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Infection > Skin and Soft Tissue Infections > Flashcards

Skin and Soft Tissue Infections Flashcards

1
Q

What are the names of the infection sites for each skin compartment?

A
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2
Q

What are the organisms that cause skin infections, in each infection site?

A
  • impetigo- s aureus, strep pyogenes
  • foliculitis- s aureus
  • erysipelas- strep pyogenes
  • cellulitis- strep pyogenes, s aureus, h influenzae, other
  • necrotising fasciitis- strep pyogenes, mixed bowel flora
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3
Q

What are predisposing factors for impetigo?

A
  • skin abrasions
  • minor trauma
  • burns
  • poor hygiene
  • insect bites
  • chicken pox
  • eczema
  • atopic dermatitis

* common 2-5 yrs

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4
Q

What are the features of impetigo?

A
  • multiple vasicular lesions on erythematous base
  • golden crust
  • highly infectious
  • face, extremities, scalp
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5
Q

What is the treatment for impetigo?

A
  • small areas- topical antibiotics
  • large areas- topical + oral antibiotics
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6
Q

What are the predisposing factors for erysipelas?

A
  • lymphoedema
  • venous stasis
  • obesity
  • paraparesis
  • diabetes
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7
Q

What are the features of erysipelas?

A
  • painful, red area (no central clearing)
  • associated fever
  • lymphadenopathy, lymphangitis
  • distinct elevated borders
  • lower limbs, face
  • high recurrence rate (30%)
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8
Q

What is the treatment for erysipelas?

A
  • anti-staphlococcal + anti-streptococcal antibiotics
  • IV antibiotics
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9
Q

What are the predisposing factors for cellulitis?

A
  • diabetes
  • tinea pedis
  • lymphoedema
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10
Q

What are the features of cellulitis?

A
  • spreading erythematous area, no distinct borders
  • fever
  • lymphadenopathy, lymphangitis
  • possible source of bacteraemia
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11
Q

What is the treatment for cellulitis?

A
  • anti-staphlococcal + anti-streptococcal antibiotics
  • IV antibiotics
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12
Q

What are the features of folliculitis?

A
  • circumsribed, pustular
  • small red papules
  • central area of purulence, may rupture and drain
  • ≤ 5mm
  • head, back, buttocks, extremities
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13
Q

What is the treatment for folliculitis?

A
  • no treatment
  • topical antibiotics
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14
Q

What are the risk factors for furunculosis?

A
  • obesity
  • diabetes
  • atopic dermatitis
  • chronic kidney disease
  • corticosteroids
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15
Q

What are the features of furunulosis?

A
  • boils
  • extends into dermis + subcutaneous tissue
  • moist, hairy, friction prone areas- face, axilla, neck, buttocks
  • may spontaneously drain purulent material
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16
Q

What is the treatment for furunculosis?

A
  • no treatment
  • topical antibiotics
  • oral antibiotics
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17
Q

What are the features of carbuncles?

A
  • involve multiple furuncles
  • neck, posterior trunk, thigh
  • multiseptated abscesses
  • purulent material may be expressed from multiple sites
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18
Q

What is the treatment for carbuncles?

A
  • surgery
  • IV antibiotics
19
Q

What are predisposing conditions for necrotising fasciitis?

A
  • diabetes
  • surgery
  • trauma
  • peripheral vascular disease
  • skin popping
20
Q

What are the features of necrotising fasciitis?

A
  • rapid onset
  • erythema, extensive oedema, severe unremitting pain
  • haemorrhagic bullae, skin necrosis, crepitus
  • fever, hypotension, tachycardia, delirium, multi-organ failure
  • anaesthesia at site of infection

* type I- mixed aerobic + anaerobic infection
type II- monomicrobial

21
Q

What is the treatment for necrotising fasciitis?

A
  • surgical review
  • imaging
  • broad spectrum antibiotics
  • flucloxacillin, gentamycin, clindamycin
22
Q

What are predisposing factors for pyomitis?

A
  • diabetes
  • HIV/immunocompromised
  • IV drug use
  • rheumatological diseases
  • malignancy
  • liver cirrhosis
23
Q

What are the features of pyomitis?

A
  • purulent, in deep striated muscle
  • abscess
  • thigh, calves, arms, gluteal region, chest wall, psoas muscle
  • fever
  • pain
  • woody induration of affected muscle
  • septic shock, death
24
Q

What is the treatment for pyomitis?

A
  • CT/MRI
  • drainage with antibiotic cover
25
Q

What are predisposing factors for septic bursitis?

A
  • rheumatoid arthritis
  • alcoholism
  • diabetes
  • IV drug abuse
  • immunosuppression
  • renal insufficiency
26
Q

What are features of septic busitis?

A
  • peribursal cellulitis
  • swelling, warmth, pain on movement, fever
  • diagnosis from aspiration of fluid
  • staph aureus
27
Q

What are the features of infectious tenosynovitis?

A
  • synovial sheaths surrounding tendons
  • flexor muscle tendons + hands
  • erythematous fusiform finger swelling, held in semiflexed position, tenderness, pain on extension
  • penetrating trauma
  • staph aureus, streptococci
  • chronic infection- mycobacteria, fungi
  • disseminated gonococcal infection
28
Q

What is the treatment for infectious tenosynovitis?

A
  • empirical antibiotics
  • hand surgeon
29
Q

What is the pathophysiology of toxin-mediated syndromes?

A
  • pyrogenic endotoxins
  • superantigens
  • endothelial leakage, haemodynamic shock, multi-organ failure, death
  • staph aureus, strep pyogenes
30
Q

What are the features of staphylococcal toxic shock syndrome?

A
  • fever
  • hypotension
  • diffuse macular rash
  • involves 3 of; liver, blood, renal, GI, CNS, muscular
  • TSST1 produced by isolate
  • develop antibody to toxin during convalescence
31
Q

what are the features of streptococcal toxic shock syndrome?

A
  • streptococci in deep seated infections, erysipelas, necrotising fasciitis
  • 50% mortality rate
32
Q

What is the treatment for toxic shock syndrome?

A
  • remove offending agent
  • IV fluid
  • inotropes
  • antibiotics
  • IV immunoglobulins
33
Q

What are the features of staphylococcal scaled skin syndrome?

A
  • staph aureus produce exfoliative toxin A/B
  • widespread bullae, skin exfoliation
  • children
34
Q

What is the treatment for staphylococcal scalded skin syndrome?

A
  • IV fluids
  • antimicrobials
35
Q

What are features of Panton-Valentine leucocidin toxin?

A
  • gamma haemolysin
  • staph aureus
  • SSTI, haemorrhagic pneumonia
  • children, young adults
  • recurrent boils, difficult to treat
36
Q

What is the treatment for Panton-Valentine leucocidintoxin?

A
  • antibiotics that dec. toxin production
37
Q

What are risk factors IV-catherter associated infections?

A
  • continuous infusion > 24 hrs
  • annula in situ > 72 hrs
  • cannula in lower limb
  • neurological/neurosurgical problems
38
Q

What are the features of IV-catheter associated infections?

A
  • nosocomial infection
  • local SST inflammation -> cellulitis -> necrotising fasciitis
  • associated bacteraemia
  • staph aureus (MRSA, MSSA)
  • endocarditis, osteomyelitis
39
Q

What is the treatment for IV-catheter associated infections?

A
  • +ve blood culture
  • echocardiogram
  • remove cannula
  • express any pus from thrombophlebitis
  • antibiotics (14 days)
40
Q

What are the different classifications of surgical site infections?

A
  • class I- clean wound
  • class II- clean-contaminated wound
  • class III- contaminated wound
  • class IV- infected wound
41
Q

What are different causes of surgical site infections?

A
  • staph aureus (MSSA, MRSA)
  • coagulase negative staphylococci
  • enterococcus
  • e coli
  • pseudomonas aeruginosa
  • enterobacter
  • streptococci
  • fungi
  • anaerobes
42
Q

What are risk factors for surgical site infections?

A
  • diabetes
  • smoking
  • obesity
  • malnutrition
  • concurrent steroid use
  • colonisation with staph aureus
  • shaving site night before procedure
  • improper preoperative skin preparation
  • improper antimicrobial prophylaxis
  • break in sterile technique
  • inadequate theatre ventilation
  • perioperative hypoxia
43
Q

What is the treatment for surgical skin infections?

A
  • pus/infected tissue cultures, swab deep structure
  • antibiotics

Infection (9 decks)

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