Skin and Soft Tissue Infection Flashcards
What is cellulitis?
Inflammation of the skin and subcutaneous tissues, typically due to infection by Streptococcus pyogenes or Staphylcoccus aureus
How does cellulitis present?
Commonly occurs on shins
Erythema
Pain
Swelling
Fever
Lymphadenopathy
How is cellulitis managed?
Flucloxacillin first line for mild/moderate
Clarithomycin (Erythomycin in pregnancy) or Doxycycline if penicllin allergy
Co-amoxiclav in severe
What is impetigo?
Bacterial skin infection, most commonly in children, caused by either staph aureus or strep pyogenes, associated with existing skin infection
How does impetigo present?
Golden crusty skin lesions typically found at the mouth
Very contagious
How is impetigo managed?
Hydrogen peroxide for those not systemically unwell
Topical fusidic acid for localised disease
Oral flucloxacillin if extensive disease
How long should children with impetigo be excluded from school?
Until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment
What are the two types of necrotising fasiculitis?
Type 1
- Caused by mixed anaerobes and aerobes, often occuring post-surgery in diabetics)
Type 2
- Caused by streptococcus pyogenes
What is the most common subtype of necrotising fasciitis?
1
What are risk factors for necrotising fascitis?
DM, particuarly if treated with SGLT-2 inhibitors
Recent trauma, burns or soft tissue infection
IVDU
Immunosuppression
How does necrotising fascitis present?
Acute onset
Pain, swelling, erythema at affected site
Often presents as rapidly worsening cellulitis with pain out of keeping with physical features
Extremely tender
Skin necrosis and gangrene if late stage
Fever and tachycardia may be abscent or occur later
How is necrotising fascitis managed?
Urgent surgical referral debridement
IV antibiotics
What is toxic shock syndrome?
Severe systemic reaction to staphylococcal exotoxins, the TSST-1 superantigen toxin, associated with tampons
How does toxic shock syndrome present?
Fever
Hypotension
Diffuse erythematous rash
Desquamation of rash, especially of the palms and soles
Involvement of 3 or more organ systems
How is toxic shock syndrome managed?
Remove the offending agent, such as retained tampon
IV fluids
IV antibiotics
What is folliculitis?
Infection of hair follicle
How is folliculitis managed?
Topical antibiotics
Furuncles/boil may require oral antibiotics
Carbuncles/collection of boils require admission, surgery and IV antibiotics
What is tetanus?
Rare infection, caused by clostridium tetani, that occurs when bacteria infects a wound
Describe a tetanus prone wound
Puncture-type injuries acquired in a contaminated environment
Wounds containing foreign bodies
Compound fractures
Wounds or burns with systemic sepsis
Certain animal bites and scratches
Describe a high risk tetanus prone wound
Heavy contamination with material likely to contain tetanus spores, such as soil or manure
Wounds or burns that show extensive devitalised tissue
Wounds or burns that require surgical intervention
Describe the management of a patient who has had a full course of tetanus vaccines, with the last dose < 10 years ago
No vaccine nor tetanus immunoglobulin is required, regardless of the wound severity
Describe the management of a patient who has had a full course of tetanus vaccines, with the last dose > 10 years ago
If tetanus prone wound, reinforcing dose of vaccine
If high-risk wound, reinforcing dose of vaccine + tetanus immunoglobulin
Describe the management of a patient whose tetanus vaccination history is unknown
Inforcing dose of vaccine, regardless of the wound severity
For tetanus prone and high-risk wounds, reinforcing dose of vaccine + tetanus immunoglobulin
What prophylactic management is given in bites?
3 day course of co-amoxiclav
