Skin and Soft Tissue Infections Flashcards
1
Q
What bacteria like to live in areas with less aciditic pH?
A
- S. Aureus
- S. Pyogenes
2
Q
What is pictured here?
A
Impetigo
3
Q
A
4
Q
Describe impetigo?
A
- Gold crusty lesions in dermis
- Mostly in children
- Cauesed by S. Aureus
5
Q
What is the treatment for Impetigo?
A
- Usually self-limiting
- Topical fusidic acid
- Systemic antibiotics if required
6
Q
What is pictured here?
A
Tinea
7
Q
Describe Tinea?
A
- Fungal infection of skin/nails
- Diagnosis made on skin scrapings
8
Q
What are the most common causes of Tinea?
A
- Microsporum
- Trichophyton
- Epidermophyton
9
Q
What is the treatment for Tinea?
A
- Terbinfine cream
- Terbinafine or Itraconazole systemically
- If severe or involves hair/nails
10
Q
A
Soft tissue abscess
11
Q
Describe Soft Tissue Abscesses?
A
- Within dermis or fat layers
- Walled-off infection and pooled pus
12
Q
What is the treatment for soft tissue abscesses?
A
Surgical drainage
13
Q
A
Cellulitis
14
Q
Describe Cellulitis?
A
- Infection of dermis
- Begins in LLs then through lymphatics
- Caused by:
- S. aureus
- Beta-haemolytic streptococci
15
Q
What is used to classify cellulitis?
A
Enron Classification
16
Q
Describe the Enron Classification of Cellulitis?
A
17
Q
Describe Streptococcal Toxic Shock?
A
- Toxin producing Group A Strep.
- Diffuse rash
- Primary infection in throat or skin
18
Q
What is the treatment for Streptococcal Toxic Shock?
A
- Surgery to drain abscess
- Penicillin and Clindamycin
- Pooled human immunoglobulin in severe cases
19
Q
A
Necrotising fasciitis
20
Q
Describe Necrotising Fasciitis?
A
- Soft tissue infection with deep involvement
- Rapid, progressive damage
- Requires sugical debridement
21
Q
What are the signs/symptoms of Necrotising Fasciitis?
A
- Rapid progression
- Pain out of proportion to clinical signs
- Severe systemic upset
- Visible necrotic tissue
22
Q
Describe the use of imaging in Necrotising Fasciitis?
A
- May demonstrate fascial oedema and gas in soft tissues
- Late sign
23
Q
What are the different types of necrotising fasciitis?
A
- Type 1 - Polymicrobial
- Type 2 - Group A Streptococcus
24
Q
Describe type 1 Necrotising Fasciitis?
A
- Polymicrobial
- Usually complicates an existing wound
- Mix of gram positives, gram negatives and anaerobes
25
Describe type 2 Necrotising Fasciitis?
* Group A streptococcus
* Occurs in previously healthy tissue
* Can follow a minor injury
* *S. Pyogenes* only
26
Describe the antibiotic treatment for Necrotising Fasciitis?
* Broad spectrum therapy
* Flucloxacillin
* Benzylpenicillin
* Gentamicin
* Clindamycin
* Metronidazole
* Four black gentlemen carried money
27
Bite injury
28
What are the two major considerations in bite injuries?
* Penetrating injuries involving vulnerable structures (hands)
* Altered microbiology of wounds
29
Describe the treatment for bite injuries?
* 1st line antibiotic - Co-amoxiclav
* 2nd line antibiotics - Doxycycline and Metronidazole
* Surgical debridement
* Prophylaxis
* Rabies
* Tetanus
30
Hospital acquired infection
31
Describe Hospial Acquired Infections?
* At wounds and vascular access sites
* Consider MRSA infection
* Vancomycin for those colonised with MRSA
* Vascular access sites at high risk of bacteraemia
* Consider initial IV antibiotic treatment
32
Describe infections in people who inject drugs?
* Late presentation with neglected soft tissue infection
* *S. Aureus* predominates
* Offer BBV testing with admission
33
What is the triad in people who inject drugs?
* *S. Aureus* bactermia
* DVT
* Multiple pulmonary abscesses
34
What is PVL Staphylococcus?
* Virulence factor in some staphlococcus
* Recurrent soft tissue boils
* Transmissible
35
What do you do if you see this?
* Possible PVL staphlococcus
* Obtain cultures and ask lab to do PVL genotyping
36
What is the treatment for PVL staphylococcus?
* Surgical drainage of abscess
* Clindamycin reduce toxin production
* Decolonisation therapy to patient contacts
37
Decribe PVL staphylococcus decolonisation therapy?
* Topical chlorhexidine for skin/hair
* Nasal mupirocin
* Wash sheets and towels
38
Describe type 1 HSV?
Stomatitis cold sore
39
Describe type 2 HSV?
Genital herpes
40
How is HSV diagnosed?
Blood or vesicle fluid used for PCR
41
What is the treatment for HSV?
Topical/oral/IV aciclovir
42
What virus causes chicken pox?
Varicella zoster
43
Chickenpox
44
Describe chickenpox?
* Can be self-limiting or contagious (day 8-21 of infection)
* Childhood infection
* Congenital abnormalities if acquired during pregnancy
45
How is chickenpox diagnosed?
PCR of vesicle fluid
46
Describe the treatment of Chickenpox?
* Treat at risk adults within 48 hours of symptoms
* Immunocompromised
* Pneumonitis
* Pregnant
* Aciclovir IV
47
Shingles
48
What virus causes shingles?
Varicella zoster virus
49
Describe shingles?
* Reactivagtion of dormant VZV from DRG
* Dermatome distribution
* Transmissible
* Painful
50
Describe the treatment of Shingles?
* Treat only high-risk patients with Aciclovir
* Pain management
* NSAIDs
* Gabepentin
51
What should you consider in someone with Shingles infection?
HIV testing
52
Describe soft tissue infections that occur due to burns?
Colonisation caused by loss of protective barrier and commensal organisms
53
What are the 3 distinct zones of burns?
* Coagulation zone
* Stasis zone
* Hyperaemia zone
54
What increases the susceptibility to infections caused by burns?
Extent of burn injury
55
What is an important complication of paediatric thermal injuries?
Toxic shock syndrome
56
Name some oppurtunistic pathogens with take advantage of burns?
* *Bacillus*
* *Enterococcus*
* *Pseudomonas*
57
Describe the treatment of burn wound infections?
* Debridement of dead/infected tissue
* Antiseptics/Antimicrobials
* Tetanus prophylaxis
58
Which stage of Enron classification would this be?
1a
* Patient not systemically unwell and no significant co-morbidities
* Patient not yet received antibiotics or have been on antibiotics for less than 48 hours
59
What would be the treatment for Cellulitis class 1a?
* Patient not systemically unwell and no significant co-morbidities
* Patient not yet received antibiotics or have been on antibiotics for less than 48 hours
* Usually oral therapy for 7 days
* Treatment to cover *S. aureus and S. pyogenes*
* 1st line - Flucloxacillin
* 2nd line - Doxycycline
60
What is the treatment for stage II of Enron classification of Cellultiis?
(Patient systemically unwell or has signfiicant co-morbidities which may complicate infection
* IV therapy initially
* 1st line - Flucloxacillin
* 2nd line - Vancomycin
* Usually switched to oral after 46-72 hours
61
What is the treatment for stage III Enron classification of Cellulitis?
* Ambulatory care
* Daily antibiotics in ambulatory care unit
* IV Ceftriazone 2g
62
What is the treatment for stage IV of the Enron classification of cellulitis?
* Hospital admission for IV therapy
* Consider surgical management
* Regular clinical review
63
What are the complications of stage IV Enron classification of Cellulitis?
* Local
* Severe tissue destruction
* Distant
* Septic shock
64
Name some conditions which can mimic cellulitis?
* Bites
* Hospital acquired infections
* Infections in people who inject drugs
* PVL Staphylococcus aureus
