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ID Review > Skin and Soft Tissue Infections > Flashcards

Skin and Soft Tissue Infections Flashcards

1
Q

What is nonbullous impetigo?

A

Honey-yellow crusted lesions likely due to GAS

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2
Q

What is bullous impetigo

A

There are superficial flaccid bullae which rupture and give rise to crusted lesions. Due to toxin producing staph aureus.

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3
Q

Complication of strep impetigo?

A

Post strep glomerulonephritis

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4
Q

Skin soft tissue coverage for MRSA orally? [3]

A
  1. Bactrim
  2. Clinda
  3. Doxy
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5
Q

Treatment of folliculitis

A
  • Mupirocin for mild infections

- Antistaph abx for more severe infections

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6
Q

What is “swimmers itch”

A

Due to avian schistosomes. Molluscan intermediate hosts release cercaria that trigger an allergic reaction within human hair follicles and pores after freshwater exposure.

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7
Q

Treatment of swimmers itch?

A

Topical corticosteroids

Antipruritics

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8
Q

What is a carbuncle?

A

Several furuncles [boils] which have merged

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9
Q

Empiric management of a carbuncle

A
  1. I and D
  2. Culture material
  3. Empiric treatment with MRSA coverage
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10
Q

Oral MRSA options for SSTI? [3]

A
  1. Bactrim
  2. Doxy
  3. Clinda
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11
Q

IV options for MRSA SSTI? [4]

A
  1. Vanco
  2. Dapto
  3. Linezolid
  4. Ceftaroline
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12
Q

Complication of a carbuncle/furuncle on the face/nares?

A

Septic cavernous sinus thrombosis

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13
Q

Presentation of cavernous sinus thrombosis?

A

HA, fever. periorbiral edema, ptosis, proptosis, chemosis, CN III, IV, V, VI [3-6] dysfunction

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14
Q

What area does erysipelas effect?

A

Upper dermis and superficial lymphatics

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15
Q

Etiology of erysipelas

A

GAS

Other beta-hemolytic strep

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16
Q

Erysipelas presentation

A

Raised, well demarcated erythematous indurated lesion of the face or lower extremities which is acute onset. May haver fever and chills.

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17
Q

Treatment of mild erysipelas

A
  1. oral penicillin [penicillin V, amoxicillin]
  2. Cephalexin
  3. Clinda
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18
Q

Treatment of moderate to severe erysipelas

A
  1. IV penicillin G
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19
Q

What area does cellulitis effect?

A

Deeper dermis and subcutaneous tissue

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20
Q

If cellulitis has fever and chills it is more likely due to what organism?

A

Strep.

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21
Q

Complication of lower extremity cellulitis?

A

Thrombophlebitis

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22
Q

Complication of orbital cellulitis? [4]

A
  1. Orbital abscess
  2. Subperiosteal abscess
  3. Brain abscess
  4. Septic cavernous sinus thrombosis
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23
Q

What is type 1 necrotizing fasciitis?

A

Mixed aerobic [Enterobacteriaceae] and anaerobic [Fusobacterium, peptostreptococcus, Bacteroiddes, Clostridum]

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24
Q

What is type 2 necrotizing fasciitis?

A

Monomicrobical infection with GAS, Staph aureus, aeromonas hydophilia or vibrio vulnificus

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25
Q

How often are blood cultures positive in necrotizing fasciitis?

A

Only 25% [more frequent than cellulitis though]

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26
Q

Work up of necrotizing fasciitis

A

CT scan if suspected to look for gas and edema along the fascial planes
MRI is too slow

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27
Q

What is the LRINEC? [6]

A

Laboratory risk indicator for necrotizing fasciitis, includes..

  1. CRP
  2. Leukocytosis
  3. Anemia
  4. Hyponatremia
  5. Renal insufficency
  6. High serum glucose
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28
Q

Treatment of necrotizing fasciitis

A
  1. Surgical debridement

2. Broad spectrum abx

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29
Q

What are the acceptable abx combinations empirically in necrotizing fasciitis [3]

A
  1. Pip-tazo + Vanco
  2. Cefipime + Flagly + Vanco
  3. Meropenem + Vanco

–> Add clinda to all therapy

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30
Q

What is pyomyositis?

A

Primary skeletal muscle abscess

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31
Q

Etiology of pyomyositis?

A

Staph aureus

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32
Q

Presentation of pyomyositis?

A

Fever with localized skeletal muscle swelling, tenderness, and fluctuance which progress in severity over time.
Sepsis wil develop

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33
Q

What type of infection is associated with pyomyositis? [2]

A
  1. HIV

2. Toxocariasis

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34
Q

Where is pyomyositis most common [region]

A

Tropics

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35
Q

Role of imaging in pyomyositis

A
  1. X-ray may show gas and edema
  2. CT and US identify abscess formation
  3. MRI is sensitive for focal muscle edema prior to abscess formation and mapping the extent of infection in detail
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36
Q

Treatment of pyomyositis [2]

A
  1. Surgery

2. Vancomycin

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37
Q

Complication of pyomyositis?

A

Compartment syndrome, esp if anterior tibial compartment is involved.

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38
Q

How does clostridium myonecrosis present?

A

Muscle pain out of proprotion to physical exam findings

Progresses to tense muscle swelling, crepitation, skin discoloration [red to purple] with bullae

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39
Q

Who gets clostridium myonecrosis? [5]

A
  1. Contaminated open fractures
  2. Penetrating wounds
  3. Bowel or biliary tract surgical wound complication
  4. Septic abortion
  5. Black tar heroin use [skin popping]
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40
Q

Who gets C. septicum myonecrosis? [2]

A
  1. GI malignancy

2. neutropenic colitis

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41
Q

Role of imaging in clostridium myonecrosis

A
  1. CT and X-ray will show gas and edema along fascial planes
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42
Q

Treatment of clostridium myonecrosis

A
  1. Surgery
  2. Empiric is same as nec fasc
  3. Targeted: Penicillin G and clindamycin combination
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43
Q

Bacteria associated with leech therapy?

A

Aeromonas hydrophila

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44
Q

Bacteria associated with freshwater and estuarine [brackish] water?

A

Aeromonas hydrophila

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45
Q

Treatment of Aeromonas hydrophila?

A
  1. 3rd gen cephalosporin
  2. Bactrim
  3. Fluoquinolone
46
Q

Who should receive prophylactic therapy for aeromonas infection and with that?

A

Leech therapy

Cipro

47
Q

Risk factors for vibrio vulnificus infection?

A

Exposure to salt or brackish water

Handling or ingesting raw or undercooked shellfish

48
Q

Presentation of vibrio vulnificus infection [3]

A
  1. SSTI
  2. Necrotizing SSTI
  3. Septicemia following ingestion in those with liver disease or hemochromatosis
49
Q

Treatment of vibrio vulnificus infection?

A

Doxy + Ceftriaxone

May convert to Cefotaxime PO

50
Q

Utility of blood cultures in vibrio vulnificus infection?

A

GOOD utility. Def get them.

51
Q

What type of exposure is mycobacterium marinum a/w? [2]

A

Aquarium

Swimming pools

52
Q

Presentation of mycobacterium marinum?

A

Minor skin trauma followed by aquatic exposure leads to small , violet papules that ulcerate superficially and scar over several weeks

53
Q

Treatment of mycobacterium marinum

A

Clarithromycin with either ethambutol of rifampin for 3-4 months.

54
Q

Percent of dog bites that become infected?

Cat bites?

A
  1. 5%

2. 80%

55
Q

Bacteria a/w dog and cat bites?

A
  1. Pasteurella
  2. Capnocytophaga canimorsus [dogs]
  3. Anaerobes
  4. Strep
  5. Staph
  6. Barontella henselae [cats]
56
Q

Treatment of a dog/cat bite? [4]

A
  1. Augmentin
  2. Cipro + clinda [alt]
  3. Bactrim + clinda [alt]
  4. Doxy + clinda [alt]
57
Q

Who gets severe capnocytophaga?

A
  1. Asplenics

2. Cirrhotics

58
Q

Etiology of human bite infection? [3]

A
  1. Staph
  2. Strep
  3. Anaerobes [Eikenalla corrodens]
59
Q

Treatment of human bite? [2]

A

Augmentin

Unasyn +/- vanco if severe

60
Q

Bites that predispose to Aeromonas hydrophila? [3]

A
  1. Leech
  2. Alligator
  3. Snake
61
Q

Bites that predispose to vibro?

A

Shark

62
Q

Bites that predispose to serratia marcescens?

A

Iguana

63
Q

What might a macaque bite transmit?

A

B virus [a herpesvirus]

64
Q

Treatment of a macaque bite?

A

Postexposure prophylaxis with valavivlovir or aciclovir

65
Q

Presentation of B virus infection

A

Vesicles or ulcers at site of bite, flu like illness.

May lead to fatal encephalomyelitis

66
Q

Punctures through rubber-soled shoe is a/w what organism?

A

Pseudomonas. May cause septic arthritis and osteomyelitis

67
Q

Traumatic wounds sustained after MVA [motorcyclists and unrestrained passengers], natural disasters, and military blast injuries are a/w what type of infection? [3]

A
  1. Mucorales
  2. Aspergillus
  3. Fusarium
68
Q

Etiology of infection in early burns?

A

Staph and strep

69
Q

Etiology of infection late in burns?

A
  1. Pseudomonas
  2. Acinetobacter
  3. Enterobacteriaceae
70
Q

Diagnosis of burn wound sepsis

A
  1. Clinical features

2. Burn wound biopsy demonstrating bacterial count >10^5

71
Q

Etiology of surgical site infections

A
  1. Staph [coag neg and aureus]
  2. Pseudomonas
  3. Enterococcus
72
Q

What should be considered in surgical site infections that develop rapidly within the first 48 hours of surgery? [2]

A
  1. GAS

2. Clostridium

73
Q

When is a surgical site infection attributed to surgery?

A

If infection develops within 30 days

Window is longer with prosthetics

74
Q

Presentation of cutaneous anthrax?

A

Pruritic papules evolve into vesicles and bullae that ulcerate leaving behind a painless black eschar with surrounding induration.

75
Q

Exposure that predisposes to anthrax?

A

Wool, animal hides

76
Q

Treatment of cutaneous anthrax and how long? [2]

A
  1. Cipro
  2. Doxy

60 days of therapy

77
Q

Presentation of erysipelothrix rhusiopathiae infection?

A

Cellulitis leading to painful violaceous lesions with associated lymphangitis. Looks like erysipelas but occurs slowly.

78
Q

What exposures put the patient at risk for erysipelothrix infection?

A
  1. Shrimp
  2. Crab
  3. Fish
  4. Animal meat and hides.
79
Q

Treatment of mild erysipelothrix infection?

A
  1. Penicillin V
  2. Cephalexin
  3. Cipro
80
Q

Treatment of severe erysipelothrix infection? [3]

A
  1. IV Pen G
  2. Ceftriaxone
  3. Imipenem
81
Q

What are dermatophytosis?

A
  1. Epidermophyton
  2. Microsporum
  3. Trichophyton

–> Causes “tinea”

82
Q

Treatment of tinea except capitis or unguium

A
  1. Topical azoles [itraconazole, fluzonazole]
  2. Oral azoles if refactory

–> Topical nystatin DOES NOT WORK.

83
Q

Treatment of tinea capitis or unguium

A
  1. Terbinafine

2. Griseofluvin

84
Q

Treatment of sporotrichosis?

A

Itraconazole

85
Q

What is toxic shock syndrome?

A

Superantigen mediated disease due to toxic shock syndrome toxin-1 and enterotoxins produced by toxigenic staph aureus

86
Q

What is erythroderma?

A

Painless sunburn like rash that gives way to desquamation in toxic shock syndrome.

87
Q

Treatment of toxic shock syndrome?

A

Vanco + clinda or linezolid
IVF
Removal of retained foreign body

88
Q

What is streptococcal toxic shock syndrome?

A

Superantigen mediated disease due to exotoxins produced my GAS
Rash is less pronounced than in staph toxic shock.

89
Q

Risk factors for strep toxic shock? [3]

A
  1. Vaginal or c-section
  2. Viral infection
  3. Traumatic injury
90
Q

Blood cultures of strep vs staph toxic shock.

A
  1. Step toxic shock has cultures positive in about 60%.

2. Staph toxic shock rarely has positive cultures

91
Q

Treatment of strep toxic shock syndrome?

A

Penicillin in combination with clindamycin
IVF
Surgical debridement of infected wounds

92
Q

Morality of staph vs strep toxic shock?

A

Staph <5% mortality

Strep 20-45% mortality

93
Q

What is staph scalded skin syndrome

A

Bilstering disease due to exfoliative toxin A or B produced by toxigenic staph

94
Q

Presentation of SSSS?

A

Superficial scarlatiniform rash that rapidly progresses to large flaccid bullae that rupture easily giving way to widespread exofliation exposing bright red areas of skin. Fever and skin tenderness are common. More common in children and neonates.

95
Q

Clinical criteria of Strep Toxic Shock?

A
  1. Hypotension
  2. Multiorgan involvement with at least 2 systems
    - Cr 2x ULN
    - Platelets <100,000 or DIC
    - ALT/AST 2x ULN
    - ARDS
    - Characteristic Rash
    - Soft tissue necrosis
96
Q

Lab criteria of Strep Toxic Shock?

A

Isolation of GAS

97
Q

Probable diagnosis of Strep Toxic Shock

A

All clinical criteria met with no other etiology and GAS isolated from a non-sterile site.

98
Q

Confirmed Strep Toxic Shock

A

All clinical criteria met and GAS isolated from a sterile site. [Blood, CSF, synovial fluid, pleural or pericardial fluid].

99
Q

Clinical criteria of staph toxic shock?

A
  1. Fever
  2. Diffuse macular erythroderma with desquamation 1-2 weeks after onset
  3. Hypotension
  4. Multiorgan involvement with 3 or more systems
100
Q

Laboratory criteria for staph toxic shock?

A
  1. Negative blood or CSF culture [or staph grews]
  2. Negative work up for…
    - RMSF
    - Lepto
    - Measles
101
Q

Probable vs confirmed Toxic Stock?

A
  1. 4 or more clinical criteria + lab criteria met

2. 5 clinical criteria + lab criteria [unless patient dies before desquamation

102
Q

Etiology of rat bite fever?

A
  1. Streptobacillus moniliformis [USA]

2. Spirillium minus [Asia]

103
Q

Presentation of rat bite fever?

A

Fever, rash that is macular/papular petechial/pustular with symmetric polyarthralgia

104
Q

Treatment of rat bite fever?

A
  1. Penicillin

2. Doxy [if pen allergic]

105
Q

Eikenella gram stain?

A

Pleomorphic gram negative rods.

106
Q

Ddx of folliculitis? [5]

A
  1. Staph
  2. Pseudomonas
  3. Malassezia furfur
  4. Candida albicans [obese, hospitalized]
  5. Idiopathic eosinophilic pustular folliculitis in AIDS patient
107
Q

Treatment of impetigo?

A
  1. Topical mupirocin
108
Q

NOTE:

A

Erysipelas on the face CANNOT be differentiated [strep or staph] due to the loose subcutaneous tissue. TREAT AS STAPH.

109
Q

Diagnosis of erysipelothrix?

A

Culture of the deep dermis

110
Q

Gram stain of erysipelothrix?

A

Gram + rod.

111
Q

Difference between SSSS and TEN

A
  1. Intraepidermal split is SSSS

2. Dermal epidermal junction is TEN

112
Q

Organisms whose growth is stimulated by iron excess? [6]

A
  1. Vibrio vulnificus
  2. E. coli
  3. Listerisa
  4. Aeromonas
  5. Rhizopus
  6. Yersenia

“VELARY”

ID Review (25 decks)

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