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Microbiology > Skin Infection > Flashcards

Skin Infection Flashcards

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1
Q

What percentage of consultations in GP are skin related?

A

15%

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2
Q

What percentages of hospital attendances are due to skin related issues?

A

6%

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3
Q

What percentage of european population is referred to a dermatologist each year?

A

1%

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4
Q

What percentage of the population have a skin diseases requiring medical intervention?

A

20%

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5
Q

How do the rates of skin infections differ?

A

Higher rates in hot humid countries that are poorer

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6
Q

What percentage of skin related GP consultations are due to infection?

A

25%

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7
Q

What percentage of skin related dermatologist consultations are due to infection?

A

5%

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8
Q

What type of infection is staphylococcus aureus?

A

Gram positive bacterial infection, purple, looks like bunches of grapes down the microscope.
Contains a capsule.

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9
Q

What does commensal mean?

A

Bacteria that can be part of a normal flora on a human’s body.
S.aureus 20-30% will carry it and cause no disease.

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10
Q

What are the medical considerations of S.aureus?

A

Commensal
Skin infection - most common cause of skin infections, variety including wound infections.
MRSA - methicillin resistant S.aureus, doesn’t cause worse infection just harder to treat.
Toxin production
Bone, joint, lung infections - lung particularly after flu s.aureus usually causes the pneumonia after flu, can go onto cause sepsis too.

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11
Q

What toxins is S.aureus able to produce?

A

Panton valentine leuocidin - virulence factor, more aggressive necrotising soft tissue infection, inflammatory abscess that is necrotic.
Exfoliative toxin - Cleavage and blister formation in the higher levels of skin, pus within blisters, typical appearance of bullous impetigo.
TSST-1(toxic shock syndrome toxin 1) - patient becomes more toxic, features of septicaemia which is blood poisoning.
Enterotoxin - If someone else is contaminated by another persons skin infection and prepares food/contamination of food with s.aureus which is producing THIS toxin, it can cause diarrhoea, transmission through food.

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12
Q

What does infection of subcorneal layer of epidermis cause?

A 
Impetigo
Forms pustules and yellow crusty sores.
Honey coloured crusty erosion.
Common in children and young people around nose and mouth.
You can get impetigonised eczema
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13
Q

What does infection of the mouth of hair follicle cause?

A

Folliculitis
Anywhere except palms of hands and soles of feet.
pimples that come to white tips

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14
Q

What does infection of the full thickness of epidermis cause?

A 
Ecthyma
Surface of the skin has died so hard to pick off
crusted sores beneath which ulcers form.
Full thickness necrosis.
Insect bites or immunosuppressed at risk
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15
Q

What does infection of abscess of hair follicle cause?

A

Boil

At first skin turns red then a tender lump develops and starts turning white as pus collects under skin

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16
Q

What does an infection of several adjacent hair follicle abscesses cause?

A

Carbuncle
Cluster of boils that have multiple pus heads, tender and painful, can cause severe infection and potentially leave scarring.

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17
Q

In which demographic does staphylococcal scalded skin syndrome occur?

A

Children under the age of about five.
Toxin that produces this provokes an immune reaction.
Looks like skin peeling after sun burn but more severe.

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18
Q

What S.aureus disease type do children and adults develop?

A

Children - Staphylococcal scalded skin syndrome, systemic toxin that widespread scalding of surface of skin
Adults - bullous impetigo

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19
Q

How is staphylococcal scalded skin syndrome treated?

A

Antibiotics

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20
Q

How is S.aureus diagnosed?

A

Swab test from centre of lesion.

Usually responds to flucoxacillin if not then it’s MRSA

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21
Q

Give an example of a gram negative bacterial skin infection

A 
Treponema Pallidum
gram negative spirochaete
STD - syphilis
12 mil new cases a year worldwide
Increases transmission of HIV
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22
Q

What are the three stages of syphilis?

A

3-8 weeks Primary – painless ulcers (chancre) at site of inoculation.
6-12 weeks Secondary – disseminated infection with rash (maculopapular) and lymphadenopathy.
Latent – asymptomatic period. Can still be transmitted particularly if pregnant
usually years later Tertiary – skin (gummatous skin lesions, bone lesions), neurological and vascular manifestations.

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23
Q

What does the child of a syphilite have?

A

Congenital syphilis, wasn’t made clear if this is 100% transmission.
Acquired prenatal
Early and late manifestations
Transfer over placenta

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24
Q

Why can blood tests be misleading at primary stage of syphilis?

A

Can be negative

Swab from surface of the lesion, dark field electron microscopy to identify spirochaete

25
Q

What does secondary rash of syphilis typically involve?

A

Palms and soles

Warty lesions around peri-anal lesions,armpits and groins called condyloma lata teaming with spirochaetes

26
Q

What is a special characteristic of tertiary syphilis?

A

Thoracic aneurysm e.g. dilated aorta

27
Q

What are the effects of congenital syphilis?

A 
Miscarriage
Still birth
Prematurity
Rashes
Brain and neuro problems
Bone disease
Saddle shaped nose, skin and bony destructive lesions, peg like teeth, blindness, basically never seen nowadays.
28
Q

How does testing change throughout progression of syphilis?

A

Primary stage - serology may be negative swab will be positive
Secondary - serology will be positive here on out.
A feature of secondary syphilis from biopsy is plasma cells from rash biopsy

29
Q

What is treatment for syphilis?

A

Antibiotics, usually penicillin.

30
Q

What is Herpes virus family?

A

All DNA viruses

31
Q

Where do each of the Herpes simplex viruses have their effect?

A

Type 1 – causes oral infections, vermilion border.
Type 2 – causes genital infections.
Type 3 - Causes chickenpox
All types can live on in nerves/latent in nerves/neurons.

32
Q

What is synonym of HSV3?

A

Varicella zoster virus

33
Q

What is the clinical presentation of Herpes simplex (1/2)?

A

Vesicular rash (little blisters), painful, burn, tingle, form little ulcers and heal up after 2 weeks usually don’t score.
Stress/illness can cause reactivation due to latency in neurons.
Herpes encephalitis - inflammation of brain
Eczema herpeticum

34
Q

What is the structure of the herpes simplex virus (in to out)

A

DNA core
Capsid
Tegument (cytoplasm looking ass)
Envelope

35
Q

What can first encounter of Herpes cause?

A

Whole mouth inflammation.

Stomatitis HSV1

36
Q

Give an example of site of latency of HSV1?

A

Trigeminal nerve ganglion

37
Q

What antiviral medication used for HSV1/2?

A

Acyclovir
No vaccine available
Can come back recurrently.

38
Q

Who does varicella zoster usually affect?

A

Children

More serious in young adults and adults.

39
Q

How does varicella zoster present?

A

Has an incubation period of about a week.
Patient will feel unwell, malaise(feeling of discomfort), fever, possible sore throat
Then develop a rash, lots of little vesicles on an erythematous(redness) base in crops
Most concentrated on face then trunk then arms and legs.

40
Q

How can you make sure it’s chicken pox?

A

Usually have lesions in the mouth too.

41
Q

What can herpes zester especially cause in the elderly?

A

Pneumonia

Bad prognosis for elderly.

42
Q

Where can herpes zester become dormant/latent?

A

Dorsal root ganglia

Stress or other illness can cause reactivation but you just get rash across one dermatome.

43
Q

What happens if it affects ophthalmic branch of trigeminal?

A

Ophthalmic shingles
Most serious affect HSV3
There is a vaccine against chicken pox.

44
Q

What are the two types of superficial skin fungal infections?

A

Dermatophytes(types of mould) - e.g. trichophyton rubrum.
Grow in keratin (protein in skin hair and nails)
Long hyphae, grow from tip
Yeasts - candida which grow on warm wet surfaces single cells and bud, infections in body folds.

45
Q

What is tinea unguium?

A

Name of a clinical presentation caused by dermatophyte infection.
Affects the nails, yellow and crumbly and pigmented.

46
Q

What is tinea capitis?

A

Effect of the scalp of children, pre-puberty, caused by dermatophyte.
Post puberty no longer susceptible.
Crusty lesion on scalp.

47
Q

What is a kerion?

A

Localised tinea capitis on the head - boggy mass with pustules.
Fungal infection by dermatophytes, can develop lymphadenopathy.
Black kids more susceptible to fungal infection thought to be due to hair shape.

48
Q

What is tinea manuum?

A

Presentation when disease transmitted from an animal. Presentation on hand.
Dorsum of the hand.

49
Q

What is tinea pedis?

A

Fungal infection between the toes, same cause - dematophytes.
Chronically wet feet.

50
Q

Tinea cruris?

A

Skin of the groin but not the scrotum.

51
Q

Tinea facei?

A

Face

Probably off a pet.

52
Q

How are tinea infections diagnosed?

A 
Clippings of nail
Scrapings of rash
Pluckings of hair
Cultured or PCR, PCR is shorter
Treatment would be terbinafine (cream) unless in scalp or nails need tablets.
53
Q

What are scabies?

A

Sarcoptes scabei
Skin infestation caused by mites
Female burrows into skin and lays her eggs.
Burrows are within the stratum corneum.

54
Q

What is the key sign to diagnose scabies?

A

Burrow
A little squiggle 4mm long may have a black dot at the end, maybe seen at the finger webs
The black dot is the head of the mite.
Can take a scraping to look down a microscope slide.
Dermatoscope (torch/magnifying glass)

55
Q

Where are burrow sites usually found?

A

o The burrow sites are usually at – genital regions(usually lumps), nipples, wrists, finger webs, instep of feet, axilla. Instep

56
Q

Describe some of the things that occur with scabies

A

The mite burrows into the surface of the skin and exposure to the mite faeces and eggs cause a delayed-type allergic reaction resulting in widespread eczematous rash occurring ~4 weeks after first infestation, asymptomatic at first.
Usually very itchy.
Secondary bacterial infection is common.

57
Q

How is sarcoptes scabei transmitted and treated?

A

Skin to skin contact

Treated with topical systemic insecticides.

58
Q

What two types of rashes are you looking for in scabies?

A

Eczematous rash

Burrows

Microbiology (5 decks)

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