivation of format varicella zoster virus in what site causes shingles?
Dorsal root ganglia
103
What is the typical distribution of shingles?
Dermatomal distribution
104
How is shingles treated?
Pain management with NSAIDs and gabapentin | High risk patients treated with acyclovir

Dermatology (8 decks)

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