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Infection > Skin and Soft Tissue Infection > Flashcards

Skin and Soft Tissue Infection Flashcards

1
Q

What is cellulitis?

A

Inflammation of the skin and subcutaneous tissues, typically due to infection by Streptococcus pyogenes or Staphylcoccus aureus

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2
Q

How does cellulitis present?

A

Commonly occurs on shins

Erythema

Pain

Swelling

Fever

Lymphadenopathy

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3
Q

How is cellulitis managed?

A

Flucloxacillin first line for mild/moderate

Clarithomycin (Erythomycin in pregnancy) or Doxycycline if penicllin allergy

Co-amoxiclav in severe

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4
Q

What is impetigo?

A

Bacterial skin infection, most commonly in children, caused by either staph aureus or strep pyogenes, associated with existing skin infection

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5
Q

How does impetigo present?

A

Golden crusty skin lesions typically found at the mouth

Very contagious

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6
Q

How is impetigo managed?

A

Hydrogen peroxide for those not systemically unwell

Topical fusidic acid for localised disease

Oral flucloxacillin if extensive disease

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7
Q

How long should children with impetigo be excluded from school?

A

Until the lesions are crusted and healed or 48 hours after commencing antibiotic treatment

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8
Q

What are the two types of necrotising fasiculitis?

A

Type 1

  • Caused by mixed anaerobes and aerobes, often occuring post-surgery in diabetics)

Type 2

  • Caused by streptococcus pyogenes
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9
Q

What is the most common subtype of necrotising fasciitis?

A

1

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10
Q

What are risk factors for necrotising fascitis?

A

DM, particuarly if treated with SGLT-2 inhibitors

Recent trauma, burns or soft tissue infection

IVDU

Immunosuppression

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11
Q

How does necrotising fascitis present?

A

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

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12
Q

How is necrotising fascitis managed?

A

Urgent surgical referral debridement

IV antibiotics

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13
Q

What is toxic shock syndrome?

A

Severe systemic reaction to staphylococcal exotoxins, the TSST-1 superantigen toxin, associated with tampons

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14
Q

How does toxic shock syndrome present?

A

Fever

Hypotension

Diffuse erythematous rash

Desquamation of rash, especially of the palms and soles

Involvement of 3 or more organ systems

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15
Q

How is toxic shock syndrome managed?

A

Remove the offending agent, such as retained tampon

IV fluids

IV antibiotics

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16
Q

What is folliculitis?

A

Infection of hair follicle

17
Q

How is folliculitis managed?

A

Topical antibiotics

Furuncles/boil may require oral antibiotics

Carbuncles/collection of boils require admission, surgery and IV antibiotics

18
Q

What is tetanus?

A

Rare infection, caused by clostridium tetani, that occurs when bacteria infects a wound

19
Q

Describe a tetanus prone wound

A

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

20
Q

Describe a high risk tetanus prone wound

A

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

21
Q

Describe the management of a patient who has had a full course of tetanus vaccines, with the last dose < 10 years ago

A

No vaccine nor tetanus immunoglobulin is required, regardless of the wound severity

22
Q

Describe the management of a patient who has had a full course of tetanus vaccines, with the last dose > 10 years ago

A

If tetanus prone wound, reinforcing dose of vaccine

If high-risk wound, reinforcing dose of vaccine + tetanus immunoglobulin

23
Q

Describe the management of a patient whose tetanus vaccination history is unknown

A

Inforcing dose of vaccine, regardless of the wound severity

For tetanus prone and high-risk wounds, reinforcing dose of vaccine + tetanus immunoglobulin

24
Q

What prophylactic management is given in bites?

A

3 day course of co-amoxiclav

25
Q

How many doses of tetanus vaccine generally confers life-long protection?

A

5

26
Q

What is head lice?

A

Pediculus humanus capitis parasite, which causes infestations of the scalp, most commonly in school aged children

27
Q

How is head lice managed?

A

Dimeticone 4% lotion can be applied to the hair and left to dry

  • Left on for 8 hours/overnight, then washed off
  • Repeat process 7 days later to kill any head lice that have hatched since treatment
28
Q

What is scabies?

A

IV hypersensitivity reaction caused by the mite Sarcoptes scabies that burrows into the skin and lays eggs in the stratum corneum, spread by prolonged skin contact and typically affecting children and young adults

29
Q

Give features of scabies

A

Widespread pruritus

Linear burrows on the side of fingers, interdigital webs and flexor aspects of the wrist

In infants, the face and scalp may also be affected

31
Q

How is scabies managed?

A

Permethrin 5% is first-line, leave on skin for 8-12 hours

Malathion 0.5% is second-line, leave on skin for 24 hours

Repeat treatment 7 days later

Avoid close physical contact with others until treatment is complete

All household and close physical contacts should be treated at the same time, even if asymptomatic

Launder, iron or tumble dry clothing, bedding, towels, etc on the first day of treatment to kill off mites

32
Q

How long can pruritus persist after scabies eradication?

A

up to 4-6 weeks post eradication

33
Q

Give features of crusted/norwegian scabies?

A

Patients with immunosuppression, particualrly HIV

The crusted skin will be teeming with hundreds of thousands of organisms

34
Q

How is crusted scabies managed?

A

Ivermectin and isolation

35
Q

What organism is associated with gangrene infection?

A

Clostridium perfringens

36
Q

What organism is associated with atheltes foot/tinea pedis?

A

Tinea/ringworm fungus

37
Q

How is athletes foot managed?

A

Topical terbinafine

Infection (9 decks)

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