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Joints, bones and skin > Skin infections and cellulitis > Flashcards

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
Q

Other differentials for cellulitis

A

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

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26
Q

Urgent hospital admission for cellulitis

A

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).

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27
Q

Primary care management of cellulitis

A

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

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28
Q

When consider prophylactic antibiotics?

A

More than 2 episodes in ayear

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29
Q

What antibiotic use for cellulitis if no signs of systemic infection and no uncontrolled comorbidities?

A

Flucloxacillin 500–1000 mg four times daily for 5–7 days
(Clarithromycin, doxycycline or erythromycin if unsuitable)

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30
Q

What antibiotic prescribe for infection near eyes or nose?

A

co-amoxiclav 500/125 mg three times a day for 7 days.
If unabailbale clarithromycin
Metronidazole

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31
Q

What antibiotic use for patinets with known lymphoedema and cellulitis? What if evidence of S.aureus infection

A

Prescribe amoxicillin 500 mg three times daily.
S.aureus - Flucloxacillin 500 mg four times a day in addition or replacement
Penicillin alergy - clarithromiycin

32
Q

Signs of S.aureus infection

A

Folliculitis
Pus formation
Crusted dermatitis

33
Q

What causes erysipelas in children?

A

Haemophilias influenzae
Otitis media

34
Q

How treat severe cellulitis?

A

IV antibiotic

35
Q

What is impetigo?

A

Superficial bacterial infection of skin
Non bullous or bullous

36
Q

Treatment for a furuncle

A

Mupiricin
Fusidic acid
Can develop into asbcess

37
Q

How do you diagnose a meningococcal rash?

A

Lumbar puncture

38
Q

What virus causes viral exanthem/roseola infantum?

A

HSV 6

39
Q

What causes shingles?

A

Painful eruption in one dermatome
Herpes zoster
usually painful, itchy, and/or tingly,

40
Q

How to treat shingles?

A

aciclovir, valaciclovir, or famciclovir
in 72 hours from onset of rash
If over 50 - reduce chance of postherpatic neuralgia

41
Q

Pain management of shingles

A

Paracetemol +/- codeine
NSAIDs
If more severe - amitryptilline, duloxetine, gabapentin, pregabalin

42
Q

When consider oral corticosteroid use in shingles?

A

first 2 weeks after rash onset
Immunocompetent adults with localised shingles if pain is severe
Must be in combination with antivirals

43
Q

When is someone with shingles infectious?

A

Until all vesicles crusted over (5-7 days after rash onset)

44
Q

Who is the shingles vaccine available to?

A

70, 78

45
Q

Complications of shingles

A

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
Q

What is ramsay Hunt syndrome?

A

Inflammation of teh geniculate ganglion of facial nerve
VZV causes
Facial paralysis, hearing loss in affected ear

47
Q

What is Hutchinsons sign?

A

Shingles rash on tip, side or root of nose
Indicates nasociliary branch involvement

48
Q

What is herpes zoster opthalmicus?

A

Shingles of opthalmic division of trigeminal nerve

49
Q

What can herpes zoster opthalmicus cause?

A

Keratitis, optic neuritis, retinitis, glaucoma, blindness if untreated

50
Q

What can herpes zoster opthalmicus cause?

A

Keratitis, optic neuritis, retinitis, glaucoma, blindness if untreated

51
Q

What type of drug is amitryptilline?

A

Used for neuropathic pain
Tricyclic antidepressant with sedative effects

52
Q

What is trigenmial neuralgia?

A

Sudden, severe facial pain. Shprt unpredicatable attacks. When normal function disrupted eg blood supply

53
Q

How do boils appear

A

Firm, tender, erythematous nodules -> painful and fluctuant after a few days

54
Q

Carbuncle presentation

A

Large, hard, red, dome shaped, v painful lump increases in size over a few days

55
Q

How does impretigo develop?

A

Primary infection in otherwise helathy skin
Complication of eczema, scabies, chickenpox

56
Q

Causative organisms impetigo

A

S.aureus
Strep pyogenes

57
Q

Causative organisms impetigo

A

S.aureus
Strep pyogenes

58
Q

Treatment for impettigo?

A

Hydrogen peroxide 1%
Fusidic acid 2%
Mucipirocin 2%
Both 3 x a day for 5 dyas

59
Q

What is tinea capitus? What causes it?

A

Scalp fungal infection - scalp ring worm caused by Trichophyton tonsurans
Common in children

60
Q

What does high Hb mena on a blood test

A

Dehydration

61
Q

Investiations for skin infections

A

Skin biopsy
mycology

62
Q

Treatment of tinea capitus

A

oral griseofulvin (licensed) or oral terbinafine
Treat empirically at first, scraping results take 4-6 weeks

63
Q

What is intertrigo? Where/who is it found ni?

A

Candida infections in skin folds of diabetics

64
Q

What is scabies?

A

Intensely itchy skin infestation caused by human parasite sarcoptes scabiei
Mite burrows into epidermis and tunnels through stratum corneum

65
Q

Treatment for scabies

A

5% permethrin cream all over skin 8-10 hours moral ivermectin 200mcg/kg

66
Q

Treatment for lice

A

Permethrin 1% solution

67
Q

What is scabies?

A

Intensely itchy skin infestation caused by human parasite sarcoptes scabiei
Mite burrows into epidermis and through stratum corneum

68
Q

What is orbital cellulitis

A

fat and muscles posterior to the orbital septum, within the orbit but not involving the glob

69
Q

What does orbital cellujlitis often originate from

A

URTI from sinuses
High mortality rate

70
Q

Risk factors for orbital cellulitis

A

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
Q

5 Ps of orbital cellulitis

A

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
Q

What does RAPD being present in orbital cellulitis suggest

A

Optic nerve involvement

73
Q

Investigations for orbital cellulitis

A

FBC - WCC, CRP etc
Clinical exam + opthalmological assessment
CT with contrast
Blood culture and microbiological swb

74
Q

Most common bacterial causes of orbital cellulitis

A

Strep, staph aureus, Hib

75
Q

Management of orbital cellulitis

A

Admit to hospital for IV antibiotics
Pre-orbital - oral antibiotics

Joints, bones and skin (31 decks)

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