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IDMM > SSTIs > Flashcards

SSTIs Flashcards

1
Q

Cat bites

  • epidemiology (how many get infected)
  • etiology
  • management
A
  • 80% of cat bites get infected
  • Pastuerella multocida most common but POLYMICROBIAL
  • Treat empirically with amoxil-clav
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2
Q

Dog bites

  • epidemiology (how many get infected)
  • etiology
  • management
A
  • 5% of dog bites get infected
  • Pastuerella canis most common but POLYMICROBIAL
  • Treat only if severe or immune-compromised host with amoxil-clav
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3
Q

Human bites

-etiology

A 
POLYMICROBIAL
Viridens strep
Staph epidermidis
Corynebacterium
S. aureus
Bacteroides
Peptostreptococcus
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4
Q

Clenched fist injury

  • epidemiology (how many get infected)
  • etiology
A
  • high risk of infection
  • patients present late
  • POLYMICROBIAL
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5
Q

Other animal bites

-general considerations

A
  • Tetanus vaccine booster or IgG if never vaccinated

- Rabies vaccine and IgG

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6
Q

Cat scratch disease

  • epidemiology (who gets it)
  • etiology
  • clinical presentation
  • diagnosis
  • Treatment
A
  • children and young adults
  • Bartonella henselae
  • local LAD +/- cutaneous lesion but can be atypical
  • serology, blood culture
  • Azithromycin
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7
Q

Disseminated gonococcal infection

-2 classic clinical presentations

A

-Triad of tenosynovitis, polyarthritis, dermatitis
OR
-purulent arthritis

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8
Q

Infectious lymphadenopathy

-etiology

A 
Viral: HIV, CMV, EBV
Bacterial: GAS, S. aureus, Bartonella henselae and many others
Mycobacteria: TB and atypical
Parasite: toxoplasma, histoplasma
Fungal: Sporotrichosis
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9
Q

Septic arthritis

-etiology

A
  • disseminated gonoccocal infection
  • staph aureus
  • strep
  • G(-)
  • TB
  • Fungal
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10
Q

Septic arthritis

-risk factors

A
  • Age > 80
  • diabetes
  • pre-existing joint disease
  • recent surgery/injection
  • prosthetic joint
  • IVDU
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11
Q

Septic arthritis

-clinical presentation

A

Triad: fever, pain (cannot bear weight), decreased range of motion

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12
Q

Septic arthritis

-diagnosis

A
  • aspirate synovial fluid and Gram stain and C&S
  • blood cultures
  • Xray to rule out osteomyelitis
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13
Q

Septic arthritis

-management

A
  • antibiotics based on C&S

- aspire fluid/ surgical drainage

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14
Q

Septic arthritis

-how does the infective agent get there

A

hematogenous> trauma >post-surgery > from osteomyelitis

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15
Q

Disseminated gonococcal infection

-diagnosis

A
  • cervical/urethral swab usually +

- blood, skin, synovial culture can be -

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16
Q

Disseminated gonococcal infection

-management

A
  • Cefotaxime+ Doxyxline
  • aspirate fluid
  • treat partners
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17
Q

Ludwig’s angina

-definition

A

-cellulitis of bilateral sublingual/submandibular spaces

18
Q

Ludwig’s angina

-risk factors

A
  • recent dental work
  • tooth pain
  • immune compromise
  • tongue piercing
  • mandibular fracture

almost always the result of an oral infection

19
Q

Ludwig’s angina

-etiology in immunecompetent and immunocompromised

A

POLYMICROBIAL

Immunecompetent: strep, G+ anaerobes, bacteroides

Immunocompromised: pseudomonas, clostridium, candida

20
Q

Ludwig’s angina

-management

A
  • monitor airway (1/3 require intubation)

- Antibiotics IV (e.g penicillin+clindamycin+metronidazole)

21
Q

Non-bullous impetigo

-clinical presentation

A
  • bilateral skin lesions that are painless and pruritic

- bumps–>blisters–>golden crust

22
Q

Non-bullous impetigo

-etiology

A

-Staph aureus, often preceded by URTI

23
Q

Non-bullous impetigo

-epidemiology (who gets it)

A

-school-aged children

24
Q

Non-bullous impetigo

-treatment

A

Topical antibiotic (Mupirocin)

25
Q

Bullous impetigo

  • epidemiology (who gets it)
  • etiology
A
  • Neonates» children> adults

- Toxin producing S. aureus

26
Q

Bullous impetigo

-diagnosis in neonate

A

-blood cultures and septic evaluation

27
Q

Bullous impetigo

-management (treatment and complications)

A
  • cloxacillin or vancomycin (if MRSA)

Complications: dehydration +/- sepsis

28
Q

Diabetic foot infection

-2 factors that contribute to diabetic foot infection

A

1) peripheral neuropathy

2) decreased blood flow (macro and microvascular)–> decreased immune system

29
Q

Diabetic foot infection

- patient assessment

A

1) The whole patient: systemic illiness? social support? comorbidities?
2) The affected limb: problems that will impair healing (e.g. charcot joint, vascular disease)?
3) The infection: is it there? how severe?

30
Q

Diabetic foot infection

-how to quantify peripheral vascular disease

A
  • use (ankle/brachial) blood pressure
31
Q

Diabetic foot infection

-risk factors

A
  • previous amputation
  • wound extending to the bone
  • peripheral vascular disease

Are the top three.

32
Q

Diabetic foot infection

-how to determine presence and severity of infection

A
  • Presence: inflammation +/- purulent discharge

- Severity: IDSA criteria (grade 1-4)

33
Q

Diabetic foot infection

-management

A

1) imaging if required
2) wound culture if pt has recently received ab
3) Ab for infected wounds: usually can just cover staph and strep (e.g. cloxacillin). This changes if risk of MRSA, or pt has received ab recently or pseudomonas risk factors
4) good wound care: cleaning, elevation

34
Q

Cellulitis

  • how it happens
  • etiology
A
  • break in skin allows normal flora to invade dermis and subcutaneous tissue
  • almost always staph and strep
35
Q

Cellulitis

-clinical presentation

A

Localized: erythema, LAD, lymphangitis

Systemic: bullae, sever swelling, hemorrhage, systemic symptoms

36
Q

Cellulitis

-management

A
  • empiric Ab based on presentation
  • elevate
  • analgesic
  • draw a line around cellulitis
37
Q

Erisypelas

  • what is it?
  • what causes it?
A
  • Infection limited to upper dermis and superficial lymphatics (cellulitis is deeper)
  • almost always B-hemolytic strep
38
Q

Erisypelas

  • clinical presentation
  • management
A

Clinical presentation: well-demarcated, raised erythema, rapid onset, fever

Management: Penicillin V or Amoxil

39
Q

Necrotizing fasciitis

  • what is it?
  • what types?
  • etiology of each type
  • which type is more common?
A
  • Deep infection of subcutaneous tissue, sever destruction of fat and fascia
  • Type 1: immunocompromised/post-operative (Polymicrobial)
  • Type 2: healthy individuals (GAS)

Type 1 is far more common

40
Q

Necrotizing fasciitis

-clinical presentation

A
  • bullae
  • disproportionate pain
  • swelling
  • erythema
  • systemic signs (fever, tachycardia, hypotension)
  • rapidly progressing
41
Q

Necrotizing fasciitis

-management

A
  • IMMEDIATE surgical consult
  • Cultures of deep tissue (surgical) and blood
  • IMMEDIATE antibiotics: piperacillin-tazo +metronidazole or clindamycin+ carbapenem+cefepime (cover everything)
42
Q

Osteomyelitis

  • what is it?
  • possible etiology
  • management (in Vancouver)
A

Definition: infection of the bone or bone marrow

Etiology: extrapulmonary TB, staph aureus

Management:

  • Imaging
  • Blood cultures
  • Surgical debridement and bone cultures
  • Ab based on bone culture
  • Check for endocarditis

IDMM (33 decks)

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