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Year 3 - Infection > Skin and soft tissue infections > Flashcards

Skin and soft tissue infections Flashcards

1
Q

Which bacteria cause impetigo?

A
  • S aureus

- Strep pyogenes

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2
Q

Which layer of the skin is affected in impetigo?

A

Epidermis

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3
Q

Which bacteria cause folliculitis?

A

S aureus

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4
Q

Which bacteria cause Erysipelas?

A

Strep pyogenes

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5
Q

Which bacteria cause cellulitis?

A
  • Strep pyogenes = Common
  • S aureus = Uncommon
  • H influenzae = Rare
  • Other = Rare
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6
Q

Which layer of the skin is affected folliculitis?

A

Hair follicle = Dermis

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7
Q

Which layer of the skin is affected erysipelas?

A

Infection of the upper dermis

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8
Q

Which layer of the skin is affected cellulitis?

A

Deep dermis and subcutaneous fat

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9
Q

Which layer of the skin is affected necrotising fasciitis?

A

Subcutaneous fat and fascia, can invade muscle

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10
Q

Which bacteria cause necrotising fasciitis?

A
  • Strep pyogenes

- Mixed bowel flora

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11
Q

What is a golden crust on the skin highly suggestive of?

A

Impetigo

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12
Q

How does impetigo present?

A
  • Superficial skin infection

- Multiple vesicular lesions on an erythematous base

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13
Q

Who is most commonly affected with impetigo?

A

2-5 years of age

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14
Q

Where does impetigo often occur?

A

Exposed parts the body:

  • Face
  • Extremeties
  • Scalp
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15
Q

Predisposing factors for impetigo?

A 
> Skin abrasions
> Minor trauma
> Burns
> Poor hygiene
> Insect bites
> Chickenpox
> Eczema
> Atopic dermatitis
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16
Q

How do you treat impetigo?

A

> Small areas can be treated with topical antibiotics alone

> Large areas need topical treatment and oral antibiotics (ex flucloxacillin)

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17
Q

How does someone present with erysipelas?

A

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

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18
Q

Signs and symptoms of erysipelas?

A

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

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19
Q

Most common cause of erysipelas?

A

Strep pyogenes

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20
Q

Which area of the body is most commonly affected by erysipelas?

A

> 70-80% of cases involved the lower limbs

> 5-20% affect the face

> Tends to occur in areas of pre-existing lymphoedema, venous stasis, obesity, paraparesis, diabetes mellitus

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21
Q

What is the reoccurrence rate of erysipelas?

A

High reoccurrence = 30% within 3 years

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22
Q

How does cellulitis present?

A

> Spreading erythematous area with no distinct borders
Fever is common
Regional lymphadenopathy and lymphangitis

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23
Q

Within diabetics which pathogens can cause cellulitis?

A

Gram negative bacteria

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24
Q

Within neutropenics which pathogens can cause cellulitis?

A

Gram negative bacteria

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25
Q

Which pathogens most commonly cause cellulitis?

A

Strep pyogenes

S aureus

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26
Q

What is a common complication of cellulitis?

A

Bacteraemia

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27
Q

Predisposing factors for cellulitis?

A
  • Diabetes mellitus
  • Tinea pedis
  • Lymphoedema/ Lyphangitis/ Lymphadenitis
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28
Q

How do you treat erysipelas and cellulitis?

A

Anti-staphylococcal and Anti-streptococcal Abx:
> Penicillins:
- Benzylpenicillin, Penicillin V
- Co-amoxiclav

> Cephalosporins:
- 1st generation, cefradine

> Clidamycin

> tigecycline

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29
Q

Hair-associated infections?

A
  • Folliculitis
  • Furunculosis
  • Carbuncles
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30
Q

What is folliculitis?

A

Circumscribed, pustular infection of a hair follicle

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31
Q

How does folliculitis presents?

A

> Small (Up to 5mm) small red papules
Central area of purulence that may rupture and drain
Typically on head, buttocks and extremities

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32
Q

Most common pathogen causing folliculitis?

A

S aureus

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33
Q

What are furuncles?

A
  • Referred to as boils

- Single hair follicle-associated inflammatory nodule

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34
Q

Which layers of the skin are affected in furuncles?

A

Extending into dermis and subcutaneous tissue

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35
Q

Which areas are most commonly affected in furunculosis?

A

Usually affected moist, hairy, friction-prone areas of body (face, axilla, neck, buttocks)

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36
Q

What are the risk factors of furunculosis?

A 
Risk factors include:
> Obesity
> Diabetes mellitus
> Atopic dermatitis
> Chronic kidney disease
> Corticosteroid use
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37
Q

What is the most common organism that causes furunculosis?

A

S aureus

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38
Q

What is a carbuncle?

A
  • Occurs when infection extends to involve multiple furuncles
  • Multiseptated abscesses
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39
Q

Most common location of carbuncles?

A

Often located back of neck, posterior trunk or thigh

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40
Q

Risk associated with carbuncles?

A

Constitutional symptoms are common

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41
Q

How to treat hair-associated infections - folliculitis?

A

No treatment or topical antibiotics are required

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42
Q

How to treat hair-associated infections - furunculosis?

A

> No treatment or topical antibiotics are required

> Oral antibiotics might be necessary if not improving

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43
Q

What is necrotising fasciitis?

A

> An infectious disease emergency

> Necrotic

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44
Q

Which area of the body is most commonly affected in necrotising fasciitis?

A

Any site can be affected

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45
Q

Predisposing conditions in necrotising fasciitis?

A 
Predisposing conditions include:
> Diabetes mellitus
> Surgery
> Trauma
> Peripheral vascular disease
> Skin popping
46
Q

Type I necrotising fasciitis?

A

Type I refers to a mixed aerobic and anaerobic infection (diabetic foot infection, Fournier’s gangrene)

47
Q

Common organisms in type I necrotising fasciitis?

A 
Typical organisms include:
> Streptococci
> Staphylococci
> Enterococci
> Gram negative bacilli
> Clostridium
48
Q

Common organisms in type II necrotising fasciitis?

A

Monomicrobial = Strep pyogenes

49
Q

What is anaesthesia at the site of an infection highly suggestive of?

A

Necrotising fasciitis

50
Q

Clinical features of necrotising fasciitis?

A

> Rapid onset

> Sequential development of erythema, extensive oedema and severe, unremitting pain

> Haemorrhagic bullae, skin necrosis and crepitus may develop

> Systemic features include fever, hypotension, tachycardia, delirium and multiorgan failure

> Anaesthesia at site of infection is highly

51
Q

Imaging or not in necrotising fasciitis?

A

Imaging may help by could delay treatment

52
Q

Which antibiotics are used in necrotising fasciitis?

A
  • Flucloxacillin
  • Gentamicin
  • Clindamycin
53
Q

If necrotising fasciitis is suggested what should be reviewed?

A

Surgical review

54
Q

What is the overall mortality in necrotising fasciitis?

A

17-40%

55
Q

What is pyomyositis?

A

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

56
Q

What does pyomyositis often occur secondary to?

A

Often secondary to seeing into damaged muscle

57
Q

Which areas of the body are commonly affected by pyomyositis?

A 
Multiple sites involved in 15%:
> Thigh
> Calf
> Arms
> Gluteal region
> Chest wall
> Psoas muscle
58
Q

How does someone present pyomyositis?

A
  • Fever
  • Pain
  • Woody indication of affected muscle
59
Q

What is the risk of untreated pyomyositis?

A

Untreated septic shock and death

60
Q

Predisposing factors for pyomyositis?

A 
Predisposing factors include:
> Diabetes mellitus
> HIV/immunocompromised
> Intravenous drug use
> Rheumatological diseases
> Malignancy
> Liver cirrhosis
61
Q

What is the most common causes of pyomyositis?

A

S aureus

62
Q

What are other organisms other than S aureus cause pyomyositis?

A

Gram positive/negatives, TB and fungi

63
Q

Investigations in pyomyositis?

A

CT/MRI

64
Q

Treatments in pyomyositis?

A

Treatment is drainage with antibiotic cover depending on Gram stain and culture results

65
Q

What is septic bursitis?

A

> Bursae are small sac-like cavities that contain fluid and are lined by synovial membrane

> Located subcutaneously between bony prominences or tendons

66
Q

What is the most common sites of septic bursitis?

A

Most common include patellar and olecranon

67
Q

What does septic bursitis usually occur due to?

A

Often from adjacent skin infections

68
Q

What are the predisposing factors of septic bursitis?

A 
Other predisposing factors include:
> Rheumatoid arthritis
> Alcoholism
> Diabetes mellitus
> Intravenous drug abuse
> Immunosuppression
> Renal insufficiency
69
Q

How does septic bursitis present?

A 
> Peribursal cellulitis
> swelling 
> warmth at the site
> Fever 
> Pain on movement also seen
70
Q

How is septic bursitis diagnosed?

A

Aspiration of the fluid

71
Q

What is the most common organism that causes septic bursitis?

A

S aureus

72
Q

What other organisms causes septic bursitis other than S aureus?

A
  • Gram negatives
  • Mycobacteria
  • Brucella
73
Q

What is infectious tenosynovitis?

A

Infection of the synovial sheats that surround tendons

74
Q

What is the most common site of tenosynovitis?

A

Flexor muscle-associated tendons and tendon sheats of the hand most commonly involved

75
Q

What is the most common cause of tenosynovitis?

A

Penetrating trauma

76
Q

What is the most common organism of tenosynovitis?

A
  • S aureus

- Streptococci

77
Q

What is the most common organism in chronic tenosynovitis?

A
  • Mycobacteria

- Fungi

78
Q

What is a risk associated with tenosynovitis?

A

Disseminated gonococcal infection

79
Q

How does infectious tenosynovitis present?

A

> Erythematous fusiform swelling of the finger
Semiflexed position
Tenderness over the length of the tendon sheet and pain with extension of finger

80
Q

How to treat infectious tenosynovitis?

A
  • Empiric Abx

- Hand surgeon to review ASAP

81
Q

Diagnostic criteria for Staphylococcal TSS?

A

> Fever

> Hypotension

> Diffuse macular rash

> Three of the following organs involved:

  • Liver
  • blood
  • renal
  • gatrointestinal
  • CNS
  • muscular

> Isolation of Staph aureus from mucosal or normally sterile sites

> Production of TSST1 by isolate

> Development of antibody to toxin during convalescence

82
Q

When does Streptococcal TSS most commonly occur?

A

In deep seated infections such as erysipelas or necrotising fasciitis

83
Q

Which TSS Strep or Staph has higher mortality rate?

A

Streptococcus 50% vs 5%

84
Q

How is streptococcal TSS treated?

A 
> Urgent surgical debridement of infected tissues
> Remove offending agent (ex tampon)
> Intravenous fluids
> Inotropes
> Antibiotics
> Intravenous immunoglobulins
85
Q

What is Staphylococcal scalded skin syndrome?

A

> Infection due to a particular strain of Staph aureus producing the exfoliative toxin A or B
Widespread bullae and skin exfoliation

86
Q

Who is most commonly affected by staphylococcal scalded skin syndrome?

A

Most common in children but rarely in adults

87
Q

What is the treatment of staphylococcal scalded skin syndrome?

A

> IV fluids and antimicrobials

88
Q

What is the mortality rate?

A

Around 3% in children but higher in adults who often are immunosuppressed

89
Q

What is Panton-Valentine leucocidin toxin?

A

Gamma haemolysin

90
Q

What is the big issue with Panton-Valentine leucocidin toxin and S aureus?

A

Can be transferred from one strain of Staph aureus to another, including MRSA

91
Q

What can Panton-Valentine leucocidin toxin cause?

A

SSTI and haemorrhagic pneumonia

92
Q

Who is commonly affected by Panton-Valentine leucocidin toxin?

A

Children and young adults

93
Q

How does someone present with Panton-Valentine leucocidin toxin?

A

Recurrent boils which are difficult to treat

94
Q

How do you treat Panton-Valentine leucocidin toxin?

A

Antibiotics that reduce toxin production

95
Q

IV-catheter associated infections progression?

A

1) Local SST inflammation
2) Cellulitis
3) Tissue necrosis
4) Can cause bacteraemia

96
Q

Risk factors for IV-catheter associated infections?

A 
Risk factors for infections
> Continuous infusion >24 hours
> Cannula in situ >72 hours
> Cannula in lower limb
> Patients with neurological/neurosurgical problems
97
Q

What is the most common organism that causes IV-catheter associated infections?

A

Staph aureus (MSSA and MRSA)

98
Q

How does Risk factors for IV-catheter can infections?

A

> Commonly forms a biofilm which then spills int bloodstream
Can seed into other places (Endocarditis, osteomyelitis)

99
Q

How are IV-catheter associated infections diagnosed?

A

Clinical or by positive blood cultures

100
Q

How is IV-catheter associated infections treated?

A

1) Remove cannula
2) Express any pus from the thrombophlebitis
3) Abx for 14 days
4) Echo to rule out endocarditis

Prevention is key!

101
Q

How can you prevent IV-catheter associated infections?

A

Prevention more important:
> 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

102
Q

Classification of surgical site infections - Class I?

A

Class I: Clean wound (respiratory, alimentary, genital or infected urinary systems not entered)

103
Q

Classification of surgical site infections - Class II?

A

Class II: Clean-contaminated wound (above tracts entered but no unusual contamination)

104
Q

Classification of surgical site infections - Class III?

A

Class III: Contaminated wound (Open, fresh accidental wounds or gross spillage from the gastrointestinal tract)

105
Q

Classification of surgical site infections - Class IV?

A

Class IV: Infected wound (existing clinical infection, infection present before the operation)

106
Q

Organisms thar cause surgical site infections?

A 
> Staph aureus (incl MSSA and MRSA)
> Coagulase negative Staphylococci
> Enterococcus
> Escherichia coli
> Pseudomonas aeruginosa
> Enterobacter
> Streptococci
> Fungi
> Anaerobes
107
Q

Risk factors for surgical site infections - Patient associated?

A 
Patient associated:
> Diabetes
> Smoking
> Obesity
> Malnutrition
> Concurrent steroid use
> Colonisation with Staph aureus
108
Q

Risk factors for surgical site infections - procedural factors?

A 
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
109
Q

Diagnosis of surgical site infections?

A

> Importance of sending pus/infected tissue for cultures especially with clean wound infections
Avoid superficial swabs – aim for deep structures
Consider an unlikely pathogen as a cause if obtained from a sterile site (ex bone infection)

110
Q

Which skin/tissue infections require urgent attention?

A 
> Necrotising fasciitis
> Pyomyositis
> Toxic shock syndrome
> PVL infecitons
> Venflon-associated infections

Year 3 - Infection (16 decks)

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