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Skin Pathology > CP 62 - Skin Soft Tissue Infection > Flashcards

CP 62 - Skin Soft Tissue Infection Flashcards

(58 cards)

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1
Q

what are the normal layers of the skin

A

outer layer, epidermis, sebaceous gland, dermis, subcutaneous adipose tissue

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2
Q

what are the function of the skins

A

Physical barrier: chemicals, UV, micro-organisms
Homeostasis: thermoregulation, prevention of dessication electrolyte loss
Immunological function: Ag presentation and phagocytosis (Langerhans cells, lymphocytes, mononuclear phagocytic cells)

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3
Q

what are some of the normal flora of the skins?

A

Coagulase-negative staphylococci, Staph. aureus, Propionibacterium, Corynebacterium spp.

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4
Q

what does herpes simplex virus cause?

A

herpes simplex

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5
Q

what does varicella zoster virus cause?

A

herpes zoster - shingles

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6
Q

what is the pathogenesis of herpes simplex

A

vesicle formation - ulceration and release vesicle fluid containing infective particles

virus enter via sensory nerve endings and migrates along nerve to dorsal root ganglion

In latent infection viral DNA exists as “episomes” and no virus-coded proteins are present to stimulate an immune response

In reactivation it is believed that virus particles migrate outwards to sensory nerve endings and cause clinical manifestations of infection

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7
Q

what can trigger HSV reactivation

A

infection or stress - preceded by tingling

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8
Q

what is primary infection of HSV

A

in infant

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9
Q

what does HSV-2 cause?

A

genital herpes

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10
Q

what does HSV-1 cause ?

A

general herpes - ie in the mouth mainly

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11
Q

what is secondary infection of HSV

A

at all ages - peri-oral/genital (which can present as weeping & vesicular)

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12
Q

what is the diagnosis of HSV

A

clinical diagnosis or if difficult PCR for herpes virus DNA

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13
Q

what is coldsore

A

?

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14
Q

what is treatment of HS eg in cold sores, genital herpes, immunosuppressed patient

A

Cold sores
Topical acyclovir
Genital herpes, immunosuppressed patient
Oral acyclovir

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15
Q

what is the previous medical history of herpes zoster (shingles)

A

Previous chickenpox
“Latent” infection

Triggered by physical or emotional insult
Preceded by tingling and/or pain

Weeping, vesicular rash
Dermatomal distribution

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16
Q

what is the diagnosis of herpes zoster (shingles)

A

Weeping, vesicular rash

Dermatomal distribution

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17
Q

what is treatment of HZS

A

Oral acicolvir/valaciclovir
IV aciclovir
Depending on age of patient, immune status and severity of shingles

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18
Q

what is Molluscum contagiosum

A

not really troublism Causative agent

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19
Q

what is the clinical presentation of Molluscum contagiosum

A

Raised, pearly lesions up to 3 mm

Umbilicated

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20
Q

what is diagnosis of Molluscum contagiosum

A

clinical diagnosis

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21
Q

what is treatment of Molluscum contagiosum

A

None – lesions usually disappear in 6-18 months
Various topical preparations
Physical treatments (cryotyherapy, diathermy, laser therapy)

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22
Q

what is the general bacterial infection?

A

Causative agents
Mainly Staph. aureus and group A β-haemolytic streptococci (S. pyogenes)
A few others e.g. Haemophilus influenzae, Pasteurella multocida, enteric organisms and rarities

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23
Q

what is the feature of S. aureus

A

Gram-positive cocci in clusters, catalase-positive

Normal nasal flora in approx. 30% of pop’n

Exotoxin production

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24
Q

what type of Streptoccus pyogenes

Study These Flashcards
A

haemolytic

Gram-positive cocci in chains, catalase-negative

Express many virulence factors

25
where does impetigo normally infect?
epidermis -Often occurs at a site of skin damage causative agent = S. aureus, S. pyogenes or both
26
how does impetigo present clinically
Plaque-like lesions Yellowish exudate Thick scabs “Honey crusted lesions”
27
how can impetigo be diagnosised
clinical diagnosis, Bacterial culture | Sensitivity testing may be useful
28
what are some of the complication of impetigo
Epidermolytic toxin production (ETA & ETB) Manifestations - Localised: Bullous impetigo Generalised: Staphylococcal scalded skin syndrome (SSSS)
29
where doe erysipelas firstly infected
dermis with causative agent - S. pyogenes
30
how can erysipelas cause problem
Often occurs at a site of skin damage Predominantly face or shin Preceded by pain & tenderness
31
what is the presentation of erysipelas
``` Examination Fever & malaise Well-demarcated inflamed lesion Red, swollen, painful and hot Lymph node enlargement ```
32
what is the diagnosis of eryspielas
Clinical diagnosis | Culture rarely helpful
33
where doe erysipelas firstly infected
``` Infection of skin and subcutaneous tissues Causative agents include: S. aureus S. pyogenes Pasteurella multocida (animal bites) Haemophilus influenzae ```
34
how will cellulitis present
Fever & malaise Diffuse inflamed lesion Erythema, swelling, tenderness, heat
35
how can cellulitis enter the system
Site of skin penetration Cut, graze, intravenous catheter, surgical instrument, bite (human or animal) etc. Any part of body Portal may not be apparent
36
how can you distinguish cellulitis from other similar condition
cellulitis is not bilacteral
37
diagnosis of cellulitis ?
- Clinical diagnosis - Broad differential diagnosis - Microbiology - Lesion swabs Positive in 85% of cases Swab if lesion is ulcerated - Lesion aspirates and skin biopsy (Positive in 10-20% of cases, Not recommended routinely) Blood cultures (only Positive in only 2-4% of cases, Use if severe sepsis or systemic signs of infection)
38
how can anthrax be acquired
Acquired from imported wool, hair and animal hides - Inoculation through breaks in the skin
39
what organism can cause antrax
Bacillus anthracis - Spore-forming aerobic Gram-positive bacillus
40
what is necrotising fasciitis
Infection of skin and subcutaneous tissues
41
what is the causative organism of necrotising fasciitis
Type 1: Polymicrobial Enteric Gram-negative bacilli Anaerobes Type 2: Streptococcus pyogenes
42
how does necrotising fasciitis present
Spontaneous or at site of skin penetration Any part of body Fever & malaise Dark, rapidly spreading, necrotic lesion
43
what is the diagnosis of necrotising fasiitis
clinical diagnosis Microscopy and culture Debrided material Blood culture - often +ve
44
what is treatment of necrotising fasciitis
Intravenous antibiotics | Surgical debridement
45
what is gas gangrene
caused by anaerobic infections
46
what is clinical feature of gas gangrene
Clinically similar to “synergistic gangrene” (polymicrobial necrotising fasciitis) Palpable subcutaneous gas
47
when is gas gangrene normally arise
post-op eg amputation
48
what is the organism of gas gangrene
Clostridium perfringens (anaerobic Gram-positive bacillus)
49
treatment of gas gangrene
Intravenous antibiotics | Surgical debridement
50
what are the 2 organisms which causes most of the infections of the skins and soft tissue
Staph. aureus or Strep. pyogenes
51
what is the empiric therapy
Flucloxacillin
52
what is special antibiotics that is used to treat necrotising fasciitis
need to cover anaerobes, Enterobacteriaceae, streptococci and staphylococci Meropenem + clindamycin
53
what is special antibiotics that is used to treat anaerobic infections
Include anti-anaerobic agents (e.g. metronidazole)
54
where does fungal infection normally arise
dermatophyte infection skin eg Tinea corporis, tinea pedis (athletes foot), tinea cruris nail - Onychomycosis Scalp - Tinea capitis (scalp ringworm, kerion)
55
what are the common causative organism of dermatophyte infection
Dermatophyte fungi Tricophyton spp. (e.g. T. rubrum) Microsporum spp. (e.g. M. canis)
56
how can you diagnosis of Dermatophyte infections
Skin scrapings - microscopy & culture | Exclude other conditions e.g. psoriasis
57
what is the treatment of Dermatophyte infections
Topical or systemic antifungal agents | Depending on site & extent of infection
58
what is the treatment for Dermatophyte infections
Skin infections Topical antifungal therapy Clotrimazole, terbinafine Scalp and nail infections Systemic antifungal therapy Terbinafine, itraconazole, griseofulvin

Skin Pathology (3 decks)

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