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Infection > Skin + Soft tissue Infections > Flashcards

Skin + Soft tissue Infections Flashcards

1
Q

What are the skin compartments (layers)?

A 
Epidermis
Dermis
Subcutaneous fat
Fascia
Muscle
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2
Q

What factors need to be considered when there is an infection?

A

The site, organism, host and environment

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3
Q

What is the significance of site of infection?

A

Possible complications with specific sites eg. face

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4
Q

What hosts are important to consider in an infection?

A 
Diabetics - leads to neuropathy/ vasculopathy
Immunosuppressed
Renal failure
Milroy's disease
Predisposing conditions
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5
Q

What factors are there to consider with environment?

A

Drug-resistant strains e.g. MRSA
Drug interactions
Drug allergies

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6
Q

What are the features of impetigo?

what is the causative organism

A

Superficial skin infection due to Staph Aureus

  • multiple vesicular lesions on erythematous base
  • highly infectious
  • occurs on exposed body parts: face, extremities
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7
Q

What predisposing factors are there?

A 
skin abrasions
minor trauma
burns
poor hygiene
insect bites
chickenpox
eczema
atopic dermatitis
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8
Q

What is the treatment for impetigo?

A

small areas = topical antibiotics

large areas = oral + topical antibiotics

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9
Q

What are the features of erysipelas?

what is the causative organism

A

infection of upper dermis - face + limbs

raised, painful, red area
fever
regional lymphadenopathy

Caused by strep pyogenes

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10
Q

What are the features of cellulitis?

what is the causative organism

A

Diffuse skin infection of dermis + epidermis
Spreading erythematous area with no distance border
Fever

Cause: strep pyogenes + staph aureus

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11
Q

What are the predisposing factors to cellulitis?

A

diabetes
tinea pedis
lymphoedema

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12
Q

What is the treatment for cellulitis?

A

Combination of anti-staphylococcal and anti-streptococcal antibiotics

In extensive disease, admission for intravenous antibiotics and rest

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13
Q

What hair associated infections are there?

A

Folliculits
Furunnculosis
Carbuncles

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14
Q

What are the features of folliculitis?

what is the causative organism

A

Pustular infection of a hair follicle

Typically found on head, back, bum, extremities

Cause= staph aureus

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15
Q

What are the features of furunculosis?

what is the causative organism

A

=Boils

inflammatory infection of a hair follicle
extends into dermis + subcutaneous tissue

Affects hair areas: face, axilla, neck, buttocks

Cause= staph aureus

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16
Q

What are the risk factors for furunculosis?

A 
Obesity
Diabetes
Atopic dermatitis
Chronic kidney disease
Corticosteroid use
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17
Q

What are the features of a carbuncle?

A

Occurs when infections involves MULTIPLE FURUNCLES

= multiseptated large abscesses
located on back of neck, thigh etc

May drain spontaneously: purulent material
Constitutional symptoms common e.g. fever

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18
Q

What is the treatment for hair-associated infections?

A 
Folliculitis= no Tx or topical antibiotics
Furunculosis= no Tx or topical antibiotics
Carbuncles= admission to hospital, surgery, IV antibiotics
19
Q

What are the features of necrotising fasciitis?

A

Infectious disease emergency
Can affect any site

Red erythema -> oedema and severe pain
Systemic features: hypotension, multiorgan failure

Surgical review is mandatory
Skin necrosis can develop

20
Q

What are the predisposing conditions to necrotising fasciitis?

A 
Diabetes
Surgery
Trauma
Peripheral vascular disease
Skin popping
21
Q

What are the types of necrotising fasciitis?

A

Type 1= mixed aerobic + anaerobic (e.g. diabetic foot infection)

Type 2= mono microbial (associated with strep pyogenes)

22
Q

What is the treatment for necrotising fasciitis?

A

Broad spectrum antibiotics:
Flucloxacillin
Gentamicin
Clindamycin

23
Q

What are the features of pyomyositis?

What are the common sites?

What is the causative organism?

A

Purulent infection within striated muscle
Manifests as an abscess
Often secondary to damaged muscle

Common sites: thigh, cold, arms, gluteal region, chest wall

cause= staph aureus

24
Q

What are the symptoms of pyomyositis?

A

Fever, pain
If untreated can lead to septic shock and death

Surgery may be needed

25
Q

What are the predisposing factors of pyomyositis?

A 
Diabetes
HIV/ immunocompromised
IV drug user
Rheumatological disease
Malignancy
Liver cirrhosis
26
Q

What is the treatment of pyomyositis?

A

first, CT/MRI then

treatment= drainage with antibiotic Tx depending on gram stain + culture results

27
Q

What are the features of septic bursitis?

A

Located subcutaneously between bony prominences
e.g. patellar or olecranon bursitis

Fever + pain on movement
Facilitate movement with reduced friction

Infection is often from adjacent skin infection

28
Q

What are the predisposing factors to septic bursitis?

A 
Rheumatoid arthritis
Alcoholism
Diabetes
IV drug use
Immunosuppression
Renal insufficiency
29
Q

What is the cause of septic bursitis? How is it diagnosed?

A 
Diagnosis= aspiration of fluid
Cause= staph aureus

Rarer organisms: gram negatives, mycobacteria

30
Q

What are the features of infectious tenosynovitis?

What is the causative organism?

A

Infection of the synovial sheet that surrounds tendons
(most commonly tendons in hand)

cause= staph aureus, strep pyogenes

presents: erythematous swelling of finger
Finger held in a semi flexed position

Needs urgent review by hand surgeon + antibiotics

31
Q

What are the features of toxin mediated syndromes?

A

Due to superantigens

Dysfunction of immune system activation (not enough T cells activated)

32
Q

What are the causative organisms and features of Toxic shock syndrome toxin 1?

A

Staph aureus and strep pyogenes

causes toxin syndrome which manifests as fever, rash, hypotension and organ failure

associated with high-absorbency tampons

33
Q

What are the differences between staphylococcal and streptococcal toxic shock syndrome (TSS)?

A

Staphylococcal:
3 of following involved: liver, blood, renal, GI, CNS, muscular
There is development of antibody to toxin during recovery

Streptococcal:
mortality rate is much higher (50%)
treatment requires urgent surgical debridement

34
Q

What is the treatment of TSS

A
  • Remove offending agent (tampon)
  • Intravenous fluids
  • Inotropes (to increase HR/BP)
  • Antibiotics
  • Intravenous immunoglobulins
35
Q

What is staphylococcal scalded skin syndrome?

what is the Tx?

A

Infection due to exfoliative toxin A or B

commonly affects children
Characterised as widespread bullae and skin exfoliation

Tx= IV fluids + antibiotics

36
Q

What is Panton-Valentine leucocidin toxin?

what is the Tx?

A

Caused by staph aureus, cause recurrent boils and haemorrhagic pneumonias

affects children + young adults

Tx= antibiotics the reduce toxin production

37
Q

What are the features of Cannula associated infections?

A

Nosocomial infection
Starts as local inflammation, progresses -> cellulitis -> necrosis

common to have bacteraemia

38
Q

What are the risk factors for cannula/venous associated infections?

A

Continuous infusion > 24 hours
Cannula in situ > 72 hours
Cannula in lower limb
Patients with neurological problems

39
Q

What are the causative organisms of cannula/venous associated infections?

A

Staph aureus:
MSSA (methicillin sensitive SA)
MRSA

40
Q

What is the diagnosis and treatment for cannula associated infections?

A 
Dx= clinically or positive blood cultures
Tx= remove cannula, antibiotics for 14 days, echocardiogram (can lead to endocarditis)
41
Q

What is the prevention for cannula associated infections?

Note prevention is more important

A

–Do not leave unused cannula
–Do not insert cannulae unless you are using them
–Change cannulae every 72 hours
–Monitor for thrombophlebitis
Use sceptic technique when inserting cannula

42
Q

What surgical site infections are there?

classification

A

Class 1= Clean wound infections:

  • Infections in a surgical site that is sterile (example joint operations).
  • Normally due to invasive organisms such as Staph aureus

Class 3= Contaminated wound infections:
- Infections at a surgical site that is either already contaminated at the start of
surgery or contaminated during surgery e.g. spillage of GI fluid
- Role of coliforms or anaerobic organisms

43
Q

What is the diagnosis and treatment for surgical site infection?

A

MRSA important source of infection
• Importance of culturing all clean wound infections

Consider unlikely pathogen is cause is from a sterile site e.g. bone infection
• Treatment according to sensitivities

44
Q

What risk factors are there for surgical site infections?

A

Patient associated: diabetes, smoking, obesity, malnutrition, steroid use

Procedural: shaving of site prior to procedure, improper pre-op skin preparation, improper antimicrobial prophylaxis, break in sterile technique, inadequate theatre ventilation

Infection (12 decks)

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