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Y2 infection > skin and soft tissue infections > Flashcards

skin and soft tissue infections Flashcards

1
Q

what is impetigo

A

epidermis - superficial skin infection

highly infectious

e.g. S. aureus (more common), Strep pyogenes

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2
Q

what is folliculitis

A

circumscribed, pustular infection of a hair follicle

e.g. S. aureus

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3
Q

what is erysipelas

A

infection of the dermis

e.g. Strep pyogenes

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4
Q

what is cellulitis

A

diffuse infection of the deep dermis and subcutaneous fat

e.g. Strep pyogenes (common), S. aures (uncommon)

H. influenzae and other (rare)

role of gram -ve bacteria in diabetics and febrile neuropaths

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5
Q

what is necrotising fasciitis

A

infection of the subcutaneous fat and underlying fascia

e.g. Strep pypgenes or mixed bowel flora

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6
Q

things to consider in skin and soft tissue infections

A

site - possible complications w/ specific sites e.g. abdo, face

organism

host

environment

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7
Q

host factors to consider in skin and soft tissue infections i.e. predisposing factors

A

diabetes leading to neuropathy and vasculopathy

immunosuppression

renal failure

Milroy’s disease

predisposing skin conditions e.g. atopic dermatitis

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8
Q

environmental factors to consider in skin and soft tissue infections

A

drug resistant strains (MRSA)

drus interactions

drug allergies

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9
Q

appearance of impetigo

A

multiple vesicular lesions on an erythematous base

golden crust is highly suggestive of this diagnosis

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10
Q

what is this skin infection

A

impetigo

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11
Q

at what age is impetigo most common

A
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12
Q

where does impetigo usually occur

A

exposed parts of the body including face, extermities and scalp

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13
Q

predisposing factors to impetigo

A

skin abrasions

minor trauma

burns

poor hygiene

inset bites

chicken pox

eczema

atopic dermatitis

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14
Q

treatment of impetigo

A

small areas - topical abx

large areas - topical treatment + oral abx (flucloxacillin)

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15
Q

appearance of erysipelas

A

painful red area

no central clearing

associated

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16
Q

what is this skin infection

A

erysipelas

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17
Q

where does erysipelas tend to occur

A

70-80% - lower limbs

5-20% - face

tends to occur in areas of pre-existing lypmphoedema, venous stasis, obesity, paraparesis, DM

may involve intact skin

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18
Q

recurrence rate of erysipelas

A

high

30% within 3yrs

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19
Q

appearance and presentation of cellulitis

A

spreading erythematous area w/ no distinct borders

fever is common

regional lymphadenopathy and lymphangitis

possible source of bacteraemia

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20
Q

what skin infection is this

A

cellulitis

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21
Q

predisposing factors to cellulitis

A

DM

tinea pedis (athlete’s foot - common cause in otherwise healthy pts)

lymphoedema

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22
Q

what condition is this

A

lymphangitis

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23
Q

treatment of erysipelas and cellulitis

A

combination of anti-staphylococcal and anti-streptococcal abx

extensive disease - admission for IV abx and rest

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24
Q

hair associated infections (3)

A

folliculitis

furunculosis

carbuncles

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25
Q

what infection is this

A
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26
Q

appearance of folliculitis

A

up to 5mm diameter

present as small red papules

central area of purulence that may rupture and drain

typically found on head, back, buttocks and extremities

constitutional symptoms not often seen

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27
Q

furunculosis

A

aka boils

single hair follicle-associated inflamamtory nodule

extending into dermis and subcutaneous tissue

usally affected moist, hairy, friction-brone areas of the body (face, axilla, neck buttocks)

systemic symptoms uncommon

may spontaneously drain purulent material

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28
Q

what infection is this

A

furunculosis

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29
Q

common causative organism for furunculosis

A
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30
Q

risk factors for furunuculosis

A

obesity

DM

atopic dermatitis

chronic kidney disease

corticosteroid use

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31
Q

carbuncle

A

infection extends to involve mutliple furunucles

often located in back of neck, posterior trunk or thigh

multiseptated abscesses

purulent material may be expressed from multiple sites

consititutional symptoms common

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32
Q

what skin infection is this

A

carbuncle

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33
Q

treatment of hair associated infections

A

folliculitis - no treatment or topical abx

furunuculosis - no treatment or topical abx, oral abx may be necessary if not improving

carbuncles - hospital admission, surgery and IV abx

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34
Q

necrotising fasciitis

A

infectious disease emergency

any site may be affected

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35
Q

predisposing conditions to necrotising fasciitis

A

DM

surgery

trauma

peripheral vascular disease

skin popping

36
Q

type I necrotising fasciitis

A

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

typical organisms: streptococci, staphylococci, enterococci, gram -ve bacilli, clostridium

37
Q

what skin infection is this

A

Fuornier’s gangrene

38
Q

type II necrotising fasciitis

A

monomicrobial

normally associated w/ strep pyogenes

39
Q

what skin infection is this

A

type II necrotising fasciitis

40
Q

presentation of necrotising fasciitis

A

rapid onset

sequential development of erythema, extensive oedma and severe unremitting pain

haemorrhagic bulla, skin necrosis, crepitus may develop

systemic features: fever, hypotension, tachycardia, delirium and multi-organ failure

anaesthesia at site of infection is highly suggestive of necrotising fasciitis

41
Q

management of necrotising fasciitis

A

mandatory surgical review

imaging may help but coule delay treatment

broad spectrum abx - flucoloxacillin, gentamicin, clindamycin

17-40% overall mortality

42
Q

what is pymomyositis

A

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

infection is often 2y to seeding into damage muscle

43
Q

sites of pyomyositis

A

multiple sites involved in 15%

common sites: thigh, calf, arms, gluteal region, chest wall, psoas muscle

44
Q

presentation of pyomyositis

A

fever

pain

woody induration of affected muscle

untreated can lead to septic shock and death

45
Q

predisposing factors to pyomyositis

A

DM

HIV/immunocompromised

IV drug use

rhematological diseases

malignancy

liver cirrhosis

46
Q

causative organisms for pyomyositis

A

S. aureus is commonest

gram+ve/-ve, TB, fungi

47
Q

management of pyomyositis

A

investiagtion w/ CT/MRI

treatment: drainage and abx cover depending on gram stain and culture results

48
Q

what does this MRI show

A

pyomyositis of R thigh muscles

49
Q

septic bursitis

A

small sac-like cavities that contain fluid and are lined by synovial membrane

located subcutaneously between bony prominences or tendons

facilitate movement w/ reduced friction

most common include patellar and olecranon

50
Q

predisposing factors for septic bursitis

A

infection is often from adjacent skin infection

rheumatoid arthritis

alcoholism

DM

IVDU

immunosuppression

renal insufficiency

51
Q

what infection is shown here

A

pre-patellar septic bursitis

52
Q

presentation of septic bursitis

A

peribursal cellulitis, swelling and warmth

fever and pain on movement

53
Q

causative organisms of septic bursitis

A

diagnosis based on aspiration of fluid

most common cause - S. aureus

rarer - gram -ve, mycobacteria, brucella

54
Q

what is infectious tenosynovitis

A

infections of the synovial sheats that surround tendons

flexor muscle-associated tendons and tendon sheeth of the hand most commonly involved

55
Q

causes of infectious tenosynovitis

A

S. aureus and streptococci

penetrating trauma is most common inciting event

chronic infections due to mycobacteria, fungi

possibility of disseminated gonococcal infection

56
Q

presentation of infectious tenosynovitis

A

erythematous fusiform swelling of finger

held in semi-flexed position

tenderness over the length of the tendon sheath and pain w/ extension of finger

57
Q

treatment of infectious tenosynovitis

A

empirial abx

hand surgeon to review

58
Q

what causes toxin mediated syndromes

A

often due to superantigens

group of pyrogenic exotoxins

associated w/ use of high absorbency tampons

can also be due to small skin infections (Staph aureus secreting TSST1)

59
Q

immune response in toxin mediated syndromes

A

don’t activate immune system via normal contact between APC and T cells

superantigens bypass this and attach directly to the T cells receptors acivating up to 20% of the total pool of T cells (instead of normal 1/10 000)

massive burst in cytokine release

leads to endothelial leakage, haemodynamic shock, mutliorgan failure and death

60
Q

causative organsisms of toxin-mediated syndromes

A

some strains of Staph aureus (TSST1, ETA and ETB) and strep pyogenes (TSST1)

61
Q

diagnostic criteria for staphylococcal TSS

A

fever

hypotension

diffuse macular rash

3 of the following involved: liver, blood, renal, GI, CNS, muscular

isolation of Staph aureus from mucosal or normally sterile sites

production of TSST1 by isolate

development of antibody to toxin during convalescence

62
Q

what condition is shown here

A

toxic shock syndrome

63
Q

streptococcal TSS

A

almost always associated w/ presence of streptococci in deep seated infections e.g. erysipelas or necrotising fasciitis

mortality rate is much higher than staphylococcal - 50% vs 5%

treatment requires urgent surgical debridement of infected tissues

64
Q

treatment of TSS

A

remove offending agent e.g. tampon

IV fluids

inotropes

abx

IV immunoglobulins

65
Q

staphylococcal scalded skin syndrome

A

infection due to a particular strain of S. aureus producing the exfoliative toxin A or b

66
Q

presentation of staphylococcal scalded skin syndrome

A

widespread bullae and skin exfoliation

usually occurs in children, rarely in adults

67
Q

treatment of staphylococcal scalded skin syndrome

A

IV fluids and antimicrobials

mortality 3% in children, higher in adults who often are immunosuppressed

68
Q

what condition is this

A

staphylococcal scalded skin syndrome

69
Q

what is panton-valentine leucocidin toxin

A

gamma haemolysin

can be transferred from one strain of S. aureus to another, including MRSA

can cause SSTI and haemorrhagic pneumonia

70
Q

presentation of panton-valentine leucocidin toxin and treatment

A

tends to affect children and young adults

pts present w/ recurrent boils that are difficult to treat

treat w/ abx that reduce toxin production

71
Q

intravenous catheter associated infections

A

nosocomial infection

normally starts as local SST infection progressing to cellulitis and even tissue necrosis

common to have associated bacteraemia

72
Q

risk factors for intravenous catheter associated infections

A

continuous infusion >24hrs

cannula in situ >72hrs

cannula in lower limb

pts w/ neurological/neurosurgical problems

73
Q

causative organisms of intravenous catheter associated infections and how it spreads

A

staph aureas (MSSA and MRSA)

commonly forms a biofilm which then spills into bloodstream

can seed into other places (endocarditis, osteomyelitis)

diagnosis made clinically or by +ve blood cultures

74
Q

what infection is shown here

A

intravenous catheter associated infections

75
Q

treatment of intravenous catheter associated infections

A

remove cannula

express any pus from the thrombophlebitis

abx for 14 days

echocardiogram

prevention is more important

76
Q

prevention of intravenous catheter associated infections

A

don’t leave unused cannula

don’t insert cannula unless it will be used

change cannula every 72hrs

monitor for thrombophlebitis

use aseptic technique when inserting cannula

77
Q

class I surgical site infection

A

clean wound

resp, alimentary, genital or infected urinary systems not entered

78
Q

class II surgical site infection

A

clean-contaminated wound

resp/GI/genital/infected urinary tract entered but no unusual contamination

79
Q

class III surgical site infection

A

contaminated wound

open, fresh accidental wounds or gross spillage from GI tract

80
Q

class IV surgical site infection

A

infected wound

existing clinical infection

infection present before the operation

81
Q

what class fo surgical site infection is this

A

class I

82
Q

what class of surgical site infection is this

A

class IV

wet gangrene

diabetic foot amputation

83
Q

causes of surgical site infections

A

staph aureus (incl MSSA and MRSA) - most common

coagulase -ve staphylococci

enterococcus

E. coli

psudomonas aeruginosa

enterobacter

streptococci

fungi

anaerobes

84
Q

patient associated risk factors for surgical site infections

A

diabetes

smoking

obesity

malnutrition

concurrent steroid use

colonisation w/ staph aureus

85
Q

procedural risk factors for surgical site infections

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

86
Q

diagnosis of surgical site infections

A

send pus/infected tissue for cultures esp w/ clean wound infections

avoid superficial swabs - aim for deep structures

consider an unlikely pathogen as a cause if obtained from a sterile site e.g. bone infection

abx to target likely organisms

Y2 infection (15 decks)

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