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Skin and Soft Tissue Infections Flashcards

1
Q

What is impetigo?

A

Superficial skin infection

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2
Q

Describe the character of impetigo skin lesions?

A
  • Multiple vesicular lesions on erythematous base
  • Golden crus highly suggestive of this diagnosis
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3
Q

What is impetigo most and least commonly due to?

A

Most commonly due to staph aureus, least commonly due to strep pyogenes

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4
Q

What infection is this?

A

Impetigo

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5
Q

Who does impetigo commonly infect?

A

Commonly affects children, is highly infectious

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6
Q

What are some risk factors for impetigo?

A
  • Skin abrasions
  • Minor trauma
  • Burns
  • Poor hygiene
  • Insect bites
  • Chickenpox
  • Eczema
  • Atopic dermatitis
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7
Q

What is the treatment of impetigo?

A
  • Small area
    • Topical antibiotics alone
  • Large area
    • Topical treatment and oral antibiotics (such as flucloxacillin)
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8
Q

What is erysipelas?

A

Infection of the upper dermis

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9
Q

What is the presentation of erysipelas?

A
  • Painful, red area (no central clearing)
  • Associated fever
  • Regional lymphadenopathy and lymphangitis
  • Typically has distinct elevated borders
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10
Q

What is erysipelas most commonly due to?

A

Most commonly due to strep pyogenes

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11
Q

What infection is this?

A

Erysipelas

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12
Q

Where does erysipelas mostly affect?

A

Mostly affects lower limbs, then face

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13
Q

What is cellulitis?

A

Diffuse skin infection involving deep dermis and subcutaneous fat

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14
Q

What is the presentation of cellulitis?

A
  • Spreading erythematous area with no distinct borders
  • Fever is common
  • Possible source of bacteraemia
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15
Q

What are the most likely organisms that cause cellulitis?

A

Most likely organisms are strep pyogenes and staph aureus

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16
Q

What infection is this?

A

Cellulitis

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17
Q

What are risk factors for cellulitis?

A
  • Diabetes
  • Tinea pedis
  • Lymphoedema
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18
Q

What is the treatment for erysipelas?

A
  • Combination of anti-staph and anti-strep antibiotics
  • In extensive disease, admission for IV antibiotics
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19
Q

What is the treatment of cellulitis?

A
  • Combination of anti-staph and anti-strep antibiotics
  • In extensive disease, admission for IV antibiotics
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20
Q

What are examples of hair associated infections?

A
  • Folliculitis
  • Furunculosis
  • Carbuncles
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21
Q

What is folliculitis?

A

Circumscribed, pustular infection of a hair follicle

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22
Q

Describe the character of folluculitis lesions?

A
  • Small red papules
  • Up to 5mm in diameter
  • Central area of purulence that may rupture and drain
  • Typically found on head, back, bum and extremities
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23
Q

What infection is this?

A

Folliculitis

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24
Q

What is the most common organism causing folliculitis?

A

Staph aureus

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25
What is the treatment for folliculitis?
* No treatment or topical antibiotics
26
What is furunculosis?
Single hair follicle associated inflammatory nodule extending into dermis and subcutaneous tissue
27
What is furunculosis commonly refered to as?
Boils
28
Describe the character of furunculosis lesions?
* Usually affects moist, hairy, friction prone areas of body
29
What infection is this?
Furunculosis
30
What organism most commonly causes furunculosis?
Staph aureus
31
What are risk factors for furunculosis?
* Obesity * Diabetes * Atopic dermatitis * CKD * Corticosteroid use
32
Are systemic symptoms with furunculosis common?
* Systemic symptoms uncommon
33
What is the treatment of furunculosis?
* No treatment or topical antibiotics * If not improving oral antibiotics
34
What is carbuncle?
Occurs when infection extends to involve multiple furuncles
35
Describe the character of carbuncle lesions?
* Often located back of neck, posterior trunk or thigh * Multiseptated abscesses
36
Are systemic symptoms common with carbuncle?
* Systemic symptoms common
37
What infection is this?
Carbuncle
38
What is the treatment for carbuncle?
* Surgery * IV antibiotics
39
Necrotising fasculitis is a...
Infectious disease emergency
40
What are risk factors for necrotising fasculitis?
* Diabetes * Surgery * Trauma * Peripheral vascular disease * Skin popping
41
What are the different types of necrotising fasculitis?
* Type 1 * Refers to mixed aerobic and anaerobic infection * Such as diabetic foot infection, or Fournier’s gangrene * Organisms includes * Streptococci * Staphylococci * Enterococci * Gram negative bacilli * Clostridium * Type 2 * Is monomicrobial * Normally associated with strep pyogenes
42
What organisms cause type 1 necrotising fascultiis?
* Streptococci * Staphylococci * Enterococci * Gram negative bacilli * Clostridium
43
What organism is type 2 necrotising fasculitis typically associated with?
Strep pyogenes
44
What is the presentation of necrotising fasculitis?
* Rapid onset * Sequential development of erythema, extensive oedema and severe paion * Haemorrhagic bullae, skin necrosis and crepitus may develop * Systemic features * Fever * Hypotension * Tachycardia * Delerium * Multiorgan failure
45
What investigations are done for necrotising fasculitis?
* Surgical review is mandatory * Imaging may help but could delay treatment
46
What is the treatment for necrotising fasculitis?
* Antibiotics should be broad spectrum * Flucloxacillin * Gentamicin * Clindamycin
47
What is pyomyositis?
Purulent infection deep within striated muscle
48
What is the presentation of pyomyositis?
* Often manifests as abscess * Common sites * Thigh * Calf * Arms * Gluteal region * Chest wall * Psoas muscle * Fever and pain * If untreated can lead to septic shock and death
49
What are risk factors for pyomyositis?
* Diabetes mellitus * HIV/immunocompromised * Intravenous drug use * Rheumatological diseases * Malignancy * Liver cirrhosis
50
What organism is the most common cause of pyomyositis?
Staph aureus
51
What investigations should be doen for pyomyositis?
* CT/MRI
52
What is the treatment for pyomyositis?
* Drain with antibiotic cover depending on gram stain and culture results
53
What are bursae?
Small sac-like cavities that contain fluid and are lined by synovial membrane
54
Where are bursae located?
Located subcutaneously or between bony prominences or tendons
55
What are risk factors for septic bursitis?
* Infection often from adjacent skin infection * Rheumatoid arthritis * Alcoholism * Diabetes mellitus * Intravenous drug abuse * Immunosuppression * Renal insufficiency
56
What infection is this?
Septic bursitis
57
What is the presentation of septic bursitis?
* Peribursal cellulitis, welling and warmth * Fever and pain on movement
58
Septic bursitis is diagnosed by what?
Diagnosis based on aspiration of fluid
59
What organism is the most common cause of septic bursitis?
Most common cause is staph aureus, rarer organisms include: * Gram negatives * Mycobacteria * Brucella
60
What is infectious tenosynovitis?
Infection of the synovial sheets that surround tendons
61
Where does infectious tenosynovitis most commonly affect?
Most commonly affects flexor muscle and associated tendons of the hand
62
What is the most common cause of infectious tenosynovitis?
Most common cause is staph aureus and streptococci, chronic infections occur due to mycobacteria and fungi
63
What is the presentation of infectious tenosynovitis?
* Erythematous fusiform swelling of finger * Hand held in semiflexed position * Tenderness over the length of the tendon sheet with pain on extension of finger
64
What is the treatment of infectious tenosynovitis?
* Empiric antibiotics * Hand surgeon to review
65
What are toxin mediated syndromes often due to?
Often due to super antigens such as group of pyrogenic exotoxins
66
Describe the pathophysiology of toxin mediated syndromes?
* Do not activate immune system via normal contact between APC and T cells * Superantigens bypass this and attach directly to T cell receptors activating them * Massive bursts of cytokines released * Leads to endothelial leakage, haemodynamic shock, multiorgan failure and maybe death
67
What are toxin mediated syndromes mostly due to?
* Some strains of staph aureus * TSST1 * ETA and ETB * Some strains of streptococcus pyogenes * TSST1
68
What toxins can staph aureus release that causes toxin mediated syndromes?
* TSST1 * ETA and ETB
69
What toxin can strep pyogenes release that causes toxin mediated syndromes?
TSST1
70
What is the diagnostic criteria for staph TSS?
* Fever * Hypotension * Diffuse macular rash * Three of following organs involved * Liver, blood, renal, GI, CNS, muscular * Isolation of staph aureus from mucosal or normally sterile sites * Production of TSST1 by isolate * Development of antibody to toxin
71
What does TSS stand for?
Toxin shock syndrome
72
Does strap or strep TSS have a higher mortality rate?
Strep (50% vs 5%)
73
What is the treatment for toxin shock syndrome?
* Remove offending agent (ex tampon) * Intravenous fluids * Inotropes * Antibiotics * Intravenous immunoglobulins
74
What often causes toxin shock syndrome?
Tampons
75
What is staph scaled skin syndrome?
Infection due to particular strain of staph aureus producing the exfoliative toxin A or B
76
What is the presentation of staph scaled skin syndrome?
* Widespread bullae and skin exfoliation * Usually occurs in children but rarely in adults
77
hat is the treatment of staph scaled skin syndrome?
* IV fluids and antimicrobials
78
What infection is this?
Staph scaled skin syndrome
79
What is the Penton-Valentine Leucocodin (PVL) toxin?
Is a gamma haemolysin Can be transferred from one strain of staph to another including MRSA
80
Describe the character os lesions due to PVL toxin?
* Recurrent boils
81
What is the treatment of PVL toxin?
* Antibiotics to reduce toxin production
82
What can PVL toxin cause?
Can cause SSTI (skin and soft tissue infection) and haemorrhagic pneumonia
83
What does SSTI stand for?
Skin and soft tissue infection
84
Where do IV catheter associated infections originate?
Nosocomial (originates in hospital) infection
85
Desribe the pathogenesis of IV catheter associated infections?
* Starts as local SST inflammation * Progresses to cellulitis and even tissue necrosis
86
What are risk factors for IV catheter associated infections?
* Continuous infusion \>24 hours * Cannula in situ \>72 hours * Cannula in lower limb * Patients with neurological/neurosurgical problems
87
What organism most commonly causes IV catheter associated infections?
Most common organism is staph aureus (MSSA and MRSA), which commonly forms a biofilm which then spills into bloodstream
88
How are IV catheter associated infections diagnosed?
* Made clinically or by positive blood cultures
89
What is the treatment for IV catheter associated infections?
* Remove cannula * Express any pus from the thrombophlebitis * Antibiotics for 14 days * Echocardiogram
90
What are ways to prevent IV catheter associated infections?
* Do not leave unused cannula * Do not insert cannulae unless you are using them * Change cannulae every 72 hours * Monitor for thrombophlebitis * Use aseptic technique when inserting cannulae
91
What are the different classification of surgical wounds?
* Class 1 * Clean wound (respiratory, alimentary, genital or infected urinary systems not entered) * Class 2 * Clean-contaminated wound (above tracts entered but no unusual contamination) * Class 3 * Contaminated wound (Open, fresh accidental wounds or gross spillage from the gastrointestinal tract) * Class 4 * Infected wound (existing clinical infection, infection present before the operation)
92
What are some examples of surgical site infection causative organisms?
* *Staph aureus* (incl MSSA and MRSA) * Coagulase negative Staphylococci * Enterococcus * *Escherichia coli* * *Pseudomonas aeruginosa* * Enterobacter * Streptococci * Fungi * Anaerobes
93
What are some risk factors for surgical site infections?
* Patient associated * Diabetes * Smoking * Obesity * Malnutrition * Concurrent steroid use * Colonisation with *Staph aureus* * Procedural factors * Shaving of site the night prior to procedure * Improper preoperative skin preparation * Improper antimicrobial prophylaxis * Break in sterile technique * Inadequate theatre ventilation * Perioperative hypoxia
94
How are surgical site infections diagnosed?
* Send pus/infection tissue for culture * Aim for deep structures with swabs not superficial
95
What is the treatment for surgical site infections?
* Antibiotics to target likely organisms

Medical Ethics & Law (52 decks)

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