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Year 3: Block 1: Infection > Skin and soft tissue infections > Flashcards

Skin and soft tissue infections Flashcards

1
Q

What is impetigo - what will it look like on the skin?

what organism is it due to?

A

Superficial skin infection
Multiple vesicular lesions on an erythematous base

  • face, scalp

GOLDEN CRUST

Staph aureus

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2
Q

Who is impetigo common in

A

children 2-5 years of age

Highly infectious

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3
Q

What are some predisposing factors of impetigo

A 
Skin abrasions
Minor trauma
Burns
Poor hygiene
Insect bites
Chickenpox
Eczema
Atopic dermatitis
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4
Q

treatment of impetigo - small vs large

A

topical antibiotics alone

Large areas need topical treatment and oral antibiotics (ex flucloxacillin)

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5
Q

What is Erysipelas

  • signs/symptoms
A

Infection of the upper dermis

Painful, red area (no central clearing)
Associated fever
Regional lymphadenopathy and lymphangitis
Typically has distinct elevated borders

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6
Q

What is Erysipelas most commonly caused by?

A

Strep pyogenes

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7
Q

Most cases of Erysipelas are on the

A

Lower limbs

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8
Q

What is cellulitis

A

skin infection involving deep dermis and subcutaneous fat

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9
Q

What does cellulitis present as

A

spreading erythematous area with no distinct borders

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10
Q

Most likely organisms of cellulitis

A

Strep pyogenes and Staph aureus

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11
Q

Gram negatives in cellulitis have a role with

A

diabetics and febrile neutropaenics

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12
Q

predisposing factors of cellulitis (3)

A

Diabetes mellitus
Tinea pedis
Lymphoedema

Patients can have lymphangitis and/or lymphadenitis

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13
Q

Treatment of erysipelas and cellulitis

A

combination of anti-staphylococcal and anti-streptococcal antibiotics

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14
Q

Treatment of erysipelas and cellulitis

A

combination of anti-staphylococcal and anti-streptococcal antibiotics

extensive = iv antibiotics and rest

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15
Q

Hair-associated infections (3)

A

Folliculitis
Furunculosis
Carbuncles

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16
Q

What is Folliculitis

what do they present as?

A

Circumscribed, pustular infection of a hair follicle

small red papule
- head , back , buttocks

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17
Q

Most common organism for folliculitis

A

Staph aureus

- benign condition

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18
Q

Furunculosis

A

Furuncles commonly referred as boils

  • single hair inflammatory nodule
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19
Q

most common organism for Furunculosis

A

staph aureus

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20
Q

Risk factors for Furunculosis

A 
Obesity
Diabetes mellitus
Atopic dermatitis
Chronic kidney disease
Corticosteroid use
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21
Q

What is a carbuncle

A

infection extends to involve multiple furuncles

  • neck, post trunk
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22
Q

Treatment of hair-associated infections

Folliculitis

A

no treatment or topical antibiotics

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23
Q

Treatment of hair-associated infections

Furunculosis

A

no treatment or topical antibiotics. If not improving oral antibiotics might be necessary

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24
Q

Treatment of hair-associated infections

Carbuncles

A

require admission to hospital, surgery and intravenous antibiotics

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25
Q

Necrotising fasciitis - features

A
  • infectious diseases emergencies
  • rapid onset
  • Any site may be affected

Anaesthesia at site of infection is highly suggestive of this disease

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26
Q

Predisposing conditions of Necrotising fasciitis include

A 
Diabetes mellitus
Surgery
Trauma
Peripheral vascular disease
Skin popping
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27
Q

Necrotising fasciitis - type 1

A

mixed aerobic and anaerobic infection (diabetic foot infection, Fournier’s gangrene)

28
Q

Typical organism of Necrotising fasciitis - type 1

A 
Streptococci
Staphylococci
Enterococci
Gram negative bacilli
Clostridium
29
Q

Necrotising fasciitis - type 2

- normally associated with

A

monomicrobial

Normally associated with Strep pyogenes

30
Q

Common signs of Necrotising fasciitis?

systemic features?

A

Sequential development of erythema, extensive oedema and severe, unremitting pain
Haemorrhagic bullae, skin necrosis and crepitus may develop

fever, hypotension, tachycardia, delirium and multiorgan failure

31
Q

Antibiotics for Necrotising fasciitis

A

Flucloxacillin
Gentamicin
Clindamycin

32
Q

What is Pyomyositis

A

Purulent infection deep within striated muscle, often manifesting as an abscess

33
Q

Common sites of Pyomyositis

A 
Thigh
Calf
Arms
Gluteal region
Chest wall
Psoas muscle
34
Q

How can Pyomyositis present

A

fever, pain and woody induration of affected muscle

35
Q

Pyomyositis if untreated, can lead to ?

A

septic shock and death

36
Q

Predisposing factors of Pyomyositis include

A 
Diabetes mellitus
HIV/immunocompromised
Intravenous drug use
Rheumatological diseases
Malignancy
Liver cirrhosis
37
Q

Most common cause of Pyomyositis

A

Staph aureus

38
Q

How to investigate Pyomyositis

A

CT/MRI

  • give antibiotics
39
Q

Septic bursitis - features

A

small sac-like cavities - fluid- synovial membrane

  • between bon prominences and tendons
40
Q

Septic bursitis - why do you get infection / predisposing factors

A

from adjacent skin infection

Other predisposing factors include
Rheumatoid arthritis
Alcoholism
Diabetes mellitus
Intravenous drug abuse
Immunosuppression
Renal insufficiency
41
Q

Septic bursitis - symptoms/diagnosis

A
  • Fever and pain on movement also seen
  • Diagnosis is based on aspiration of the fluid
  • Most common cause is Staph aureus
42
Q

Infectious tenosynovitis

A
  • synovial sheats that surround tendons

- penetrating trauma

43
Q

Infectious tenosynovitis - most common organism

A

cause Staph aureus and streptococci

Chronic infections due to mycobacteria, fungi
Possibility of disseminated gonococcal infection

44
Q

Infectious tenosynovitis - presentation?

A

erythematous fusiform swelling of finger
Held in a semiflexed position

  • tenderness of tendon
  • empiric antibiotics
45
Q

Toxin-mediated syndromes are often due to

A

superantigens

46
Q

Toxin-mediated syndromes are mostly due to

A

some strains of Staphylococcus aureus (TSST1) (ETA +B)

and Streptococcus pyogenes

47
Q

Diagnostic criteria for Staphylococcal TSS

A 
Fever 
Hypotension
Diffuse macular rash
Three of the following organs involved
Liver, blood, renal, gatrointestinal, CNS, muscular

ANTIBODY toxin
TSST1
isolation of staph aureus

48
Q

Streptococcal TSS s almost always associated with

A

presence of Streptococci

  • much higher mortality than streptococcal
  • URGENT surgical debridement
49
Q

Treatment of TSS (5)

A 
Remove offending agent (ex tampon)
Intravenous fluids
Inotropes
Antibiotics
Intravenous immunoglobulins
50
Q

Staphylococcal scalded skin syndrome is infection due to

A

particular strain of Staph aureus producing the exfoliative toxin A or B

51
Q

Staphylococcal scalded skin syndrome - treatment

A

intravenous fluids and antimicrobials

52
Q

Staphylococcal scalded skin syndrome is characterised by

A

widespread bullae and skin exfoliation

53
Q

What is the Panton-Valentine leucocidin toxin

can be transferred from?

A

gamma haemolysin

Staph aureus to another, including MRSA

54
Q

Panton-Valentine leucocidin toxin can go on to cause

A

SSTI and haemorrhagic pneumonia

55
Q

Panton-Valentine leucocidin toxin - patients present with

A

recurrent boils which are difficult to treat

Treat with antibiotics that reduce toxin production

56
Q

Intravenous-catheter associated infections - what type of infection?

Normally start off as what?

can have associated?

A

Nosocomial infection

SST inflammation progressing to cellulitis and even tissue necrosis

bacteraemia

57
Q

Risk factors for Intravenous-catheter associated infections (4)

A

Continuous infusion >24 hours
Cannula in situ >72 hours
Cannula in lower limb
Patients with neurological/neurosurgical problems

58
Q

Intravenous-catheter associated infections - most common organism? how do they work?

How is a diagnosis made

A

Staph aureus (MSSA and MRSA)

Commonly forms a biofilm which then spills into bloodstream

clinically or positive blood cultures

59
Q

Intravenous-catheter associated infections - treatment ?

A

to remove cannula
Express any pus from the thrombophlebitis
Antibiotics for 14 days
Echocardiogram

60
Q

Intravenous-catheter associated infection - methods of prevention (5)

A

Do not leave unused cannula
Do not insert cannulae unless you are using them
Change cannulae every 72 hours
Monitor for thrombophlebitis
Use aseptic technique when inserting cannulae

61
Q

Surgical site infections - what are the 4 classes

A

1 - clean wound
2- clean- contaminated
3- contaminated
4- infected wound

62
Q

List some Causes of Surgical site infections

A 
Staph aureus (incl MSSA and MRSA)
Coagulase negative Staphylococci
Enterococcus
Escherichia coli
Pseudomonas aeruginosa
Enterobacter
Streptococci
Fungi
Anaerobes
63
Q

Risk factors for surgical site infections - PATIENT associated

A 
Patient associated
Diabetes
Smoking
Obesity
Malnutrition
Concurrent steroid use
Colonisation with Staph aureus
64
Q

Risk factors for surgical site infection - Procedural factors (7)

A 
Shaving of site the night prior to procedure
Improper preoperative skin preparation
Improper antimicrobial prophylaxis
Break in sterile technique
Inadequate theatre ventilation
Perioperative hypoxia
65
Q

Diagnosis of surgical site infections (4 main)

A

Importance of sending pus/infected tissue for cultures especially with clean wound infections
Avoid superficial swabs – aim for deep structures
Consider an unlikely pathogen as a cause if obtained from a sterile site (ex bone infection)
Antibiotics to target likely organisms

Year 3: Block 1: Infection (14 decks)

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