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Infection > Skin & Soft Tissue Infection > Flashcards

Skin & Soft Tissue Infection Flashcards

1
Q

Name the 3 common bacterial infections of the skin

A

Impetigo (surface)
Cellulitis (dermis)
Eryipleas (cellulitis)

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2
Q

What re the 2 most common bacterial infections of the skin?

A

Gram Positive Staphylococcus Aureus

Strep Pyogenes

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3
Q

What is the classical presentation of Impetigo?

A

Honeycomb well circumscribe lesion on the nose and face, children aged 2-5

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4
Q

What is the treatment of impetigo?

A

Topical fusidic acid

Or if severe or longer than 7 days then Flucloxacillin

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5
Q

What is the most common cause os erysipelas?

A

Superficial dermal infection with strep progenies

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6
Q

what are the clinical features of erysipelas?

A

Painful red areas, no central clearing with associated fever and lymohadenopathy

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7
Q

Which condition does Erysipelas have the same treatment as?

A

Cellulitis

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8
Q

what is cellulitis?

A

This is infection of the deep dermis caused by PS or SA

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9
Q

What are 3 predisposing factors to cellulitis?

A

CM
Tinea pedis
Lymphedema

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10
Q

What are the clinical features of cellulitis?

A

Hot, swollen, oedematous diffuse skin rash, which is painful, associated with fever and lymphadenopathy

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11
Q

What is the management of cellulitis and therefore also eriypleas?

A

Elevate the leg
Benzylpenicillin + Flucloxacillin
If serve or extensive then admit

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12
Q

What is folliculitis?

A

Pustular SA infection of the hair follicle LESS than 5mm

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13
Q

What is furniculosis?

A

Single hair follicle associated inflammatory nodule, infection to the subcutaneous tissue

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14
Q

What is a carbuncle

A

Extensive Furniculosis leading to an access and purulent discharge

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15
Q

What is the management for F and F?

A

Nothing or topical antibiotic

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16
Q

What is the management of a carbuncle?

A

Admission
Drainage
Oral antibiotics

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17
Q

What is Necrotising Fasciitis?

A

This is an infection of the deep subcutaneous fat, dermis and muscle, leading to necrosis

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18
Q

Is NF an emergency?

A

Yes

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19
Q

What are the risk factors for necrotising fasciitis?

A

DM
Trauma
Syrgery
Venous thrombosis

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20
Q

What are the 2 types of necrotising fasciitis?

what are the common causes of each?

A

Type 1 = Mixture of aerobic and anaerobic bacteria
Staphylococci
Steptococci, enterococci
Gram negative bacilli
Type 2 = mono microbial and caused by STREP PYOGENES

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21
Q

What site is affected in necrotising fasciitis?

A

Any site in the body

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22
Q

What are the clinical features?

A

Rapid onset with development of erythema, extensive oedema, sever unremitting pain, haemorrhage bull, systemic symptoms, skin necrosis, crepitus
ANASTHESIA at the site of infection is particularly indicative

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23
Q

How do you diagnose necrotising fasciitis?

A

Clinical diagnosis

Imaging can help but delays the treatment

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24
Q

What Is the first line management of NF?

A

Surgical review -open wound, don’t close
IV fluid
IV broad spectrum antibiotics = flucloxacillin
Gentamycin
Clindamycin
IV opiates

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25
Q

What is the mortality rate of NF?

A

17-40%

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26
Q

What is the definition of pyomyositis?

A

This is an access within any muscle in the body but is usually un the lower limbs and is caused from an area of cellulitis or endocarditis

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27
Q

What is the causative organism in pyomyositis?

A

Staphylococcus aureus

28
Q

What are the predisposing factors to PM?

A 
DM
Immunocompromised
IVDU
Steroid use 
Malignancy
Rheumatological disease
Liver cirrhosis
29
Q

What are the common clinical features of PM?

A

Fever
WOODY INDURATION od the affected muscle
Pain

30
Q

What can PM develop into?

A

Sepsis and septic shock

31
Q

What is the key investigation of PM?

A

CT/MRI

32
Q

What are the 2 key treatments for PM?

A

Surgical drainage and broad spectrum antibiotics

33
Q

What is septic bursitis?

A

This is infective inflammation of the bursae

34
Q

What is the causative organism in SB?

A

Staphylococcus Aureus

35
Q

What 2 bursae are commonly affected?

A

Patellar

Olecranon

36
Q

What re the symptoms of SB?

A 
Pain
Inability to kove
Fever
Oedema
Erythematous
37
Q

What is the single KEY investigation of SB?

A

Aspiration (may not actually do though because it introduces the infection into the joint

38
Q

Who is particularly at risk of septic bursitis?

A

Rheumatoid Arthritis patients
DM
IVDU
Immunocompromised

39
Q

What is the management of septic bursitis?

A

This would be antibiotics

40
Q

What is infective tenosynovitis

A

This is infection of the synovial tendon flexor sheaths

41
Q

What is the most common cause of IT?

A

Penetrating trauma

42
Q

What is the most common causative organism of IT?

A

Staphylococcus aureus

Strep

43
Q

What tendons are usually affected?

A

The flexor muscle tendons or the tendon sheaths of the hands

44
Q

What are the 3 main clinical findings in IT?

A

Erythematous fusiform swelling of the finger
Hand held in a semi flexed position
Pain on extension of the finger

45
Q

What are the management options for IT?

A

Empirical antibiotics

Hand surgeon review ASAP

46
Q

What is toxic shock syndrome?

A

This is acute septicaemia in women usually from a retained tampon

47
Q

What are 2 causes of toxic shock syndrome?

A

Retained high absorbance tampon

Small skin infections such as staph aureus that secretes TSST1

48
Q

what are the 2 causative organisms of toxic shock syndrome?

A

Staph aureus

Streptococci

49
Q

How does toxic shock syndrome come about pathogenesis wise?

A

The retained tampon becomes colonised with SA
Creates a super antigen that doesn’t activate the immune system normally
Superantigen binds directly to T cell receptors activating 20% and this leads to a massive cytokine release causing endothelial leakage, haemodynamic shock, multi-organ failure, death

50
Q

What are the diagnostic criteria symptoms?

A 
Fever 
Hypotension 
Diffuse macular rash, + involvement of 3 or more of the following organs:
Liver
Blood
Renal 
GI 
CNS
Muscular
51
Q

What are the 3 clinical investigation findings than contribute to TSS?

A

Isolation of SA
Production of TssT1 by isolate
Development of an antibody to toxin during convalescence

52
Q

If it is confirmed Streptococcal TSS, then what is this usually associated with?

A

Strep in depp seated infection such as necrotising fasciitis

53
Q

What are the investigations and results in TSS?

A

FBC etc

Increased CPK and low platelets

54
Q

What are the general measure of management of TSS?

A 
Remove the offending agent 
IV fluids
IV antibiotics 
Inotropes
Immunoglobuins
55
Q

What antibiotic therapy is suitable for TSS?

A

Flucloxacillin

56
Q

If it streptococcal infection then what other measures do you wish to take?

A

Urgent surgical debridement of the infected tissues

57
Q

What is the mortality rate for Staph

Strep?

A

5%

50%

58
Q

What is Staphylococcal Scaled Skin Syndrome?

A

This occurs in children and is caused by a toxin secreting SA

59
Q

What is the pathogenesis of SSSS?

A

The toxin, exfoliatin, causes intra-epidermal cleavage at the level of the stratum corneum leading to the formation of large flaccid blisters that shear readil

60
Q

What are the clinical presentations of SSSS?

A

Widespread bull and skin exfoliation

61
Q

What re the 2 managements for SSSS?

A

IV fluids

IV antibiotics

62
Q

What organisms causes a IV associated infection?

A

Staph Areus
MSSA
MRSA

63
Q

what re the 4 risk factors of a IV AI?

A

Continuous infection over 48 hours
Cannula in situ for more than 72 hours
Cannula in the lower limb
Patients with neurological. neurosurgical issues

64
Q

How can you diagnose it?

A

With positive blood cultures

Do ECHO to check for endocarditis

65
Q

What organism is the cause of a surgical site wound infection?

A

Staphylococcus Aureus including MRSA, MSSA

Coagulase negative streptococci

66
Q

What re the 4 classes of a surgical wound infection?

A

Class I: clean wound (respiratory, alimentary, genital or infected urinary systems not entered)
Class II: clean contaminated wound (above tracts entered but no unusual contamination)
Class III: contaminated wound (open, fresh, accidental wounds or gross spillage from GI tract)
Class IV: infected wound (existing clinical infection, infection present before operation)

67
Q

What re the managements of these 2 infections?

A

Remove the cannula
Express pus
Antibiotic for 14 days

Infection (12 decks)

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