Skin and soft tissue infections

Question 1

what are risk factors for cellulitis?

Answer 1

immunosuppression
diabetes mellitus 
febrile neutropenics
tinea pedis 
lymphoedema

Question 2

what are risk factors for erysipelas?

Answer 2

tends to occur in areas of pre existing;

• lymphadenopathy
• venous stasis
• obesity
• paraparesis
• diabetes

Question 3

what are the different hair infections?

Answer 3

folliculitis
furunculosis (boil)
carbuncle

Question 4

what is the difference in type I and II necrotising fasciitis?

Answer 4

type 2 caused by mixed aerobic and anaerobic infection

type 1 caused by strep pyogenes

Question 5

what organism is responsible for polymyositis?

Answer 5

staph aureus

Question 6

what is the presentation of pyomyositis?

Answer 6

fever
pain
woody induration of muscle

Question 7

what is septic bursitis?

Answer 7

infection oft the synovial fluid of joints

infection is often from adjacent skin

Question 8

what is the name for infection of the synovial sheaths that surround tendons?

Answer 8

infectious tenosynovitis

Question 9

what is the main cause of infectious tenosynovitis?

Answer 9

penetrating trauma

Question 10

what is responsible for toxic mediated syndromes?

Answer 10

super antigens which are groups of pyrogenic exotoxins

Question 11

what presents with recurrent boils?

Answer 11

panton-valentine leucocidin toxin (VPL)

Question 12

what type of toxin is VPL and what organism does it come from?

Answer 12

gamma haemolysin

staph aureus

Question 13

what is the treatment for VPL?

Answer 13

gentamycin

Question 14

what does VPL present with?

Answer 14

recurrent boils and/or haemorrhage pneumonia

Question 15

what is the treatment for staphylococcal scalded skin syndrome?

Answer 15

IV antibiotics i.e. flucloxacillin & IV fluids

Question 16

what is toxic shock syndrome?

Answer 16

when a bacteria releases its toxin and causes rapid onset of systemic symptoms which quickly progress and can be fatal

Question 17

what are the 2 different aetiologies of toxic shock syndrome?

Answer 17

staph aureus - associated with high absorbency tampons or small infections

strep - associated with deep seated strep infection i.e. necrotising fasciitis or erysipelas

Question 18

what increases your risk of IV cannula associated infection?

Answer 18

continuous infusion > 24 hours
cannula inset > 72 hours
cannula in lower limb
patients with neurological/neurosurgical problems

Question 19

after how many hours should you remove a cannula to minimise risk of cannula associated infection?

Answer 19

72 hours

Question 20

what infections require urgent attention?

Answer 20

necrotising fasciitis 
PVL
toxic shock syndrome 
cannula-associated infections
pyomyositis

Question 21

what organism(s) is responsible for type II necrotising fasciitis?

Answer 21

strep pyogenes

Question 22

what organism(s) is responsible for erysipelas?

Answer 22

strep pyogenes

Question 23

what organism(s) is responsible for cellulitis?

Answer 23

staph aureus

strep progenies

Question 24

what organisms are flucloxacillin active against?

Answer 24

streptococcal infections

Question 25

what are the systemic symptoms of necrotising fasciitis?

Answer 25

fever
hypotension
tachycardia
delerium 
multi organ failure

Question 26

what is the management of necrotising fasciitis?

Answer 26

sepsis 6
surgical fasciotomy
If type II then give antibiotics

Question 27

what are the predisposing factors for pyomyositis?

Answer 27

diabetes
HIV/immunosuppression  
IV drug abuse
rheumatological diseases
malignancy
liver disease

Question 28

what is pyomyositis?

Answer 28

purulent infection deep within skeletal muscle forming abscesses