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IDMM > SSTs (4) > Flashcards

SSTs (4) Flashcards

1
Q

list the SST/joint infections we are expected to know

A
  1. animal bites
  2. infectious lymphadenitis
  3. septic arthritis
  4. disseminated gonococcal infection
  5. deep space infections (Ludwig’s angina)
  6. superficial skin infections (impetigo, scalded skin)
  7. diabetic foot
  8. cellulitis/erisypelas
  9. necrotizing fasciitis
  10. osteomyelitis
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2
Q

what % of cat bites get infected

A

80%

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3
Q

what is the etiologic agent most common in infected cat bites

A

Pasteurella multocida

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4
Q

what type of infections result from cat bites

A

deep space
bone
joint

these types are more likely with cat bites

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5
Q

Tx for cat bites

A

empiric = amoxicillin-clavulanate

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6
Q

what % of dog bites get infected

A

5%

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7
Q

what is the etiologic agent in infected dog bites

A

Pasteurella canis

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8
Q

Tx for infected dog bites

A

treat only if bite is severe or pts is immunocompromised

amoxicillin-clavulanate

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9
Q

what is the etiologic agent in cat scratch disease

A

Bartonella henselae

cats are natural reservoir

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10
Q

what is the etiologic agent in infected human bites

A

polymicrobial

  1. STREP VIRIDANS (100%)
  2. bacteroides (82%)
  3. S. epidermis (53%)
  4. corynebacterium
  5. S. aureus
  6. Peptostreptococcus
  7. Eikenella
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11
Q

what is “clenched fist injury”

A

“reverse bite”

very high risk of infection

risk of septic joint and osteomyelitis

administer IV Ab and imaging

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12
Q

Tx for human bite infections

A

either amoxicillin-clavulanate or pipercillin-tazobacter (because has coverage for pseudomonas)

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13
Q

what two other diseases should you consider in a patient with a bite wound

A

tetanus

rabies (i.e bats)

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14
Q

what is another name for infectious lymphadenitis

A

cat scratch disease

Bartonella henselae

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15
Q

clinical presentation of cat scratch disease/infectious lymphadenitis

A

local lymphadenitis with or without cutaneous lesion

skin lesion shows several days after exposure and lasts 1-3 weeks

10% = atypical–> liver, spleen, ocular, neuro, MSK, FUO involvement

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16
Q

Tx for cat scratch disease

A

azithromycin

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17
Q

other than cat scratch disease, other etiologies of infectious lymphadenitis

A
  1. GAS
  2. S. aureus
  3. toxoplasma
  4. viral: HIV, CMV, EBV
  5. mycobacteria
  6. sporotrichosis, histoplasma, francisella, bacillus anthracis, borellia burgdorferi, yersenia pestis, hocardia
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18
Q

risk factors for septic arthritis

A
  1. older than 80
  2. diabetes
  3. pre-existing joint disease
  4. recent joint surgery or infection
  5. prosthetic joint
  6. IVDU
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19
Q

etiologic agents in septic arthritis

A

S. AUREUS

S. aureus»strep>gram -orgs/TB/fungal

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20
Q

how do you diagnose septic arthritis

A

arthrocentesis (synovial fluid analysis)

gram stain/culture
blood culture
xray to rule out osteomyelitis

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21
Q

if septic arthritis is due to S. aureus, how is it treated

A

remove joint

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22
Q

what is disseminated gonoccoccal infection

A

a type of septic arthritis

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23
Q

clinical presentation of disseminated gonococcal infection

A

2 classic syndromes

  1. triad of tenosynovitis, polyarthritis and dermatitis
  2. purulent arthritis
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24
Q

Tx of disseminated gonococcal infection

A

ceftriaxone and doxycycline

doxy covers chlamydia (most people need both)

if purulent arthritis, IV therapy with joint aspiration

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25
Q

where do deep space infections arise from

A

progression of an oral infection

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26
Q

what is Ludwig’s angina

A

deep space infection

cellulitis of bilateral sublingual/submandibular spaces

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27
Q

risk factors for Ludwig’s angina

A
  1. immune compromised
  2. tongue piercing
  3. mandibular fracture

almost always results from oral infection (2nd and 3rd molars are most common)

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28
Q

etiologic agents for Ludwig’s angina

A

strep and anaerobes (gram +)

can also be bacteroides

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29
Q

clinical presentation of deep space infection/Ludwig’s angina

A

swollen neck
difficulty opening mouth, swallowing
fever and malaise

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30
Q

Tx for deep space infections

A

monitor and protect airway (1/3 patients require intubation)

antibiotics: penicillin G OR clindamycin + metronidazole

surgical evaluation
CT to assess size and spread

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31
Q

what type of infections are superficial skin infections

A

toxin mediated skin damage

32
Q

etiological agent for scalded skin syndrome

A

S. aureus

33
Q

classical presentation of scalded skin syndrome

A

NIKOLSKYS SIGN

reddened skin
fluid collects underneath
skin rubs off leaving red base

34
Q

diagnosis of scalded skin syndrome

A

clinical

35
Q

Tx scalded skin syndrome

A

symptomatic

usually vancomycin if need Abs

36
Q

2 types of impetigo

A

bullous

non-bullous

37
Q

which type of impetigo is highly contagious and is seen in school aged kids?

which type is seen in neonates?

A

non bullous = highly infectious and seen in school aged kids

bullous = seen often in neonates

38
Q

etiologic agent of non bullous impetigo

A

S. aureus

also GAS

39
Q

etiologic agent of bullous impetigo

A

TOXIN producing S. aureus

exfoliative toxin A and B

40
Q

diagnosis of impetigo

A

clinical

for bullous may have cultures, septic eval

41
Q

Tx nonbullous impetigo

A

topical antibiotic–MUPIROCIN
PO–cloxacillin
cephalosporins

42
Q

Tx bullous impetigo

A

oral or IV Ab
cloxacillin
cephalosporin
vancomycin is MRSA suspected

43
Q

what type of infection is diabetic foot

A

peripheral vascular disease related soft tissue infection

44
Q

diabetic food risk factors

A 
previous amputation
wound extending to bone
peripheral vascular disease
ulcer duration > 30 days 
loss of sensation 
Hx of recurring ulcers
wound caused by trauma

40% of infected people have peripheral vascular disease

45
Q 
etiologic agents in
1. mild 
2. moderate
3. severe 
diabetic foot
A
  1. S. aureus (MSSA), streptococcus
  2. S. aureus (MSSA), streptococcus
  3. assume everything
46
Q

how do you assess diabetic foot

A

“assess at 3 levels”

  1. whole patients–>signs of systemic illness, social support
  2. affected limb/foot–> problems impairing healing, peripheral vascular disease
  3. infection–> is an infection present? how severe? hospitalize all patients with a severe infection or moderate infection with low social support or failing outpatient management

surgery consult if suspect deep space infection or necrotizing fasciitis

47
Q

how do you correctly culture a diabetic foot infection

A
  1. clean and debride the wound
  2. scrape or biopsy the ulcer base
  3. aspirate purulent secretions –> never swab an uninfected wound or a dirty infected wound
  4. send for gram stain, aerobic and anaerobic culture
48
Q

Tx for diabetic foot infection

A

majority of mild and moderate cases can be treated with Abs that cover staph and strep

ALL infected wounds should have Abs

CLOXACILLIN (choice) or 1st generaton cephalosporin

if you think high risk for MRSA give empiric MRSA coverage

49
Q

what is cellulitis

A

infection of the deep dermis and subcutaneous fat

50
Q

how does cellulitis happen

A

break in skin allowing normal skin flora or exogenous flora to invade dermis and subcutaneous tissue

51
Q

epidemiology of cellulitis

A

diabetics

peripheral vascular disease

52
Q

etiologic agent of cellulitis

A

almost always strep or staph

53
Q

clinical presentation of cellulitis

A

simple, localized cellulitis–> no fever/other systemic symptoms; WBC normal; lymphademopathy and lymphangitis

severe cellulitis–> systemic symptoms, bullae, hemorrhage, severe swelling

54
Q

how do you monitor the progression of suspected cellulitis

A

infection spreads rapidly… draw a line around the infected area’s borders to monitor spread

55
Q

Tx for cellulitis

A

empiric Abs
elevate
analgesics

56
Q

what is erisypelas

A

infection limited to upper dermis and superficial lymphatics

57
Q

what causes erisypelas

A

almost always B hemolytic strep (i.e GAS/S pyogenes)

58
Q

clinical presentation of erisypelas

A

sharp, raised, well demarcated edema

rapid onset

fever and signs of systemic toxicity

59
Q

Tx of erisypelas

A

mild/moderate = outpatient –> penicillin or amoxicillin

severe = admit to hospital –> IV benzathine penicillin G

60
Q

what type of infection is necrotizing fasciitis

A

rapidly progressive soft tissue infection

61
Q

where does necrotizing fasciitis infect

A

deep infection of the subcutaneous tissue causing severe destruction of fat and fascia

62
Q

etiologic agent of
1. type 1
2. type 2
necrotizing fasciitis

A
  1. immunocompromised or post operation patients–> POLYMICROBIAL
  2. healthy individuals of any age –> GROUP A STREP (GAS) aka Beta hemolytic strep
63
Q

clinical presentation of necrotizing fasciitis

A 
Skin:
bullae
disproportionate pain 
swelling
erythema
crepitus
(gangrene)

systemic:
fever
tachycardia
hypotension

64
Q

how do you test for necrotizing fasciitis

A

deep tissue cultures during debridement

65
Q

Tx of necrotizing fasciitis

A

IMMEDIATE SURGICAL CONSULT

IV Abs–>
Type 1: piperacillin-tazobactam and metronidazole -OR- clindamycin
(also carbapenems + vanco?) (for polymicrobial)

Type 2: clindamycin and penicillin G (for GAS)

66
Q

what is osteomyelitis

A

inflammation or infection of the bone or bone marrow

67
Q

what causes osteomyelitis

A

depends on the route of infection and patients characteristics

IVDU in vancouver–> S. aureus (MRSA)

otherwise if its spinal osteomyelitis its likely TB

68
Q

how do you diagnose osteomyelitis

A

CT

69
Q

Tx for osteomyelitis

A
  1. for IVDU–> debridement and bone culture in the OR; Ab = VANCO (+ screen for endocarditis)
  2. for spinal osteomyelitis (due to TB)–> TB TX for 12 months
70
Q

what do all bite injuries need to be assessed for

A

tetanus and rabies risk

71
Q

septic arthritis is _____ spread and the most common organism is _____

A

hematogenously

S. aureus

72
Q

what is the most reliable way to test for disseminated gonococcal infection

A

cervical or urethral swab

73
Q

what organism do cat and dog bites usually contain? what should they be treated with?

A

pasteurella

amoxicillin-clavulanate

74
Q

what SST infection is a surgical emergency

A

necrotizing fasciitis

75
Q

non-bullous impetigo is usually caused by ____ and can be treated with _____

A

S. aureus

topical or oral Abs

76
Q

bullous impetigo is usually caused by ____ and can be especially severe in _____

A

S. aureus TOXIN

neonates

77
Q

what increases the risk of infection in diabetics

A
  1. impaired sensation
  2. impaired healing
  3. frequent peripheral vascular disease

IDMM (29 decks)

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