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Skin infections and cellulitis Flashcards

1
Q

Two top bacterial cause of cellulitis?

A

S.aureus
Strep pyogenes A, C/G

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2
Q

Presentation of cellulitis

A

Unilateral
Red, hot, swollen
Lower leg
Acute
Tender to touch
May have close proximity to trauma - entry for bacteria
Ass w systemic symptoms
Can get abscess formation

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3
Q

Systemic red flags with cellulitis

A
  • Fever
  • Chills
  • Sweating
  • Dizziness, light headed
  • Drowsiness
  • Looks sick
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4
Q

At risk of cellulitis

A
  • Diabetes
  • Thin skin - less good blood supply
  • Older people
  • Prev cellulitis
  • Immobile
  • obesity
  • Chemotherapy
  • Immunosupressatns
  • Recent surgery
  • Pressure ulcers
  • Cuts in skin
    Lymphoedema
    Leg oedema
    Venous insuffienciency
    Pregnanyc
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5
Q

Complications cellulitis

A

Gangrene
Necrosis
Amputation
Sepsis
Septic shock

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6
Q

Investiations cellulitis

A

Swab and diagnose for bacteria (can rarely isolate - CLINICAL DIAGNOSIS)
Blood culutres if systemically unwell
D-dimer to rule out DVT

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7
Q

Mangement cellulitis

A

Flucloxacillin
Clindamycin or doxycycline if allergic to penicillin orally
Clindamycin or teicoplanin IV
Linezolid if MRSA history
Analgesia

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8
Q

Causative agent of eczema herpeticum

A

HSV1 or 2

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9
Q

What do you treat eczema herpeticum with?

A

Aciclovir

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10
Q

Erysipelas features

A

Symmetric, more superficial from of cellulitis. Disinguished by raised and well demarcated borders

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11
Q

What is cellulitis?

A

Acute bacterial infection of dermis spreading to SC tissue

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12
Q

Features of cellulitis

A

Pain, warmth, swelling, erythema
May have blosters and bullae
fever, malaise, nausea, rogirs

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13
Q

Other bacterial causes of cellulitis

A

Pseudomonas aeruginosa — following exposure to contaminated hot tubs, sponges, or nail puncture.
Vibrio vulnificus — following salt water exposure.
Aeromonas hydrophila — following fresh water exposure.
Erysipelothrix rhusiopathiae — in butchers, vets, or fish handlers.
Mycobacterium marinum — in aquarium keepers.
Pasteurella multocida and Capnocytophaga canimorsus — following cat or dog bites.
Eikenella corrodens — following human bite or fist injuries.
Streptobacillus moniliformis — following rat bite.
Streptococcus pneumoniae, Haemophilus influenzae, gram negative bacilli, and anaerobes — following injury, burns, and other co‐existing diseases (for example people who are immunocompromised, have diabetes, cancer, or malnutrition)

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14
Q

Risk factors for rapid progression cellulitis or delayed response to treatment

A

Conditions that predispose to infection, including diabetes mellitus, chronic liver or renal disease, immunocompromise, and neutropenia.
Chickenpox - varicella
Alcohol misuse
Neuropathy

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15
Q

Risk factors for recurrent cellulitis

A

Age
Prev cellulitis
Chronic lymphoedema - Saphenous venectomy for coronary artery bypass grafting.
Pelvic surgery or irradiation.
Lymphadenectomy or node dissection.
Mastectomy.

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16
Q

Acute complications of cellulitis

A

Deep seated infection eg necrotising fasciitis - deep SC and fascia
Myosistis - inflammation of muscle
Sespsis
Subcutaneous absecesses
Post strep nephritis

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17
Q

Chronic complciations of cellulitis

A

Persistent leg ulceration.
Lymphoedema (cellulitis causes lymphatic inflammation leading to permanent damage).
Recurrent cellulitis.

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18
Q

How is cellulitis classified

A

Eron classification - Class I-IV

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19
Q

Eron classification - each class

A

*Class I - no -signs systemic toxicity and person has no uncontrolled comorbidities
II - Systemically unwell or well witjh comorbidity
III - Systemic upset
IV - Sepsis or life threat infection eg NF

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20
Q

When do swab of cellulitis

A

Open wound
Penetrating injury
Obvious portal or microbial entry
Exposure to water bonre,outside UK
severe cellulitis
Often polymicrobial

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21
Q

Investigations

A

Often unceccessary
Swab
US - nonpurulent vs abscess, if drainable
Skin biopsy -
WCC, ESR, CRP
Tests to differentiate from septic arthritis, acute gout, DVT - D-dimer, urate

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22
Q

Common conditions presenting with unilateral redness and swelling

A

DVT
Septic arthritis
Acute gout
Ruptured bakers cyst
Thrombophlebitis
Cutaneous abscess
Erysipelas

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23
Q

Common chronic conditions presenting similaraly to cellulitis

A

Varicose eczema/venous insufficiency
Contact allergic dermatitis
Lipodermatosclerosis
Cutaneous small vessel vasculitis
Lymphoedema
Oedema with blisters
Panniculitis - SC adipose tissue

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24
Q

What is Wells syndrome?

A

Eosinophilic cellulitis
Large indurated erythematous plawues that develop over several weeks
blood eosinophilia
Cna lead to eosinphilic fasciitis

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25
Other differentials for cellulitis
Drug reaction Necrotising fasciitis Metastatic cnacer - carcinoma erysipeloides, most commonoly from breast cancer Wet gangrene - ischaemia of tissues with adjacent cellulitis Erythema nodosum Pyoderma gangrenosum
26
Urgent hospital admission for cellulitis
Has Class IV cellulitis (sepsis or severe life-threatening infection, such as necrotizing fasciitis). Has Class III cellulitis (significant systemic upset, such as acute confusion, tachycardia, tachypnoea, hypotension, or unstable comorbidities, or a limb-threatening infection due to vascular compromize). Has severe or rapidly deteriorating cellulitis (for example extensive areas of skin). Is very young (under 1 year of age) or frail. Is immunocompromized. Has significant lymphoedema. Has facial cellulitis (unless very mild). Has suspected orbital or periorbital cellulitis (admit to ophthalmology). Has Class II cellulitis (systemically unwell or systemically well but with a comorbidity). Admission may not be necessary if the facilities and expertise are available in the community to give intravenous antibiotics and monitor the person (check local guidelines). Has symptoms or signs suggesting a more serious illness or condition (such as osteomyelitis, or septic arthritis).
27
Primary care management of cellulitis
High dose oral antibiotic eg ' Paracetemol or ibuprofen for pain and fever Stay hydrated Elevate leg Safety net - if becomes worse or systemically more unwell Identify and manage comorbidities eg emollients, weight Review after 2-3 days
28
When consider prophylactic antibiotics?
More than 2 episodes in ayear
29
What antibiotic use for cellulitis if no signs of systemic infection and no uncontrolled comorbidities?
Flucloxacillin 500–1000 mg four times daily for 5–7 days (Clarithromycin, doxycycline or erythromycin if unsuitable)
30
What antibiotic prescribe for infection near eyes or nose?
co-amoxiclav 500/125 mg three times a day for 7 days. If unabailbale clarithromycin Metronidazole
31
What antibiotic use for patinets with known lymphoedema and cellulitis? What if evidence of S.aureus infection
Prescribe amoxicillin 500 mg three times daily. S.aureus - Flucloxacillin 500 mg four times a day in addition or replacement Penicillin alergy - clarithromiycin
32
Signs of S.aureus infection
Folliculitis Pus formation Crusted dermatitis
33
What causes erysipelas in children?
Haemophilias influenzae Otitis media
34
How treat severe cellulitis?
IV antibiotic
35
What is impetigo?
Superficial bacterial infection of skin Non bullous or bullous
36
Treatment for a furuncle
Mupiricin Fusidic acid Can develop into asbcess
37
How do you diagnose a meningococcal rash?
Lumbar puncture
38
What virus causes viral exanthem/roseola infantum?
HSV 6
39
What causes shingles?
Painful eruption in one dermatome Herpes zoster usually painful, itchy, and/or tingly,
40
How to treat shingles?
aciclovir, valaciclovir, or famciclovir in 72 hours from onset of rash If over 50 - reduce chance of postherpatic neuralgia
41
Pain management of shingles
Paracetemol +/- codeine NSAIDs If more severe - amitryptilline, duloxetine, gabapentin, pregabalin
42
When consider oral corticosteroid use in shingles?
first 2 weeks after rash onset Immunocompetent adults with localised shingles if pain is severe Must be in combination with antivirals
43
When is someone with shingles infectious?
Until all vesicles crusted over (5-7 days after rash onset)
44
Who is the shingles vaccine available to?
70, 78
45
Complications of shingles
Post herpatic neuralgia Superinfection of rash Herpes zoster oticus (Ramsay Hunt syndrome) Herpes zoster opthalmicus Peripheral motor neuropathy CNS complications - encephalitis, meningoencephalitis, myelitis, cerebilitis, Cerebrovascular disease, readiculitis, Guillian Barre syndrome CVS complications - vascular diseas, stroke, TIA, MI Systemic dissemination
46
What is ramsay Hunt syndrome?
Inflammation of teh geniculate ganglion of facial nerve VZV causes Facial paralysis, hearing loss in affected ear
47
What is Hutchinsons sign?
Shingles rash on tip, side or root of nose Indicates nasociliary branch involvement
48
What is herpes zoster opthalmicus?
Shingles of opthalmic division of trigeminal nerve
49
What can herpes zoster opthalmicus cause?
Keratitis, optic neuritis, retinitis, glaucoma, blindness if untreated
50
What can herpes zoster opthalmicus cause?
Keratitis, optic neuritis, retinitis, glaucoma, blindness if untreated
51
What type of drug is amitryptilline?
Used for neuropathic pain Tricyclic antidepressant with sedative effects
52
What is trigenmial neuralgia?
Sudden, severe facial pain. Shprt unpredicatable attacks. When normal function disrupted eg blood supply
53
How do boils appear
Firm, tender, erythematous nodules -> painful and fluctuant after a few days
54
Carbuncle presentation
Large, hard, red, dome shaped, v painful lump increases in size over a few days
55
How does impretigo develop?
Primary infection in otherwise helathy skin Complication of eczema, scabies, chickenpox
56
Causative organisms impetigo
S.aureus Strep pyogenes
57
Causative organisms impetigo
S.aureus Strep pyogenes
58
Treatment for impettigo?
Hydrogen peroxide 1% Fusidic acid 2% Mucipirocin 2% Both 3 x a day for 5 dyas
59
What is tinea capitus? What causes it?
Scalp fungal infection - scalp ring worm caused by Trichophyton tonsurans Common in children
60
What does high Hb mena on a blood test
Dehydration
61
Investiations for skin infections
Skin biopsy mycology
62
Treatment of tinea capitus
oral griseofulvin (licensed) or oral terbinafine Treat empirically at first, scraping results take 4-6 weeks
63
What is intertrigo? Where/who is it found ni?
Candida infections in skin folds of diabetics
64
What is scabies?
Intensely itchy skin infestation caused by human parasite sarcoptes scabiei Mite burrows into epidermis and tunnels through stratum corneum
65
Treatment for scabies
5% permethrin cream all over skin 8-10 hours moral ivermectin 200mcg/kg
66
Treatment for lice
Permethrin 1% solution
67
What is scabies?
Intensely itchy skin infestation caused by human parasite sarcoptes scabiei Mite burrows into epidermis and through stratum corneum
68
What is orbital cellulitis
fat and muscles posterior to the orbital septum, within the orbit but not involving the glob
69
What does orbital cellujlitis often originate from
URTI from sinuses High mortality rate
70
Risk factors for orbital cellulitis
Childhood Prev sinus infection Lack of haemophilus influenzae type B vaccination Recent eyelid infection/insect bite on eyelid -> peri orbital cellulitis Ear or facial infection
71
5 Ps of orbital cellulitis
Pain - throbbing o deep ache Intensifies with eye movements and can radiate Proptosis/exophtalmos - forawrd displacement or protrusion of eyeball Periocular swelling - oedema Pupil involvement and vision cahgnes - blurred, decreased acuity, diplopia, loss of vision, RAPD Palsy - opthalmoplega - imparied ete movements Additional = fever, malaise etc
72
What does RAPD being present in orbital cellulitis suggest
Optic nerve involvement
73
Investigations for orbital cellulitis
FBC - WCC, CRP etc Clinical exam + opthalmological assessment CT with contrast Blood culture and microbiological swb
74
Most common bacterial causes of orbital cellulitis
Strep, staph aureus, Hib
75
Management of orbital cellulitis
Admit to hospital for IV antibiotics Pre-orbital - oral antibiotics

Joints, bones and skin (31 decks)

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