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Infection > Skin and Soft Tissue Infections > Flashcards

Skin and Soft Tissue Infections Flashcards

1
Q

What is the most superficial skin infection?

A

Impetigo

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2
Q

How does impetigo present?

A

Multiple vesicular lesions on an erythematous base
Golden crust highly suggestive
Most commonly on extremities, face and scalp
Most common in children aged 2-5

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3
Q

What are the common causative organisms of impetigo?

A 
Staph aureus (most common)
Strep pyogenes
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4
Q

What are the predisposing factors for impetigo?

A 
Skin abrasions
Minor trauma
Burns
Poor hygiene
Insect bites
Chickenpox
Eczema
Atopic dermatitis
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5
Q

How is impetigo treated?

A

Topical antibiotics alone if only small area affected

Oral antibiotics plus topical antibiotics if large are

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6
Q

What is erysipelas an infection of?

A

The upper dermis

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7
Q

How does erysipelas present?

A

Painful, bubbly, raised, red area with no central clearing. Rash usually has distinct elevated borders
Associated fever
Regional lymphadenopathy
Lymphangitis
Most cases affect lower limb but can affect face too

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8
Q

What is the most common causative organism for erysipelas?

A

Strep pyogenes

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9
Q

When is erysipelas most common?

A

In areas of pre-existing lymphoedema, venous stasis, obesity, paraparesis or diabetes

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10
Q

What is infected in cellulitis?

A

Deep dermis

Subcutaneous fat

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11
Q

How does cellulitis present?

A

A spreading erythematous area with no distinct borders
Fever
Regional lymphadenopathy
Lymphangitis

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12
Q

What are the most common causative organisms of cellulitis?

A

Strep pyogenes

Staph aureus

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13
Q

What are the predisposing factors for cellulitis?

A

Diabetes mellitus
Tinea pedis
Lymphoedema

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14
Q

How are erysipelas and cellulitis treated?

A

Combination of anti-staphylococcal and anti-streptococcal antibiotics

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15
Q

What are the common hair-associated infections?

A

Folliculitis
Furunculosis
Carbuncles

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16
Q

What is folliculitis?

A

Circumscribed, pustular infection of a hair follicle

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17
Q

How does folliculitis present?

A

Small red papules that are up to 5mm in diameter
Central area of purulence that may rupture and drain
Lesions are typically found on the head, back, buttocks and extremities

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18
Q

What is the most common causative organism of folliculitis?

A

Staph aureus

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19
Q

How is folliculitis treated?

A

Treatment rarely required

Topical antibiotics

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20
Q

What is furunculosis?

A

Involves furuncles
A single hair follicle-associated inflammatory nodule that extends into the dermis and subcutaneous tissue
Most common on face, axilla, neck and buttocks

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21
Q

What is the most common causative organism of furunculosis?

A

Staph aureus

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22
Q

What are the risk factors for furunculosis?

A 
Obesity
Diabetes mellitus
Atopic dermatitis
Chronic kidney disease
Corticosteroid use
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23
Q

How is furunculosis treated?

A

Treatment rarely required
Topical antibiotics
Oral antibiotics if condition won’t improve

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24
Q

What are the features of carbuncles?

A

Occur when infection extends to involve multiple furuncles
Often on back of neck, posterior trunk and thigh
Present as multiseptated abscesses and purulent material can be expressed from multiple sites
Systemic symptoms common
Treatment involves admission, surgery and IV antibiotics

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25
Q

What are the predisposing factors for necrotising fasciitis?

A 
Diabetes mellitus
Surgery
Trauma
Peripheral vascular disease
Skin popping (IV drug users run out of venous sites and inject intra-dermally)
26
Q

What is the difference between type I and type II necrotising fasciitis?

A

Type I- mixed aerobic and anaerobic infection

Type II- monomicrobial, more common than type I

27
Q

What are the causative organisms of type I and II necrotising fasciitis?

A 
Type I:
-Streptococci
-Staphylococci
-Enterococci
-Gram negative bacilli
-Clostridium
Type II usually strep pyogenes
28
Q

How does necrotising fasciitis present?

A

Lesion similar to cellulitis but pain is severe
Rapid onset
Sequential development of erythema, extensive oedema and severe pain
Haemorrhagic bullae, skin necrosis and crepitus may also develop
Systemic features can include fever, hypotension, tachycardia, delirium and multiorgan failure
Anaesthesia at sight of infection highly suggestive of NF

29
Q

How should necrotising fasciitis be managed?

A

Surgical review mandatory
Imaging can be helpful but shouldn’t delay treatment
Broad spectrum antibiotics should be used (gentamicin, flucloxacilin, clindamycin)

30
Q

What is pyomyositis?

A

A purulent infection deep with striated muscle, often manifesting as an abscess

31
Q

What are the common sites of pyomyositis?

A 
Thigh
Calf
Arms
Gluteal region
Chest wall
Psoas muscle
32
Q

How does pyomyositis present?

A

Fever
Pain
Woody induration of affected muscle (cardinal sign)
If untreated the infection can lead to septic shock and death

33
Q

What are the predisposing factors for pyomyositis?

A 
Diabetes mellitus
HIV/immunocompromised
Intravenous drug use
Rheumatological diseases
Malignancy
Liver cirrhosis
34
Q

What are the common causative organisms of pyomyositis?

A

Staph aureus (most common)
TB
Fungi

35
Q

How is pyomyositis managed?

A

CT and MRI can be helpful

Drainage plus antibiotics

36
Q

What is septic bursitis?

A

Infection of the bursae

37
Q

What are the predisposing factors for septic bursitis?

A 
Adjacent skin infection
Rheumatoid arthritis
Alcoholism
Diabetes mellitus
Intravenous drug abuse
Immunosuppression
Renal insufficiency
38
Q

What are the clinical features of septic bursitis?

A 
Peri-bursal cellulitis
Swelling
Warmth
Fever 
Pain on movement
39
Q

How is septic bursitis diagnosed?

A

Aspiration of fluid (FNA not often done in practice due to risk of infecting an uninfected bursa)

40
Q

What are the common causative organisms of septic bursitis?

A

Staph aureus (most common)
Gram-negative bacteria
Mycobacteria
Brucella

41
Q

What is infectious tenosynovitis?

A

Infection of the synovial sheets surrounding tendons

Flexor muscle-associated tendons and tendon sheets of the hand are the most commonly affected

42
Q

What are the causes of infectious tenosynovitis?

A

Penetrating trauma

Most common causative organisms are staph aureus and streptococci

43
Q

How does infectious tenosynovitis present?

A

Erythematous fusiform swelling of a finger that is held in a semi-flexed position
Tenderness over the length of the tendon sheet
Pain when extending finger

44
Q

How is infectious tenosynovitis managed?

A

Empirical antibiotics

Reviewal from hand surgeon

45
Q

Describe the process of toxin-mediated syndromes?

A

Often due to superantigens, resulting in a massive burst in cytokine release. This leads to endothelial leakage, haemodynamic shock, multi organ failure and death

46
Q

What are the most common causative organisms of toxin-mediated syndromes?

A

Staph aureus

Strep pyogenes

47
Q

What are the diagnostic criteria for staphylococcal toxic shock syndrome?

A

Fever
Hypotension
Diffuse macular rash
Three of the following organs involved (Liver, blood, renal, gatrointestinal, CNS, muscular)
Isolation of Staph aureus from mucosal or normally sterile sites
Production of TSST1 by isolate
Development of antibody to toxin during convalescence

48
Q

What are the characteristics of streptococcal toxic shock syndrome?

A

Streptococcal toxic shock syndrome is almost always associated with the presence of streptococci in deep seated infections such as erysipelas or necrotising fasciitis. Mortality rate is much higher than in staphylococcal TSS. Treatment requires urgent surgical debridement of the infected tissues.

49
Q

How is toxic shock syndrome treated?

A 
Remove offending agent (ex tampon)
Intravenous fluids
Inotropes
Antibiotics
Intravenous immunoglobulins
50
Q

What is staphylococcal scalded skin syndrome?

A

An infection due to a particular strain of staphylococcal aureus producing the exfoliative toxin A or B

51
Q

How is staphylococcal scalded skin syndrome characterised?

A

Widespread bullae and skin exfoliation. It usually occurs in children but can also occur in adults

52
Q

How is staphylococcal scalded skin syndrome treated?

A

IV fluids and antimicrobials

53
Q

What are the characteristics of Panton-Valentine leucocidin toxin?

A

Can be transferred from one staph aureus strain to another
Can cause SSTI and haemorrhagic pneumonia
Most commonly affects children and young adults
Patients present with recurrent, difficult to treat boils
Treatment with antibiotics

54
Q

What are the risk factors for IV-catheter associated infections?

A

Continuous infusion >24 hours
Cannula in situ >72 hours
Cannula in lower limb
Patients with neurological/neurosurgical problems

55
Q

What is the most common infective organism in IV-catheter associated infections?

A

Staph aureus

56
Q

How are IV-catheter associated infections diagnosed?

A

Clinically

Positive blood cultures

57
Q

How are IV-catheter associated infections treated?

A

Removal of cannula
Removing pus from the thrombophlebitis
Antibiotics for 14 days
ECG to check for spread to heart wall

58
Q

What are the preventative measures for IV-catheter associated infections?

A

Do not leave unused cannula
Do not insert cannulae unless you are using them
Change cannulae every 72 hours
Monitor for thrombophlebitis
Use aseptic technique when inserting cannulae

59
Q

How are surgical site wounds classified?

A

Class I: Clean wound (respiratory, alimentary, genital or infected urinary systems not entered)
Class II: Clean-contaminated wound (above tracts entered but no unusual contamination)
Class III: Contaminated wound (Open, fresh accidental wounds or gross spillage from the gastrointestinal tract)
Class IV: Infected wound (existing clinical infection, infection present before the operation)

60
Q

What are the risk factors for surgical site infections?

A 
Diabetes
Smoking
Obesity
Malnutrition
Concurrent steroid use
Colonisation with Staph aureus
Shaving of site the night prior to procedure
Improper preoperative skin preparation
Improper antimicrobial prophylaxis
Break in sterile technique
Inadequate theatre ventilation
Perioperative hypoxia
61
Q

How are surgical site infections diagnosed?

A

Sending pus or infected tissue for cultures

Avoid superficial swabs

Infection (13 decks)

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