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Year 2- Infectious Disease > Skin and Soft Tissue Infections > Flashcards

Skin and Soft Tissue Infections Flashcards

1
Q

RECAP- what are the layers of the skin?

A

Epidermis
Dermis
Subcutaneous fat
Fascia
Muscle

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2
Q

Impetigo?

A

Superficial skin infection

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3
Q

What sign is highly indicative of impetigo?

A

Golden crust

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4
Q

What is impetigo most commonly due to?

A

Staph. aureus infection

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5
Q

In which age group in impetigo more common?

A

Children aged 2-5

->it is highly infective so can be passed on at nursery

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6
Q

Which parts of the body does impetigo usually effect?

A

Exposed parts of the body e.g. face, extremities and scalp

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7
Q

What are some predisposing factors for impetigo?

A

Skin abrasions
Minor trauma
Burns
Poor hygiene
Insect bites
Chickenpox
Eczema
Atopic dermatitis

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8
Q

What is the treatment of impetigo?

A

Small area- topical antibiotics
Large area- topical treatment and oral antibiotics e.g. flucloxacillin

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9
Q

Erysipelas?

A

Infection of the upper dermis

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10
Q

How does erysipelas present?

A

Painful red area with no central clearing
Associated fever
Typically elevated borders
Regional lymphadenopathy (swelling of lymph nodes)

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11
Q

What organism is usually the cause of erysipelas?

A

Strep. pyogenes

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12
Q

Where does erysipelas usually effect?

A

Lower limbs
Areas of pre-existing lymphoedema, venous stasis, obesity, paraparesis and diabetes

->high reoccurrence rate, with 30% getting reoccurrence within 3yrs

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13
Q

Where does cellulitis infect?

A

Deep dermis and subcutaneous fat

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14
Q

How does cellulitis present?

A

Spreading erythematous area with no distinct borders

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15
Q

Which organisms are most likely to cause cellulitia?

A

Strep. pyogenes
Staph. aureus

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16
Q

What is the most common skin infection?

A

Cellulitis

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17
Q

What symptom is common in cellulitis?

A

Fever

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18
Q

Which blood related issue can cellulitis be the source of?

A

Bacteraemia

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19
Q

What are some predisposing factors for cellulitis?

A

Diabetes
Tinea pedis- athlete’s foot
Lymphoedema

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20
Q

What are some features of cellulitis?

A

Fever
Lymphangitis and/or lymphadenitis

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21
Q

What is the treatment for erysipelas and cellulitis?

A

Combination of anti-staphylococcal and anti-streptococcal antibiotics

->extensive cases may require admission for IV antibiotics and rest

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22
Q

Name three hair associated infections.

A

Folliculitis
Furunculosis
Carbuncles

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23
Q

Folliculitis?

A

Circumcised pustular infection of a single hair follicle

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24
Q

Furuncle?

A

Red, tender nodule surrounding a hair follicle with one draining point

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25
Q

Carbuncle?

A

Deep follicular abscess with several drainage points

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26
Q

How does folliculitis present?

A

Small red papules
Typically found on head, back, buttocks and extremities

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27
Q

What is the most common causative organism of folliculitis?

A

Staph.aureus

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28
Q

What are furuncles commonly referred to as?

A

Boils

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29
Q

Which layers of the skin is affected by furunculosis?

A

Dermis and subcutaneous fat

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30
Q

Which areas of the body does furunculosis usually affect?

A

Moist, hairy, friction prone areas e.g. face, axilla, neck and buttocks

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31
Q

What is the most common causative organism of furunculosis?

A

Staph.aureus

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32
Q

Are systemic symptoms common is furunculosis?

A

No

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33
Q

What are some of the risk factors for furunculosis?

A

Obesity
Diabetes
Atopic dermatitis
CKD
Corticosteroid use

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34
Q

To make sure you were paying attention, use of which drug can increase risks of furunculosis?

A

Corticosteroids

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35
Q

When does a carbuncle occur?

A

When infection spreads to involve multiple furuncles

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36
Q

Where would a carbuncle often be located?

A

Back of neck
Posterior trunk or thigh

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37
Q

What type of abscess is a carbuncle?

A

Multiseptated abscess

->pus may be expressed from multiple sites

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38
Q

What is the management of carbuncle?

A

Usually requires hospital admission as patients often unwell
Surgery and IV antibiotics required

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39
Q

What is the treatment of folliculitis?

A

No treatment required

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40
Q

What is the treatment of furunculosis?

A

If not improving, oral antibiotics

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41
Q

Which condition is one of the infectious disease emergencies relating to skin?

A

Necrotising fasciitis

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42
Q

What are some of the predisposing conditions which increase risks of necrotising fascitis?

A

Diabetes
Surgery
Trauma
Peripheral vascular disease
Skin popping- something to do w drugs, not picking dw gal

43
Q

There are two types of necrotising fasciitis. What does type 1 refer to?

A

Mixed aerobic and anaerobic infection

44
Q

List some of the typical organisms associated with necrotising fasciitis.

A

Streptococci
Staphylococci
Enterococci
Gram negative bacilli
Clostridium

45
Q

Type 2 necrotising fasciitis is usually monomicrobial.
Which organism is it usually associated with?

A

Strep.pyogenes

46
Q

What is the presentation of necrotising fasciitis?

A

Rapid onset
Development of erythema, extensive oedema and severe, unremitting pain

47
Q

What are some signs of necrotising fasciitis which may develop?

A

Haemorrhagic bullae
Skin necrosis
Crepitus

48
Q

What are some of the systemic features of necrotising fasciitis?

A

Fever
Hypotension
Tachycardia
Delirium
Multiorgan failure

49
Q

Pyomyositis?

A

Purulent infection deep within striated muscle

Often secondary to seeding in damaged muscle

50
Q

How does pyomyositis often manifest?

A

Often manifests as an abscess

51
Q

What are some of the common sites of pyomyositis?

A

Thigh
Calf
Arms
Gluteal region
Chest wall
Psoas muscle

52
Q

How can pyomyositis present?

A

Fever, pain, woody induration of affected muscle

53
Q

If pyomyositis is left untreated, what can it lead to?

A

Septic shock and death

54
Q

What are some of the predisposing factors for pyomyositis?

A

Diabetes
HIV/immunocompromised
IVDU
Rheumatological disease
Malignancy
Liver cirrhosis

55
Q

What is the commonest cause of pyomyositis?

A

Staph aureus

56
Q

Which investigations are used in pyomyositis?

A

CT/MRI

57
Q

What is the treatment of pyomyositis?

A

Drainage with antibiotic cover depending on gram stain and culture results

58
Q

Bursae?

A

Small sac-like cavities that contain fluid and are lined by synovial membrane
They facilitate movement and prevent friction

59
Q

Where are bursae found?

A

Between bony prominences or tendons

60
Q

What often causes septic bursitis?

A

Trauma

61
Q

Where are the most common sites of septic bursitis?

A

Patellar
Olecranon

62
Q

How does infection cause septic bursitis?

A

Infection usually spreads from adjacent skin infection

63
Q

What are some predisposing factors to septic bursae?

A

Rheumatoid arthritis
Diabetes
Alcoholism
IVDU
Immunosuppression
Renal insufficiency

64
Q

What are some of the features of septic bursitis?

A

Peritbursal cellulitis. swelling and warmth
Fever
Pain on movement

65
Q

What is septic bursitis most commonly caused by in terms of organism?

A

Staph aureus

66
Q

How is a diagnosis of septic bursitis made?

A

Aspiration of fluid

67
Q

Infectious tenosynovitis?

A

Infection of the synovial sheaths that surround tendons

68
Q

Which tendons are most often involved in infectious tensosynovitis?

A

Flexor muscle associated tendons
Tendon heaths of hand

69
Q

Which organisms are the most common cause of infective tenosynovitis?>

A

Staph aureus
Streptococci

70
Q

How does infectious tenosynovitis present?

A

Erythematous fusiform swelling of the finger

71
Q

What are the features of infectious tenosynovitis?

A

Finger is held in a semiflexed position
Tenderness over the length of tendon sheath
Pain with extension of finger

72
Q

What is the management of infectious tenosynovitis?

A

Empiric antibiotics
Need a hand surgeon to review ASAP

73
Q

What are toxin-mediated syndromes usually because of?

A

Superantigens

->Superantigens are a class of immunostimulatory molecules produced by bacteria and viruses.

74
Q

What happens in toxic-mediated syndromes?

A

Massive burst in cytokine release
Leads to endothelial leakage, haemodynamic shock and multi-organ failure and even death

75
Q

Give some examples of toxin-mediated syndromes caused by staph.aureus.

A

TSST1
ETA and ETB

76
Q

Give some examples of toxin-mediated syndromes caused by strep pyogenes.

A

TSST1

77
Q

What can cause toxic shock syndrome?

A

Leaving in a tampon for too long
Can be due to small skin infections due to staph aureus secreting TSST1

78
Q

What is the diagnostic criteria for staphylococcal TTS?

A

Fever
Hypotension
Diffuse macular rash
Three of the following organs involved : liver, blood, renal. GI, CNS, muscular

79
Q

What is streptococcal TSS usually always associated with?

A

Presence of streptococci in deep seated infections e.g. erysipelas or necrotising fasciitis

80
Q

Which has a higher mortality rate; staphylococcal TTS or streptococcal TTS?

A

Streptococcal

50% mortality rate compared to 5%

81
Q

What is the treatment of streptococcal TTS?

A

Urgent surgical debridement of infected tissue

82
Q

What is the general treatment of TTS?

A

Removal of offending agent e.g. tampon
IV fluids
Inotropes
Antibiotics
IV immunoglobulins

83
Q

Staphylococcal scalded skin syndrome?

A

Infection due to a particular strain of staph aureus producing the exfoliative toxin A or B

84
Q

Who is usually affected by staphylococcal scalded skin syndrome?

A

Children

85
Q

What is staphylococcal scalded skin syndrome characterised by?

A

Widespread bullae and skin exfoliation

86
Q

What is the treatment of staphylococcal scalded skin syndrome?

A

IV fluids
Antimicrobials

87
Q

What can Panton-Valentine leucocidin toxin cause?

A

SSTI- skin and soft tissue injuries
Haemorrhagic pneumonia

88
Q

Who is usually affected by Panton-Valentine leucocidin toxin?

A

Children and young adults

89
Q

How do patients with Panton-Valentine leucocidin toxin present?

A

Recurrent boils which are difficult to treat

90
Q

A teenager presents consistently with boils which are not responding to usual treatment.

What is the likely diagnosis?

A

Panton-Valentine leucocidin toxin

91
Q

What is the treatment of Panton-Valentine leucocidin toxin?

A

Antibiotics which reduce the production of toxins

92
Q

IV catheter associated infections usually start as a local skin or soft tissue inflammation but what can they progress to?

A

Cellulitis or even tissue necrosis

93
Q

What are the risk factors for IV-catheter infections?

A

Continuous infusion >24hrs
Canula in situ >72 hrs
Cannula in lower limbs
Patients with neurological/neurosurgical problems

->lecturer said to never do a cannula in the lower limb

94
Q

What is the most common organisms responsible for IV-catheter associated infections?

A

Staph aureus

95
Q

What is the treatment of IV-catheter associated infections?

A

Remove cannula
Express any pus from the thrombophlebitis
Antibiotics for 14 days
ECHO

->prevention more important than treatment so do not leave cannula in if unused, for over 72hrs or don’t use them if you don’t need to

96
Q

There are four classes of surgical site infections.

What is meant by class I?

A

Clean wound - resp, alimentary, genital or infected urinary systems not entered

97
Q

There are four classes of surgical site infections.

What is meant by class II?

A

Clean-contaminated wound (previously mentioned tracts entered but no unusual contamination)

98
Q

There are four classes of surgical site infections.

What is meant by class III?

A

Contaminated wound

Open, fresh accidental wounds or spillage from GIT

99
Q

There are four classes of surgical site infections.

What is meant by class IV?

A

Infected wound

->infection present before operation

100
Q

List some risk factors for surgical site infections.

A

Smoking
Diabetes
Obesity
Malnutrition
Concurrent steroid use
Colonisation w Staph aureus

101
Q

What are some of the procedural factors which can increase risks of surgical site infections?

A

Shaving of site the night before
Improper preoperative skin prep
Improper antimicrobial skin prophylaxis
Break in sterile technique
Perioperative hypoxia

102
Q

How is a diagnosis of a surgical site infection made?

A

Sending pus/infected tissue for cultures
Deep structure swabs

103
Q

What is the treatment of surgical site infections?

A

Antibiotics to target the likely causative organisms

104
Q
A

Year 2- Infectious Disease (12 decks)

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