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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
where do deep space infections arise from
progression of an oral infection
26
what is Ludwig's angina
deep space infection cellulitis of bilateral sublingual/submandibular spaces
27
risk factors for Ludwig's angina
1. immune compromised 2. tongue piercing 3. mandibular fracture almost always results from oral infection (2nd and 3rd molars are most common)
28
etiologic agents for Ludwig's angina
strep and anaerobes (gram +) can also be bacteroides
29
clinical presentation of deep space infection/Ludwig's angina
swollen neck difficulty opening mouth, swallowing fever and malaise
30
Tx for deep space infections
monitor and protect airway (1/3 patients require intubation) antibiotics: penicillin G OR clindamycin + metronidazole surgical evaluation CT to assess size and spread
31
what type of infections are superficial skin infections
toxin mediated skin damage
32
etiological agent for scalded skin syndrome
S. aureus
33
classical presentation of scalded skin syndrome
NIKOLSKYS SIGN reddened skin fluid collects underneath skin rubs off leaving red base
34
diagnosis of scalded skin syndrome
clinical
35
Tx scalded skin syndrome
symptomatic usually vancomycin if need Abs
36
2 types of impetigo
bullous | non-bullous
37
which type of impetigo is highly contagious and is seen in school aged kids? which type is seen in neonates?
non bullous = highly infectious and seen in school aged kids bullous = seen often in neonates
38
etiologic agent of non bullous impetigo
S. aureus also GAS
39
etiologic agent of bullous impetigo
TOXIN producing S. aureus | exfoliative toxin A and B
40
diagnosis of impetigo
clinical | for bullous may have cultures, septic eval
41
Tx nonbullous impetigo
topical antibiotic--MUPIROCIN PO--cloxacillin cephalosporins
42
Tx bullous impetigo
oral or IV Ab cloxacillin cephalosporin vancomycin is MRSA suspected
43
what type of infection is diabetic foot
peripheral vascular disease related soft tissue infection
44
diabetic food risk factors
``` 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
``` etiologic agents in 1. mild 2. moderate 3. severe diabetic foot ```
1. S. aureus (MSSA), streptococcus 2. S. aureus (MSSA), streptococcus 3. assume everything
46
how do you assess diabetic foot
"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
how do you correctly culture a diabetic foot infection
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
Tx for diabetic foot infection
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
what is cellulitis
infection of the deep dermis and subcutaneous fat
50
how does cellulitis happen
break in skin allowing normal skin flora or exogenous flora to invade dermis and subcutaneous tissue
51
epidemiology of cellulitis
diabetics | peripheral vascular disease
52
etiologic agent of cellulitis
almost always strep or staph
53
clinical presentation of cellulitis
simple, localized cellulitis--> no fever/other systemic symptoms; WBC normal; lymphademopathy and lymphangitis severe cellulitis--> systemic symptoms, bullae, hemorrhage, severe swelling
54
how do you monitor the progression of suspected cellulitis
infection spreads rapidly... draw a line around the infected area's borders to monitor spread
55
Tx for cellulitis
empiric Abs elevate analgesics
56
what is erisypelas
infection limited to upper dermis and superficial lymphatics
57
what causes erisypelas
almost always B hemolytic strep (i.e GAS/S pyogenes)
58
clinical presentation of erisypelas
sharp, raised, well demarcated edema rapid onset fever and signs of systemic toxicity
59
Tx of erisypelas
mild/moderate = outpatient --> penicillin or amoxicillin severe = admit to hospital --> IV benzathine penicillin G
60
what type of infection is necrotizing fasciitis
rapidly progressive soft tissue infection
61
where does necrotizing fasciitis infect
deep infection of the subcutaneous tissue causing severe destruction of fat and fascia
62
etiologic agent of 1. type 1 2. type 2 necrotizing fasciitis
1. immunocompromised or post operation patients--> POLYMICROBIAL 2. healthy individuals of any age --> GROUP A STREP (GAS) aka Beta hemolytic strep
63
clinical presentation of necrotizing fasciitis
``` Skin: bullae disproportionate pain swelling erythema crepitus (gangrene) ``` systemic: fever tachycardia hypotension
64
how do you test for necrotizing fasciitis
deep tissue cultures during debridement
65
Tx of necrotizing fasciitis
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
what is osteomyelitis
inflammation or infection of the bone or bone marrow
67
what causes osteomyelitis
depends on the route of infection and patients characteristics IVDU in vancouver--> S. aureus (MRSA) otherwise if its spinal osteomyelitis its likely TB
68
how do you diagnose osteomyelitis
CT
69
Tx for osteomyelitis
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
what do all bite injuries need to be assessed for
tetanus and rabies risk
71
septic arthritis is _____ spread and the most common organism is _____
hematogenously S. aureus
72
what is the most reliable way to test for disseminated gonococcal infection
cervical or urethral swab
73
what organism do cat and dog bites usually contain? what should they be treated with?
pasteurella amoxicillin-clavulanate
74
what SST infection is a surgical emergency
necrotizing fasciitis
75
non-bullous impetigo is usually caused by ____ and can be treated with _____
S. aureus topical or oral Abs
76
bullous impetigo is usually caused by ____ and can be especially severe in _____
S. aureus TOXIN neonates
77
what increases the risk of infection in diabetics
1. impaired sensation 2. impaired healing 3. frequent peripheral vascular disease

IDMM (29 decks)

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