Staph and Strep infections Flashcards
When does staphylococcal scalded skin syndrome usually occur?
After a history of a sore throat
Who does staphylococcal scalded skin syndrome occur in?
Younger people- infants up to about 6 years old
How does staphylococcal scalded skin syndrome present
- Widespread erythroderma (>90%)
- Fluid filled blisters lead to desquamation
- Fever and irritable
- Nikolsky sign positive
- ORAL MUCOSA UNAFFECTED
What will be positive in someone with staphylococcus scalded skin syndrome?
Nikolsky sign positive
What is unaffected in staphylococcal scalded skin syndrome?
Oral mucosa is unaffected
How is staphylococcal scalded skin syndrome diagnosed?
Skin biopsy
What is the management of staphylococcal scalded skin syndrome?
IV antibiotics
What is staphylococcal toxic shock syndrome?
Severe systemic reaction to staphylococcal exotoxins
What staphylococcal exotoxin causes toxic shock syndrome?
TSST-1 superantigen toxin.
What diagnostic criteria is used for toxic shock syndrome?
Centers for Disease Control and Prevention diagnostic criteria
What is the Centers for Disease Control and Prevention diagnostic criteria fort toxic shock syndrome?
- fever: temperature > 38.9ºC
- hypotension: systolic blood pressure < 90 mmHg
- diffuse erythematous rash
- desquamation of rash, especially of the palms and soles
Where in particular would you see desquamation of the rash with toic shock syndrome?
Palms and soles of feet
How many organ systems need to be involved for the diagnosis of toxic shock syndrome?
3 or more
What organ system involvement can there be for the diagnosis of toxic shock syndrome?
- gastrointestinal (diarrhoea and vomiting)
- mucous membrane erythema
- renal failure
- hepatitis
- thrombocytopenia
- CNS involvement (e.g. confusion)
What is the initial management of toxic shock syndrome?
Removal of infection focus (e.g. retained tampon)
What medical management can you do for toxic shock syndrome?
- IV fluids
* IV antibiotics
Which IV antibiotics would you give for toxic shock syndrome?
Flucloxacillin and clindamycin
What is the main cause of scarlet fever?
Group A haemolytic streptococci
Which group A streptococci is usually responsible for scarlet fever?
Streptococcus pyogenes
What is scarlet fever due to?
A reaction to erythrogenic toxins produced by Group A haemolytic streptococci
Who is most commonly affected by scarlet fever?
Children aged 2 - 6 years with the peak incidence being at 4 years.
How is scarlet fever spread?
Via the respiratory route by inhaling or ingesting respiratory droplets
or
By direct contact with nose and throat discharges
How does scarlet fever tend to present?
- fever
- malaise, headache, nausea/vomiting
- sore throat
- ‘strawberry’ tongue
- rash
- fine punctate erythema (‘pinhead’) first on the torso and spares the palms and soles
How long does a fever typically last with scarlet fever?
24 to 48 hours
What are the 2 characteristic presentations of scarlet fever?
Strawberry tongue
Fine punctate erythema (‘pinhead’)
Where does the fine punctate erythema (‘pinhead’) first appear with scarlet fever?
On the torso
Spares the palms and soles
What is the typical presentation of a child with scarlet fever?
children often have a flushed appearance with circumoral pallor.
The rash is often more obvious in the flexures
it is often described as having a rough ‘sandpaper’ texture
desquamination occurs later in the course of the illness,
How is scarlet fever diagnosed?
Throat swab
When should antibiotics for scarlet fever be commenced?
Immediately- before the results of the throat swab come back
What is the medical management of scarlet fever?
Penicillin V
What is the medical management of scarlet fever in someone with a penicillin allergy?
Azaithromycin
When can children return to school after starting antibiotics for scarlet fever?
24 hours after starting antibiotics
What can scarlet fever be complicated by?
Otitis media
Rheumatic fever
Acute glomerulonephritis
