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Y4: Infectious Disease > Skin and Soft Tissue Infections > Flashcards

Skin and Soft Tissue Infections Flashcards

1
Q

What bacteria like to live in areas with less aciditic pH?

A
  • S. Aureus
  • S. Pyogenes
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2
Q

What is pictured here?

A

Impetigo

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3
Q
A
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4
Q

Describe impetigo?

A
  • Gold crusty lesions in dermis
  • Mostly in children
  • Cauesed by S. Aureus
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5
Q

What is the treatment for Impetigo?

A
  • Usually self-limiting
  • Topical fusidic acid
  • Systemic antibiotics if required
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6
Q

What is pictured here?

A

Tinea

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7
Q

Describe Tinea?

A
  • Fungal infection of skin/nails
  • Diagnosis made on skin scrapings
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8
Q

What are the most common causes of Tinea?

A
  • Microsporum
  • Trichophyton
  • Epidermophyton
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9
Q

What is the treatment for Tinea?

A
  • Terbinfine cream
  • Terbinafine or Itraconazole systemically
    • If severe or involves hair/nails
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10
Q
A

Soft tissue abscess

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11
Q

Describe Soft Tissue Abscesses?

A
  • Within dermis or fat layers
  • Walled-off infection and pooled pus
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12
Q

What is the treatment for soft tissue abscesses?

A

Surgical drainage

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13
Q
A

Cellulitis

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14
Q

Describe Cellulitis?

A
  • Infection of dermis
  • Begins in LLs then through lymphatics
  • Caused by:
    • S. aureus
    • Beta-haemolytic streptococci
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15
Q

What is used to classify cellulitis?

A

Enron Classification

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16
Q

Describe the Enron Classification of Cellulitis?

A
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17
Q

Describe Streptococcal Toxic Shock?

A
  • Toxin producing Group A Strep.
  • Diffuse rash
  • Primary infection in throat or skin
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18
Q

What is the treatment for Streptococcal Toxic Shock?

A
  • Surgery to drain abscess
  • Penicillin and Clindamycin
  • Pooled human immunoglobulin in severe cases
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19
Q
A

Necrotising fasciitis

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20
Q

Describe Necrotising Fasciitis?

A
  • Soft tissue infection with deep involvement
  • Rapid, progressive damage
  • Requires sugical debridement
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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
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22
Q

Describe the use of imaging in Necrotising Fasciitis?

A
  • May demonstrate fascial oedema and gas in soft tissues
  • Late sign
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23
Q

What are the different types of necrotising fasciitis?

A
  • Type 1 - Polymicrobial
  • Type 2 - Group A Streptococcus
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24
Q

Describe type 1 Necrotising Fasciitis?

A
  • Polymicrobial
  • Usually complicates an existing wound
  • Mix of gram positives, gram negatives and anaerobes
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25
Q

Describe type 2 Necrotising Fasciitis?

A
  • Group A streptococcus
  • Occurs in previously healthy tissue
  • Can follow a minor injury
  • S. Pyogenes only
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26
Q

Describe the antibiotic treatment for Necrotising Fasciitis?

A
  • Broad spectrum therapy
    • Flucloxacillin
    • Benzylpenicillin
    • Gentamicin
    • Clindamycin
    • Metronidazole
  • Four black gentlemen carried money
27
Q
A

Bite injury

28
Q

What are the two major considerations in bite injuries?

A
  • Penetrating injuries involving vulnerable structures (hands)
  • Altered microbiology of wounds
29
Q

Describe the treatment for bite injuries?

A
  • 1st line antibiotic - Co-amoxiclav
  • 2nd line antibiotics - Doxycycline and Metronidazole
  • Surgical debridement
  • Prophylaxis
    • Rabies
    • Tetanus
30
Q
A

Hospital acquired infection

31
Q

Describe Hospial Acquired Infections?

A
  • 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
Q

Describe infections in people who inject drugs?

A
  • Late presentation with neglected soft tissue infection
  • S. Aureus predominates
  • Offer BBV testing with admission
33
Q

What is the triad in people who inject drugs?

A
  • S. Aureus bactermia
  • DVT
  • Multiple pulmonary abscesses
34
Q

What is PVL Staphylococcus?

A
  • Virulence factor in some staphlococcus
  • Recurrent soft tissue boils
  • Transmissible
35
Q

What do you do if you see this?

A
  • Possible PVL staphlococcus
  • Obtain cultures and ask lab to do PVL genotyping
36
Q

What is the treatment for PVL staphylococcus?

A
  • Surgical drainage of abscess
  • Clindamycin reduce toxin production
  • Decolonisation therapy to patient contacts
37
Q

Decribe PVL staphylococcus decolonisation therapy?

A
  • Topical chlorhexidine for skin/hair
  • Nasal mupirocin
  • Wash sheets and towels
38
Q

Describe type 1 HSV?

A

Stomatitis cold sore

39
Q

Describe type 2 HSV?

A

Genital herpes

40
Q

How is HSV diagnosed?

A

Blood or vesicle fluid used for PCR

41
Q

What is the treatment for HSV?

A

Topical/oral/IV aciclovir

42
Q

What virus causes chicken pox?

A

Varicella zoster

43
Q
A

Chickenpox

44
Q

Describe chickenpox?

A
  • Can be self-limiting or contagious (day 8-21 of infection)
  • Childhood infection
  • Congenital abnormalities if acquired during pregnancy
45
Q

How is chickenpox diagnosed?

A

PCR of vesicle fluid

46
Q

Describe the treatment of Chickenpox?

A
  • Treat at risk adults within 48 hours of symptoms
    • Immunocompromised
    • Pneumonitis
    • Pregnant
  • Aciclovir IV
47
Q
A

Shingles

48
Q

What virus causes shingles?

A

Varicella zoster virus

49
Q

Describe shingles?

A
  • Reactivagtion of dormant VZV from DRG
  • Dermatome distribution
  • Transmissible
  • Painful
50
Q

Describe the treatment of Shingles?

A
  • Treat only high-risk patients with Aciclovir
  • Pain management
    • NSAIDs
    • Gabepentin
51
Q

What should you consider in someone with Shingles infection?

A

HIV testing

52
Q

Describe soft tissue infections that occur due to burns?

A

Colonisation caused by loss of protective barrier and commensal organisms

53
Q

What are the 3 distinct zones of burns?

A
  • Coagulation zone
  • Stasis zone
  • Hyperaemia zone
54
Q

What increases the susceptibility to infections caused by burns?

A

Extent of burn injury

55
Q

What is an important complication of paediatric thermal injuries?

A

Toxic shock syndrome

56
Q

Name some oppurtunistic pathogens with take advantage of burns?

A
  • ​Bacillus
  • Enterococcus
  • Pseudomonas
57
Q

Describe the treatment of burn wound infections?

A
  • Debridement of dead/infected tissue
  • Antiseptics/Antimicrobials
  • Tetanus prophylaxis
58
Q

Which stage of Enron classification would this be?

A

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
Q

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
A
  • Usually oral therapy for 7 days
  • Treatment to cover S. aureus and S. pyogenes
    • 1st line - Flucloxacillin
    • 2nd line - Doxycycline
60
Q

What is the treatment for stage II of Enron classification of Cellultiis?

(Patient systemically unwell or has signfiicant co-morbidities which may complicate infection

A
  • IV therapy initially
    • 1st line - Flucloxacillin
    • 2nd line - Vancomycin
  • Usually switched to oral after 46-72 hours
61
Q

What is the treatment for stage III Enron classification of Cellulitis?

A
  • Ambulatory care
    • Daily antibiotics in ambulatory care unit
    • IV Ceftriazone 2g
62
Q

What is the treatment for stage IV of the Enron classification of cellulitis?

A
  • Hospital admission for IV therapy
  • Consider surgical management
  • Regular clinical review
63
Q

What are the complications of stage IV Enron classification of Cellulitis?

A
  • Local
    • Severe tissue destruction
  • Distant
    • Septic shock
64
Q

Name some conditions which can mimic cellulitis?

A
  • Bites
  • Hospital acquired infections
  • Infections in people who inject drugs
  • PVL Staphylococcus aureus

Y4: Infectious Disease (18 decks)

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