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Infection > Skin and Soft Tissue Infections > Flashcards

Skin and Soft Tissue Infections Flashcards

1
Q

2 groups of skin infections

A

Hospital acquired

Community acquired

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2
Q

Risk factors for skin and soft tissue infections - host

A

DM leading to neuropathy and vasculopathy
Immunosuppression
Renal failure
Milroy’s disease
Predisposing skin condition (e.g. atopic dermatitis)

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3
Q

Where in the skin does impetigo affect?

A

Superficial skin infection only affecting the epidermis

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4
Q

Layers of the skin (superficial to deep)

A 
Epidermis
Dermis
Subcutaneous fat
Fascia 
Muscle
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5
Q

Who is impetigo common in?

A

Children 2-5 years of age

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6
Q

Causative organisms of impetigo

A

Commonly -> staph aureus

Less commonly -> strep pyogenes

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7
Q

Is impetigo infectious?

A

Yes - highly infectious

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8
Q

Presentation of impetigo

A

Multiple vesicular lesions on an erythematous base
Golden crust
Usually occurs on parts of body including face, extremities and scalp

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9
Q

Predisposing factors for impetigo

A 
Skin abrasions
Minor trauma
Burns
Poor hygiene 
Inset bites
Chickenpox 
Eczema 
Atopic dermatitis
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10
Q

Treatment of impetigo

A

Small areas = topical antibiotics alone

Large areas = topical treatment with oral antibiotics (e.g. flucloxacillin)

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11
Q

Definition of erysipelas

A

Infection of the upper dermis

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12
Q

Presentation of erysipelas

A

Painful, red area (no central clearing)
Assosiated fever
Regional lymphadenopathy and lymphangitis
Distinct elevated borders

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13
Q

Most common causative organism of erysipelas

A

Strep pyogenes

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14
Q

Where does erysipelas affect?

A 
70-80% lower limbs
5-20% face 
Areas of pre existing
- lymphoedema
- venous stasis
- obesity
- paraparesis
- diabetes mellitus 
May involve intact skin
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15
Q

Treatment of erysipelas

A 
Combination of 
- anti-staphylococcal (flucocaxillin) and anti-streptococcal (benzylpenicillin) antibiotics 
extensive disease
- admission for IV antibiotics
- rest
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16
Q

Presentation of cellulitis

A 
Spreading erythematous area with no distinct areas
Fever 
Pain 
Regional lymphadenopathy + lymphangitis 
Systemic upset
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17
Q

Definition of cellulitis

A

Diffuse skin infection involving deep dermis and subcutaneous fat

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18
Q

Likely causative organisms of cellulitis

A

Strep pyogenes

Staph aureus

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19
Q

Predisposing factors of cellulitis

A

DM
Tinea pedis
Lymphoedema
Obesity

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20
Q

Treatment of cellulitis

A 
Combination of 
- anti-staphylococcal antibiotics (flucocloxacillin) and anti-streptococcal antibiotics (benzylpenicillin)
Extensive disease
- IV antibiotics
- rest
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21
Q

Definition of folliculitis

A

Circumscribed, pustular infection of a single fair follicle

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22
Q

Where is folliculitis commonly found?

A

Head
Back
Buttocks
Extremities

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23
Q

Most common organism for folliculitis

A

Staph aureus

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24
Q

Definition of furunculosis

A

Infection of a single hair follicle has spread from the follicle to the surrounding tissue

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25
Q

What are furuncles commonly referred to as?

A

Boils

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26
Q

What layers of the skin do furuncles affect?

A

Dermis

Subcutaneous tissue

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27
Q

Where do furuncles usually affect?

A

Moist, hairy, friction prone areas of the body (face, axilla, neck, buttocks)

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28
Q

Most common organism for furunculosis

A

Staph aureus

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29
Q

Risk factors for furunculosis

A 
Obesity
DM
Atophic dermatitis 
Chronic kidney disease
Corticosteriod use
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30
Q

What is another name for atophic dermatitis

A

Eczema

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31
Q

Definition of carbuncles

A

Infection extends to involve multiple furuncles

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32
Q

Where are carbuncles found?

A

Back of neck
Posterior thigh
Posterior trunk

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33
Q

Presentation of carbuncles

A

Multiseptated abscesses
Purulent material expressed from multiple sites
Constitutional symptoms common

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34
Q

Treatment of carbuncles

A

IV antibiotics

Often require surgery

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35
Q

What does the presence of carbuncles indicate?

A

An underlying cause e.g. HIV as a normal healthy person should not get carbuncles from furunculosis

36
Q

Predisposing conditions to necrotising fasciitis

A 
DM
Surgery 
Trauma
Peripheral vascular disease
Skin popping (PWID into dermis as veins collapsed)
37
Q

What does type I necrotising fasciitis involve?

A

Mixed aerobic and anaerobic infection (diabetic foot, Fournier’s gangrene)

38
Q

Typical organisms of type I necrotising fasciitis

A 
Streptococci 
Staphylococci 
Enterococci 
Gram -ve bacilli
Clostridium
39
Q

Typical organisms of type II necrotising fasciitis

A

Monomicrobial - usually strep pyogenes

40
Q

Presentation of necrotising fascitis

A 
Rapid onset
Sequential development of 
- erythema, extensive oedema and severe, unremitting pain 
haemorrhagic bullae
skin necrosis
Crepitus 
Systemic features
- fever, hypotension, tachycardia, delirium, multiorgan failure 
Anaesthesia at site of infection
41
Q

What is highly suggestive of necrotising fasciitis?

A

Anaesthesia at the site of infection

42
Q

Treatment of necrotising fascitis

A

Surgical review mandatory
Antibiotics - broad spectrum
- flucloxacillin, gentamicin, clindamycin

43
Q

Prognosis of necrotising fasciitis

A

Overall mortality 17-40%

44
Q

Definition of pyomyositis

A

Purulent deep infection within striated muscle, often manifesting as an abscess

45
Q

What is pyomyositis often secondary to?

A

Seeding into damaged muscle

46
Q

Common sites of pyomyositis

A 
Thigh 
calf
arms
gluteal region 
chest wall
psoas muscle
47
Q

Presentation of pyomyositis

A

Fever
Pain
Woody induration of affected muscle

48
Q

Predisposing factors for Pyomyositis

A 
DM
HIV/immunocompromised 
IVDU
Rheumatological disease
Malignancy 
Liver cirrhosis
49
Q

Causative organisms of pyomyositits

A

Staph aureus most common
gram -ve/+ve
TB
fungi

50
Q

Investigations of pyomyositis

A

CT/MRI

51
Q

Treatment of pyomyositis

A

Drainage with antibiotic cover

52
Q

Definition of septic bursitis

A

infection of the bursae (fluid filled sacs)

53
Q

Where are bursae found?

A

Subcutaenously between bony prominences or tendons

54
Q

most common septic bursae sites

A

platellar

olecrannon

55
Q

causes of septic bursitis

A

adjacent skin infection

repeated flexion and extension

56
Q

Predisposing factors for septic bursitis

A 
rheumatoid arthritis
alcoholism 
DM
IVDU
Immunosuppression 
Renal insufficiency
57
Q

Causative organisms of septic bursitis

A 
Staph aureus  - MOST COMMON
Rarer
- gram -ves
- mycobacteria
- brucella
58
Q

Presentation of septic bursitis

A 
Peribursal cellulitis
Swelling
warmth 
fever
pain on movement
59
Q

Definition of infectious tenosynovitis

A

Infections of the synovial sheets that surround tissues

60
Q

Where is the most commonly affected in infectious tenosynovitis?

A

Flexor muscle associated tendons

Tendon sheets of the hand

61
Q

What is the most common inciting event of infectious tenosynovitis?

A

Penetrating trauma

62
Q

Causative organisms of infectious tenosynovitis

A

MOST COMMON - staph aureus and streptococci
CHRONIC INFECTIONS - mycobacteria and fungi
Possibility of disseminated gonococcal infection

63
Q

Presentation of infectious tenosynovitis

A

Erythematous fusiform swelling of finger
held in a semi flexed position
Tenderness over length of tendon sheath and pain with extension of finger are classical

64
Q

Treatment of infectious tenosynovitis

A

Empirical antibiotics

Hand surgeon to review asap

65
Q

What are toxin mediated syndromes often due to?

A

Superantigens

66
Q

What do toxin mediated syndromes result in?

A

Endothelial leakage
Haemodynamic shock
Multiorgan failure and death

67
Q

Possible causes of toxic shock syndrome

A

High absorbency tampons during menstruation

Small skin infections due to staph aureus secreting TSST1

68
Q

What are a lot of toxin mediated syndromes due to? (organisms)

A

TSST1

69
Q

Presentation of toxic shock syndrome

A 
Fever
Hypotension 
Diffuse macular rash 
3 of the following organs involved 
- liver, blood, renal, GI, CNS, muscular
70
Q

Investigations of toxic shock syndrome

A

Isolation of staph aureus from mucosal or normally sterile sites
Production of TSST1 by isolate
Development of antibody to toxin during convalescence

71
Q

What is streptococcal toxic shock syndrome almost always associated with?

A

Presence of streptococci in deep seated infections such as erysipelas or necrotising fasciitis

72
Q

Streptococcal TSS vs staphylococcal TSS

A

Strep much higher mortality rate than staph (50% vs 5%)

73
Q

Treatment of toxic shock syndrome

A 
remove offending agent (ex tampon)
IV fluids
Inotropes
Antibiotics
IV immunoglobulins (in ITU/HDU)
74
Q

Toxins causing toxin mediated syndromes

A 
Staph aureus
- TSST1
- ETA and ETB
Streptococcus pyogenes 
- TSST1
75
Q

Causes of staphylococcal scalded skin syndrome

A

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

76
Q

Who does staphylococcal scalded skin syndrome affect?

A

Children but rarely adults as well

77
Q

Presentation of staphylococcal scalded skin syndrome

A

Widespread bullae and skin exfoliation

78
Q

Treatment of staphylococcal scalded skin syndrome

A

IV fluids and antimicrobials

79
Q

Pathology of IV catheter associated infections

A

Starts at local STT inflammation
Progressing to cellulitis
And possibly tissue necrosis

80
Q

Risk factors for IV catheter infections

A

Continuous infusion > 24 hours
Cannula in situ > 72 hours
Cannula in lower limb
patients with neurological/neurological problems

81
Q

Most common causative organism for IV catheter infections

A

Staph aureus (MSSA and MRSA)

82
Q

Investigations for IV catheterisation associated infections

A

Clinically

+ve blood cultures

83
Q

Treatment of IV catheterisation associated infections

A

Remove cannula
Express any pus from thrombophlebitis
Antibiotics for 14 days
ECG

84
Q

Prevention of IV catheter associated infections

A 
Do not leave unused cannula 
Do not insert cannula unless using them 
change cannula every 72 hours
monitor for thrombophlebitis 
Use aseptic technique when inserting cannula
85
Q

Classification of surgical wound infections

A

class I
- clean wound (other systems not entered)
class II
- clean-contaminated wound (above tracts entered but no unusal contamination)
class III
- contaminated wound (open, fresh accidental wounds or gross spillage from GI tract)
class IV
- infected wound (existing clinical infection, infection present before operation)

86
Q

3 examples of causative organisms of surgical site infection

A

Staph aureus
Fungi
streptococci
anaerobes

87
Q

Risk factors for surgical site infection

A 
DM
Smoking
obesity
malnutrition 
concurrent steroid use
colonisation with staph A
shaving of site night prior to the procedure
improper preoperative skin preparation 
break in sterile technique
improper antimicrobial prophylaxis 
inadequate theatre ventilation 
perioperative hypoxia

Infection (16 decks)

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