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Infection > Skin and Soft Tissue Infections > Flashcards

Skin and Soft Tissue Infections Flashcards

1
Q

What is the presentation of impetigo?

A

GOLDEN CRUST
Multiple vesicular lesions on erythematous base
Tends to be face, limbs
Children 2-5y

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2
Q

Where is impetigo an infection of?

A

Upper epidermis

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3
Q

What bacteria tend to cause impetigo?

A

Staph aureus (less commonly strep pyogenes)

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4
Q

What factors predispose to impetigo infection?

A

Broken skin basically

Skin abrasions, minor trauma, burns, poor hygiene, insect bites, chickenpox, eczema, atopic dermatitis

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5
Q

How do you treat impetigo?

A

Flucloxacillin

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6
Q

Where is erysipelas an infection of?

A

Upper dermis

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7
Q

What does erysipelas present like?

A

Pain, red area + fever + regional lymphadenopathy+ lymphangitis
ELEVATED BORDERS
Tends to be lower limbs

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8
Q

What tends to cause erysipelas?

A

Strep pyogenes

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9
Q

What can predispose to erysipelas?

A

Pre-existing lymphoedema, venous stasis, obesity, paraparesis, DM

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10
Q

Why is there high recurrence of erysipelas?

A

There is damage to the lymphatic system which never returns to its original function

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11
Q

Where does cellulitis affect?

A

Deep dermis and s/c fat

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12
Q

What does cellulitis present like?

A

Erythematous area with no distinct borders + fever + regional lymphadenopathy + lymphangitis (inflammation of lymphatic system)

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13
Q

What organism causes cellulitis most likely?

A

Strep pyogenes and staph aureus

Gram -ve infections in febrile neutropenia and DM

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14
Q

How might someone have ended up with cellulitis?

A

Portals of entry to skin (e.g. fungal foot infection) or infection secondary to systemic infection

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15
Q

What is the appearance of lymphangitis?

A

Red lines along line of lymphatic vessels

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16
Q

What conditions predispose to cellulitis?

A

DM, tinea pedis, lymphoedema

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17
Q

How do you treat erysipelas and cellulitis?

A

Flucloxacillin & benzyl penicillin (others: vancomycin/teicoplanin)
IV in extensive dx

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18
Q

What is folliculitis?

A

Circumscribed, pustular infection of a hair follicle

Up to 5mm

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19
Q

What does folliculitis present like?

A

Small red papules with central area of purulence that may rupture and drain

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20
Q

What typically causes folliculitis?

A

Staph aureus

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21
Q

What are furnucles?

A

Boils

Single hair follicle-associated inflammatory nodule (infection spreads into dermis and forms an abscess in s/c tissue)

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22
Q

Where do furnucles tend to occur?

A

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

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23
Q

What tends to cause furnucles?

A

Staph aureus

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24
Q

What are the risk factors for furnucles?

A

Obesity, DM, atopic dermatitis, CKD, corticosteroid use, shaving/waxing

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25
What are carbuncles?
When infection extends to involve multiple furnucles Multiseptated abscesses + high temp, low BP, signs and symptoms of sepsis
26
What does having a carbuncle normally mean?
Patient is immunocompromised
27
How do you treat carbuncles?
Systemic antibiotics | May req. surgery and admission to hospital
28
What is necrotising fasciitis?
Rapidly progressive infection resulting in extensive necrosis of deep tissue (s/c tissue, fascia, muscle) & systemic infection that can become lifethreatening
29
What can predispose to necrotising fasciitis?
DM, surgery, skin popping (IVDA into s/c fat), trauma, peripheral vascular disease
30
What are the two types of necrotising fasciitis?
Type 1 - mixed aerobic and anaerobic (diabetic foot infection, Fournier's gangrene) Type 2 - monomicrobial (strep pyogenes usually)
31
What are the typical organisms involved in type 1 necrotising fasciitis?
Strep, staph, enterococci, gram -ve bacilli, clostridium
32
What are the clinical features of necrotising fasciitis?
Rapid onset Development of erythema, extensive oedema, severe, unremitting pain Anaesthesia at site of injury Haemorrhagic bullae, skin necrosis, crepitus Systemic features: fever, hypotension, tachycardia, delirium, multi-organ failure
33
What can necrotising fasciitis progress to?
Gangrene, amputations, fatality
34
How do you treat necrotising fasciitis?
Surgical review Broad spectrum antibiotics - flucloxacillin, gentamicin, clindamycin, benzyl penicillin & metronidazole) Rx for sepsis
35
What is pyomyositis?
Purulent infection deep within striated muscle, often manifesting as pus filled absncess
36
What is pyomyositis secondary to?
Seeding into damaged muscle (i.e. infection is elsewhere and spreads via bloodstream to muscle)
37
Where are common sites for pyomyositis?
Thigh, calf, arms, gluteal region, chest wall, psoas
38
What is the presentation for pyomyositis?
Fever, pain, woody induration of affected muscle | can lead to septic shock and death
39
What predisposes to pyomyositis?
DM, HIV, immunocomp, IVDA, rheumatological dx, malignancy, liver cirrhosis
40
What organism tends to cause pyomyositis?
Staph aureus | Others: TB/fungi
41
How do you investigate pyomyositis?
CT/MRI
42
How do you Rx pyomyositis?
Drainage & antibiotics depending on gram stain and culture result
43
Where is septic bursitis most common?
Patellar and olecranon
44
How does septic bursitis tend to occur?
From adjacent skin infection
45
What factors predispose to septic bursitis?
RA, alcoholism, DM, IVDA, immunosuppression, renal insufficiency
46
What is the presentation of septic bursitis?
``` Area of redness over joint Loses definition around joint Peribursal cellulitis, swelling, war Fever Pain on movement ```
47
How do you differentiate septic bursitis from septic arthritis?
In septic arthritis unable to flex and extend the joint
48
How do you diagnose septic bursitis?
Aspiration of fluid
49
What organism tends to cause septic bursitis?
Staph aureus | Others: gram -ves, mycobacteria, Brucella
50
What is infectious tenosynovitis?
Infection of synovial sheaths surrounding the tendon
51
What tendons are most commonly involved in infectious tenosynovitis?
Flexor muscle assoc tendons & tendon sheaths of hands most commonly injured
52
What tends to be the initiating event in infectious tenosynovitis?
Penetrating trauma
53
What organisms most commonly cause infectious tenosynovitis?
Staph aureus and strep Chronic infections due to mycobacteria and fungi Rare cause: disseminated gonorrhoea infection
54
What is the presentation of infectious tenosynovitis?
``` Erythematous fusiform (tapers at both ends) swelling of finger Held in semi-flexed position (least amount of pain) Tenderness over length of tendon sheath and pain with extension of finger are classical ```
55
How do you treat infectious tenosynovitis?
Empirical antibx | Referral to hand surgeon
56
What is the pathophysiology behind toxin mediated syndromes?
Due to superantigens Group of pyrogenic exotoxins Do not activate immune system via normal contact between APC cells and T cells Superantigens bypass this and attach directly to T cell receptors --> huge activation of T cells --> massive cytokine release --> endothelial leakage, haemodynamic shock, multiorgan failure & sometimes death
57
What are the strains that can cause toxin mediate syndromes?
Staph aureus: TSST1, ETA and ETB | Strep pyogenes: TSST1
58
Define toxic shock syndrome
Systemic inflammatory reaction caused by bacterial exotoxins
59
What can cause toxic shock syndrome?
E.g. tampon use, small skin infections due to staph aureus secreting TSST1
60
What is the diagnostic criteria for Staphylococcal TTS?
Fever, hypotension, diffuse macular rash (pink, blanching, all over body) Three of liver, blood, renal, GI, CNS, muscular systems involved Isolation of staph aureus from normally sterile sties Production of TSST1 from isolate Development of antibody to toxin during convalescence
61
What is streptococcal TTS always associated with?
Presence of streptococci in deep seated infections, e.g. NF/erysipelas
62
How do you treat streptococcal TTS?
Urgent surgical debridement of infected tissues | Mortality much higher than for staph TTS!!
63
How do you Rx TSS?
``` Remove offending agent, e.g. tampon IV fluids Inotropes Antibiotics IV Ig ```
64
What causes staphylococcal scalded skin syndrome?
Staph aureus producing the exfoliative A or B toxin
65
What is staphylococcal scalded skin syndrome characterised by?
Widespread bullae and skin exfoliation
66
How do you treat SSS?
IV fluids and antibiotics
67
What is Panton-Valentine Leucoidin toxin?
Toxin produced by some strains of staph aureus (gamma haemolysin that can be transferred from one strain of staph aureus to another)
68
What does PVL toxin cause?
Skin and soft tissue infections and haemorrhagic pneumonia | Patients present with recurrent boils which are difficult to treat
69
What are IV-catheter associated infections often presenting like?
Local skin and soft tissue inflammation, but may progress to cellulitis and even tissue necrosis Common to have assoc. bacteraemia
70
What are risk factors for IV-catheter associated infections?
Continuous infusion >24h Cannula in situ >72h Cannula in lower limb Patients with neurological/neurosurgical problems
71
What bacteria tends to cause IV catheter assoc. infections?
``` Staph aureus (MSSA/MRSA) Commonly forms biofilm ```
72
How do you diagnose IV catheter assoc. infections?
+ve blood cultures or clinical diagnosis
73
What are the presentations of IV catheter assoc. infections?
Area of thrombophlebitis going up Veins feel really hard Assoc. fever
74
How do you Rx IV catheter assoc. infections?
Remove cannula Express any pus from thrombophlebitis Antibx for 14 days ECG
75
How can you prevent IV catheter assoc. infections?
``` Do not leave in unused cannulas Do not insert cannula unless req. Change cannula every 72h Monitor for thrombophlebitis Use aseptic technique when inserting cannula ```
76
What is the classification of surgical site infections?
1 - clean wound (resp, alimentary, genital, urinary systems not entered) 2 - clean wound (above tracts entered but no unusual contamination) 3 - contaminated wound (open, fresh, aciidental wounds or gross spillage from GI tract) 4 - infected wound (existing clinical infection, infection present before op)
77
What can cause surgical site infections?
``` Staph aureus (MSSA/MRSA) Coagulase -ve staph Enterococcus E. coli Pseudomonas aeruginosa Enterobacter Strep Fungi Anaerobes ```
78
What are risk factors for surgical site infections?
``` Diabetes Smoking Obesity Malnutrition Steroid use Colonisation with staph aureus Shaving of site prior to procedure Improper prep of skin preoperatively Improper antimicrobial prophylaxis Break in sterile technique Inadequate theatre ventilation perioperative hypoxia ```
79
How do you diagnose surgical site infections?
Sending pus/infected tissue for cultures Avoid superficial swabs Consider unlikely pathogen as cause if obtained from sterile site

Infection (22 decks)

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