Skin, Soft Tissue And Bone Infections Flashcards by selcan icli

Name the skin layers starting from the outer layer to the inner layer

Epidermis
Dermis
Subcutaneous

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What features does the epidermis have

Waterproof

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What features does the dermis have

Connective tissue
Sweat glands
Hair follicles

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What features does the subcutaneous layer have

Fat

Connective tissue

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Which bacteria can colonise onto the skin

Staphylococci: staph aureus
Streptococci: group a (s.pyogenes)
Corynebacteria

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When does infection occur in the skin

When the immune system is overcome e.g the physical barrier

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Which cells are involved in the innate defeneces of the skin

Macrophages
Langerhans
Lymphocytes
Antibodies

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Name a infection that tends to occur in the face

Impetigo/folliculitis

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What is impetigo

A golden crusting rash on the face

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What is folliculitis

Infection of the hair follicles

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Which organism tends to cause impetigo/folliculits

S.aures

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What is cellulitis

Infection of the skin and the subcutaenous tissues i.e it is deeper infection

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When can cellulitis occur

When the skin is breached

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How does bacteria breach the skin

Bacteria penetrate the skin
Bacteria multiple in the skin
Host fails to control the multiplication to cause cellulitis

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What are the risk factors for cellulitis

Poor blood supply: arterial, venous or lymphatic
Diabetes
Immunosuppressed: chemotherapy, steroid use, malnutrition

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Where does cellulitis commonly occur in the body

arms and legs i.e limbs

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Give examples when the skin can be breahed

Cut
Scratch
Ulcers
Athletes foor 
Burns 
Foreign bodies e.g drains 
Eczema

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What are the local symptoms of cellultis

Redness
Warmth
Pain
Swelling

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What are the systemic symptoms of cellulitis

Fever
Malasie
Chills

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What investigations can we do for cellulitis

Bloods: FBC, CRP- Raised WBC
Superficial swab
Blister fluid
Blood culture- take if the patient is febrile and unwell

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What is erysipelas

A subgroup of cellulitis that is limited to the dermis therefore does not include the subcutaenous tissue and is superficial

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What is the feature of erysipelas

Demarcated and raised

Which organism tends to cause erysipelas

streptococci

What is the treatment of erysipelas

Penicillin

Clindamycin

What is the management of cellulitis

Broad specturm antibiotics as we dont known the organism to direct the antibitoics towards

What is the organism for cellulitis likely to be

Staph aueres | Streptococci

In cellulitits if there is MRSA positive what is the treatment

Vancomycin | Co trimoxazole/clindaymycin

In cellulitis if its MRSA negative what is the treatment

Beta lactams e.g flucloxacillin | Macrolide e.g clindamycin

What are the other management of cellulitis

Analgesia Elevation of limb to prevent swelling Fluid Treat predisposing factors e.g diabetes

What can occur in severe cellulitis

Toxix shock

Why can toxic shock occur in severe cellulitis

streptococci can produce superantigens which are proteins that cross link t cell receptors and antigen presenting cells to cause them a release of cytokines

What is the treatment for severe cellulitis

Adjunctive therapy e.g IVIG

How can we prevent cellulitis in the first place

- Reduce skin bacteria colonisarion by skin hygiene, MRSA eradications, prophylatic antibodies - Prevent skin breaks, clean wounds, treat eczema and atheletes foot - Maxmise defences: treat vascular disease, reduce oedema, and good diabtes control

What is necrotising Fasciitis

Severe infection of the deep fascial layers

What are the featuers of necrotising fasciitis

Pain | Dusky bruised apperance

What is the management of necrotising fasciitis

Surgical emergency for surgeons (cutting away the tissue) and clindamycin antibiotics

What is pyomyositis

Acute bacterial infection of the skeletal muscle

What are the features of pyomyositis

Muscle pain Tenderness Swelling

Which organism is the most common cause of pyomyositis

Staph aureus

What typical history does pyomyositis have i,e when does occur

After trauma or vigourous exercise

What is the diagnosis of pyomyositis by

MRI scan: can show muscle odema | CT scan

What is the management of pyomyositis

Drainage | Antibiotics

What is septic arthritis

Infection of the joint space that becomes acutely swollen

Which bacteria are involved in septic arthritis

Streptococci Staphylococci TB

How does the ogranism enter the joint space

Directly to the blood stream | Haemtogenous deposition

How is the diagnosis of septic arthritis made

By clinical picture Imaging: US and MRI Joint aspiration- sample then looked at with microscopy and PCR

What is the management of septic arthritis

Surgical washing out | Antibiotics

What is osteomyelitis

Bacterial infection of the bone

How does bacteria spread into the bone

Haemtogenous deposition | Direct inoculation: trauma, surgery or spread from skin

What is the management of osteomyelitis

Surgery | Antibiotics

What is chronic osteomyelitis characterised by

Reactive bone Sinus formation Trapped necrotic bone formation Biofilm

What are the investigations for osteomyelitis

X-ray MRI Ct- to aid surgery Ultrsound for biopsy

Which organism is common to cause osteomyelitis

S.aureus

What is the antibiotic management of osteomyelitis

Beta lactam: fluxloxacillin, cephalosporins Lincosamide: clindamycin Fluroquinolones: ciprofloxacin, moxifloxacin Linezolid, fucidic acid, rifampicin, cotrimoxazole