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Infections > Skin + Soft Tissue Infections > Flashcards

Skin + Soft Tissue Infections Flashcards

1
Q

Things to consider

A

site, organisms, host, environment

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2
Q

Impetigo presentation

A
  • SUPERFICIAL SKIN INFECTIONS
  • MULTIPLE VESICULAR LESIONS on ERYTHEMATOUS BASE
  • GOLDEN CRUST (highly suggestive of impetigo, if vesicles burst)
  • Usually EXPOSED PARTS of BODY incl. FACE, EXTREMITIES, SCALP
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3
Q

Impetigo predisposing factors

A
  • SKIN ABRASIONS
    • MINOR TRAUMA
    • BURNS
    • POOR HYGIENE
    • INSECT BITES
    • CHICKENPOX
    • ECZEMA
    • ATOPIC DERMATITIS
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4
Q

Impetigo organisms

A
  • MORE COMMONLY = S. AUREUS

* LESS COMMONLY = STREP. PYOGENES

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5
Q

Impetigo management

A
  • SMALL AREAS = TOPICAL ANTIBIOTICS ALONE

* LARGE AREAS = TOPICAL Rx + ORAL ANTIBIOTICS e.g. FLUCLOXACILLIN

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6
Q

Erysipela presentation

A
  • INFECTION of UPPER DERMIS
  • PAINFUL RED AREA (NO CENTRAL CLEARING)
    • Inflammatory process causes inflammation - stretches nn. fibres
  • ASS. FEVER
  • REGIONAL LYMPHADENOPATHY + LYMPHANGITIS
  • DISTINCT ELEVATED BORDERS
  • 70 - 80% = involves LOWER LIMBS
  • 5 - 20% = affect FACE
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7
Q

Erysipela risk factors

A

AREAS of:

* PRE-EXISTING LYMPHOEDEMA
* VENOUS STASIS
* OBESITY
* PARAPARESIS
* DM

MAY involve INTACT SKIN - haematogenic spread to area

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8
Q

Erysipela organisms

A

• MOST COMMONLY = STREP. PYOGENES

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9
Q

Erysipela management

A
  • COMBINATION of ANTI-STAPHYLOCOCCAL + ANTI-STREPTOCOCCAL ANTIBIOTICS
  • EXTENSIVE DISEASE = ADMISSION for IV ANTIBIOTICS + REST
  • 1ST = FLUCLOXACILLIN
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10
Q

Cellulitis presentation

A
  • DIFFUSE SKIN INFECTION involving DEEP DERMIS + S/C FAT
  • SPREADING ERYTHEMATOUS AREA w/ NO DISTINCT BORDERS
  • FEVER is common
  • REGIONAL LYMPHADENOPATHY + LYMPHANGITIS
    • Pt. can have LYMPHANGITIS and/or LYMPHADENITIS
  • GOLDEN BULLAE - RELEASE STRAW COLOURED FLUID when they BURST
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11
Q

Cellulitis predisposing factors

A
  • DM
    • TINEA PEDIS - ATHLETE’S FOOT
    • LYMPHOEDEMA
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12
Q

Folliculitis presentation

A
  • CIRCUMSCRIBED, PUSTULAR INFECTION of a HAIR FOLLICLE
  • ≤ 5 mm in DIAMETER
  • SMALL RED PAPULES
  • CENTRAL AREA of PURULENCE that may RUPTURE + DRAIN

• CONSTITUTIONAL SYMPTOMS NOT OFTEN

Typically found on HEAD, BACK, BUTTOCKS, EXTREMITIES

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13
Q

Furunculosis presentation

A
  • SINGLE HAIR FOLLICLE-ASS. INFLAMMATORY NODULE
  • EXTENDING into DERMIS + S/C TISSUE
  • Usually affects MOIST, HAIRY FRICTION-PRONE BODY AREAS - FACE, AXILLA, NECK, BUTTOCKS
  • May SPONTANEOUSLY DRAIN PURULENT AREA
  • SYSTEMIC SYMPTOMS UNCOMMON
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14
Q

Carbuncle presentation

A
  • Occurs when INFECTION EXTENDS to involve MULTIPLE FURUNCLES
  • Often located on BACK of NECK, POSTERIOR TRUNK/THIGH
  • MULTI-SEPTATED ABSCESSES - v. difficult to treat
  • PURULENT MATERIAL may be EXPRESSED FROM MULTIPLE SITES
  • CONSTITUTIONAL SYMPTOMS COMMON = PT. V. UNWELL, ass. w/ BACTERAEMIA + can present w/ SEPTIC SHOCK
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15
Q

Carbuncle presentation

A
  • Occurs when INFECTION EXTENDS to involve MULTIPLE FURUNCLES
  • Often located on BACK of NECK, POSTERIOR TRUNK/THIGH
  • MULTI-SEPTATED ABSCESSES - v. difficult to treat
  • PURULENT MATERIAL may be EXPRESSED FROM MULTIPLE SITES
  • CONSTITUTIONAL SYMPTOMS COMMON = PT. V. UNWELL, ass. w/ BACTERAEMIA + can present w/ SEPTIC SHOCK
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16
Q

Furunculosis risk factors

A
  • OBESITY
    • DM
    • ATOPIC DERMATITIS
    • CKD
    • CORTICOSTEROID USE
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17
Q

Folliculitis organisms

A

• FOLLICULITIS MOST COMMON = S. AUREUS

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18
Q

Furunculosis organisms

A

• FURUNCULOSIS MOST COMMON = S. AUREUS

19
Q

Folliculitis management

A

NOT Rx/TOPICAL ANTIBIOTICS

20
Q

Furunculosis management

A

NO Rx/TOPICAL ANTIBIOTICS - if NO IMPROVEMENT = ORAL ANTIBIOTICS may be necessary

21
Q

Carbuncle management

A

often req. HOSPITAL ADMISSION, SURGERY, IV ANTIBIOTICS

22
Q

Necrotising fasciitis presentation

A
  • INFECTIOUS DISEASE EMERGENCY
  • ANY SITE can be AFFECTED
  • RAPID ONSET
  • SEQUENTIAL DEVELEOPMENT of ERYTHEMA + EXTENSIVE OEDEMA + SEVERE UNREMITTING PAIN
  • HAEMORRHAGIC BULLAE, SKIN NECROSIS, CREPITUS may develop (if skin touched - may feel as if it’s creaking underneath due to air)
  • SYSTEMIC FEATURES incl. FEVER, HYPOTENSION, TACHYCARDIA, DELIRIUM, MULTI-ORGAN FAILURE
  • ANAESTHESIA at INFECTION SITE = HIGHLY SUGGESTIVE of this disease
23
Q

Necrotising fasciitis presentation

A
  • INFECTIOUS DISEASE EMERGENCY
  • ANY SITE can be AFFECTED
  • RAPID ONSET
  • SEQUENTIAL DEVELEOPMENT of ERYTHEMA + EXTENSIVE OEDEMA + SEVERE UNREMITTING PAIN
  • HAEMORRHAGIC BULLAE, SKIN NECROSIS, CREPITUS may develop
  • SYSTEMIC FEATURES incl. FEVER, HYPOTENSION, TACHYCARDIA, DELIRIUM, MULTI-ORGAN FAILURE
  • ANAESTHESIA at INFECTION SITE = HIGHLY SUGGESTIVE of this disease
24
Q

Necrotising fasciitis organisms

A
  • TYPE 1 = MIXED AEROBIC + ANAEROBIC INFECTION (DIABETIC FOOT INFECTION, FOURNIER’S GANGRENE)
    • TYPICAL = STREPTOCOCCI, STAPHYLOCOCCI, ENTEROCOCCI, GRAM -VE BACILLI, CLOSTRIDIUM
  • TYPE 2 = MONOMICROBIAL
    • Normally ass. w/ = STREP. PYOGENES
25
Q

Necrotising fasciitis management

A
  • SURGICAL REVIEW MANDATORY
  • IMAGING may help - could delay rx
  • BROAD-SPECTRUM ANTIBIOTICS = FLUCLOXACILLIN, GENTAMICIN, CLINDAMYCIN
26
Q

Pyomyositis presentation

A
  • PURULENT INFECTION DEEP w/I STRIATED MUSCLE, often manifests as ABSCESS
  • INFECTION OFTEN SECONDARY to SEEDING INTO DAMAGED MUSCLE (e.g. haematogenic spread)
  • MULTIPLE SITES involved in 15%
  • COMMON SITES = THIGH, CALF, ARMS, GLUTEAL REGION, CHEST WALL, PSOAS MUSCLE
  • FEVER, PAIN, WOODY INDURATION of AFFECTED MUSCLE
  • UNTREATED = SEPTIC SHOCK, DEATH
27
Q

Pyomyositis predisposing factors

A
  • DM
    • HIV/IMMUNOCOMPROMISED
    • PWID
    • RHEUMATOLOGICAL DISEASES
    • MALIGNANCY
    • LIVER CIRRHOSIS
28
Q

Pyomyositis organisms

A
  • COMMONEST = S. AUREUS

* OTHER = GRAM +VE, GRAM -VE, TB, FUNGI

29
Q

Pyomyositis investigations

A

• CT/MRI

30
Q

Pyomyositis management

A

• DRAINAGE w/ ANTIBIOTIC COVER depending on GRAM STAIN + CULTURE RESULTS

31
Q

Septic bursitis presentation

A
  • INFECTION often from ADJACENT SKIN INFECTION
  • PERIBURSAL CELLULITIS, SWELLING, WARMTH are COMMON
  • FEVER + PAIN ON MOVEMENT
32
Q

Septic bursitis predisposing factors

A
  • RHEUMATOID ARTHRITIS - deformed joints, abnormal synovium due to inflammatory process
    • ALCOHOLISM
    • DM
    • PWID
    • IMMUNOSUPPRESSION
    • RENAL INSUFFICIENCY
33
Q

Septic bursitis organisms

A
  • MOST COMMON = S. AUREUS

* RARE = GRAM -VE, MYCOBACTERIA, BRUCELLA (SEPTIC BURSITIS, FARMERS, RECURRENT BURSITIS)

34
Q

Septic bursitis investigations

A

• DIAGNOSIS = based on ASPIRATION of FLUID

35
Q

IV catheter ass. infection presentation

A
  • NOSOCOMIAL INFECTION

* Normally starts as LOCAL SST INFLAMMATION (red area, swollen vein) - progresses to CELLULITIS + TISSUE NECROSIS

36
Q

IV catheter ass. infection risk factors

A
  • CONTINUOUS INFUSION > 24 HRS
    • CANNULA IN SITU > 72 HRS
    • CANNULA IN LOWER LIMB
    • PT. w/ NEUROLOGICAL/NEUROSURGICAL PROBLEMS
37
Q

IV catheter ass. infection organisms

A
  • MOST COMMON = S. AUREUS (MSSA + MRSA)
    • COMMONLY forms BIOFILM - which then SPILLS INTO BLOODSTREAM
    • Can SEED OTHER PLACES e.g. endocarditis, OM
38
Q

IV catheter ass. infection investigations

A

• DIAGNOSIS = made CLINICALLY/+VE BLOOD CULTURES

39
Q

IV catheter ass. infection management

A
  • REMOVE CANNULA
  • EXPRESS ANY PUS from THROMBOPHLEBITIS
  • IV ANTIBIOTICS for AT LEAST 14 DAYS
  • ECHO

PREVENTION MORE IMPORTANT:

* DO NOT LEAVE UNUSED CANNULA
* DO NOT INSERT CANNULA UNLESS THEY WILL BE USED
* CHANGE CANNULAS EVERY 72HRS
* MONITOR for THROMBOPHLEBITIS
* USE ASEPTIC TECHNIQUE when INSERTING CANNULAE
40
Q

Surgical site infection presentation

A
  • CLASS 1 = CLEAN WOUND (RESPIRATORY, ALIMENTARY, GENITAL, INFECTED URINARY SYSTEMS NOT ENTERED)
    • CLASS 2 = CLEAN-CONTAMINATED WOUND (ABOVE TRACTS ENTERED, BUT NO UNUSUAL CONTAMINATION)
    • CLASS 3 = CONTAMINATED WOUND (OPEN, FRESH ACCIDENTAL WOUNDS/GROSS SPILLAGE from GIT e.g. ruptured appendix, peritonitis)
    • CLASS 4 = INFECTED WOUND (EXISTING CLINICAL INFECTION, INFECTION PRESENT BEFORE OPERATION)
41
Q

Surgical site infection organisms

A
  • S. AUREUS
  • COAGULASE -VE STAPHYLOCOCCI
  • ENTEROCOCCUS
  • E. COLI
  • PSEUDOMONAS AERUGINOSA
  • ENTEROBACTER
  • STREPTOCOCCI
  • FUNGI
  • ANAEROBES
42
Q

Surgical site infection investigations

A

DIAGNOSIS:

* SEND PUS/INFECTED TISSUE for CULTURES esp. w/ CLEAN WOUND INFECTIONS
* AVOID SUPERFICIAL SWABS - AIM for DEEP STRUCTURES
* CONSIDER UNLIKELY PATHOGEN as CAUSATIVE IF OBTAINED from STERILE SITE e.g. bone infection
43
Q

Surgical site infection management

A

• ANTIBIOTICS to TARGET LIKELY ORGANISMS

Infections (6 decks)

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