Skin & soft tissue infections Flashcards
what is the epidermis?
thin layer portion consisting of several layers of epithelial cells
- when unbroken, an effective physical barrier against microbes
what is the dermis?
thick inner layer portion; provides strength and flexibility and supports growth of the epidermis
- blood vessels, nerve endings, hair follicles, sweat an oil glands
- follicles an glands can serve as passageways for microorganisms
in what part of the body does the normal flora change?
when its warm and moist
what is the benefit of the microbiome?
microbial antagonism
what is the risk of the microbiome?
entry into tissues
normal flora must be resistant to what?
drying and high salt concentrations
concentration of microbes vary with available nutrients, moisture, pH, temp, salt and sebum levels. T or F
T
90% of normal skin flora is which microbe?
staphylococcus epidermidis
what other bacteria is also present in normal skin flora?
cutibacterium acnes, proprionibacteria)
when does normal skin flora become pathogenic?
when skin barrier is broken or invaded (catheterization)
how can the skin have microbial growth in hospital environment?
covered in salt, sweat and sebum which contains antimicrobials
what is a bullae?
is a large vesicle (>5mm), will rupture easily to tough, fluid is clear
what is a skin rash?
a vesicle forms from accumulation of fluid under the epidermis
- any change in colour or texture
what is a palpule?
a raised lesion resulting from accumulation of material, infectious or otherwise, in the dermis.
what is plaque?
is a large raised area that forms a plateau
what is enanthem?
rash on mucous membranes accompanied by systemic symptoms such as fever, malaise and headache
what is exanthem?
skin rash accompanied by systemic symptoms, fever, malaise and headache
what is a macule?
is a flat lesion that cannot be palpated, like a freckle
what is a wheal?
is a raised, itchy area of the skin that is almost always an overt sign of allergy
what is a nodule?
is a large papule that travels deeper into the skin
what is a skin rash most commonly associated with?
an infection
why does a rash form?
reaction to a toxin produced by the bacteria, damage to the skin by a pathogen, immune response to a pathogen BUT… can also be associated with drug reactions, allergy, autoimmune diseases
what is an ulcer?
is an open sore often caused by initial abrasion
what is an ulcer maintained by?
- inflammation, 2. infection, 3. medical conditions that impede healing
what is a pustule?
a pus filled raised lesion on the skin, usually the result of a buildup of the cellular debris of inflammatory cells, with or without microorganisms, under the epidermis
what sampling techniques are available?
- skin scraping
- biopsy and needle aspiration
- swabs are only useful is sample contains suspected pathogen
what do swabs collect?
swabs only sample surface and collect a small amount of fluid
where should samples be stored?
in a sterile container for immediate transport
the skins normal flora will interfere with what?
sampling
- normal flora will colonize the wound and different than bacteria deeper in the wound which are true pathogens
skin infections arise from what 3 things?
- exogenous penetration
- hematogenous spread
- superficial structures of skin (hair follicles)
what is exogenous penetration?
animal and insect bites, surgery, trauma (skin abrasions, etc)
what is hematogenous spread?
disseminated infection (eg. gonococcal infections)
is group A streptococci gram neg or pos?
beta-hemolytic, gram pos cocci, catalase negative
what does group A streptococci colonize?
colonizer of skin and nasopharynx
what diseases can group A streptococci cause?
skin an soft tissue infections, bone an joint infections, strep, scarlet fever, rheumatic fever, bacteremia and glomerulonephritis
is staphylococcus aureus gram neg or pos?
gram pos cocci, catalase positive, coagulase positive
what does staphylococcus aureus colonize?
colonizes nasopharynx, axillae, rectum, skin
what diseases can staphylococcus aureus cause?
skin an soft tissue, bone, joint, heart valves, kidneys, lungs, brain, bacteremia, food poisoning
what is folliculitis?
localized infection of the hair follicle (red, swollen an pus filled), lesions vary in size and may scar
what are the manifestations of folliculitis?
pain, tenderness and localized edema at site of infection
when does folliculitis resolve?
1 - 2 weeks
what is carbuncle (folliculitis)?
cluster of boils, often hard round and deep infection of multiple hair follicles
- associated with fever and are slower to heal
where does carbuncle usually appear?
often occurs on back of knees, neck, shoulders or thighs (especially in men where skin is thick)
what are furuncles (folliculitis)?
large, painful, raised nodular lesion - extension of folliculitis into surrounding hypodermis