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Infection > Skin and Soft Tissue > Flashcards

Skin and Soft Tissue Flashcards

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1
Q

What are the skin compartments?

A

Epidermis, dermis, subcutaneous fat, fascia and muscle

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2
Q

What are the infection sites of the skin?

A

Impetigo - epidermis
Folliculitis - hair follicle
Erysipelas - deeper in skin

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3
Q

What are things to consider about the host?

A

Diabetes leading to neuropathy and vasculopathy
Immunosuppression
Renal failure
Milroy’s disease - lymphoedema of lower limbs
Predisposing skin conditions

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4
Q

Describe impetigo

A

Superficial skin infection
Multiple vesicular lesions on erythematous base
Golden crust is highly suggestive of diagnosis
Highly infectious

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5
Q

What most commonly causes impetigo?

A

Staph. aureus
Less common - strep pyogenes

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6
Q

What are predisposing factors for impetigo?

A

Skin abrasions, minor trauma, burns, poor hygiene, insect bites, chickenpox, eczema and atopic dermatitis

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7
Q

Where does impetigo mainly occur?

A

Exposed parts of body including face, extremities and scalp
Common in children 2-5 years

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8
Q

What is the treatment for impetigo?

A

Small areas can be treated with topical antibiotics alone
Large need topical treatment and oral antibiotics - flucloxacillin

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9
Q

Describe erysipelas

A

Infection of the upper dermis
Painful, red area with associated fever
Regional lymphadenopathy and lymphangitis
Distinct elevated borders
High recurrence rate

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10
Q

What is erysipelas most commonly due to?

A

Strep pyogenes

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11
Q

Where does erysipelas mainly involve?

A

70-80% of cases involve lower limbs and 5-20% effect face
Tends to occur in areas of pre-existing lymphoedema, venous stasis, obesity, paraparesis and DM

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12
Q

Describe cellulitis

A

Diffuse skin infection involving deep dermis and subcutaneous fat
Presents as spreading erythematous area with no distinct borders
Fever is common
Regional lymphadenopathy and lymphangitis
Possible source of bacteraemia

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13
Q

What is cellulitis most commonly due to?

A

Strep pyogenes and staph aureus
Gram negatives in diabetics and febrile neutropenic

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14
Q

What are some predisposing factors of cellulitis?

A

DM, tinea pedis (athletes foot) and lymphoedema
Patients can have lymphangitis and/ or lymphadenitis

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15
Q

What is the treatment for erysipelas and cellulitis?

A

Combination of anti-staphylococcal and anti-streptococcal antibiotics
In extensive disease - admission for IV antibiotics and rest

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16
Q

What are some hair assocated infections?

A

Folliculitis, furunculosis and carbuncles

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17
Q

Describe folliculitis

A

Circumscribed, pustular infection of a hair follicle
Up to 5mm in diameter
Present as small red papules
Central areas of purulence that may rupture and drain
Constitutional symptoms not often seen

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18
Q

Where is folliculitis mainly found?

A

Head, back, buttocks and extremities

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19
Q

What is the most common organism causing folliculitis?

A

Staph aureus
Benign condition

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20
Q

Describe furunculosis

A

Referred as boils
Single hair follicle associated inflammatory nodule extending into dermis and subcutaneous tissue
Usually affected moist, hairy, friction prone areas of skin
May spontaneously drain purulent material

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21
Q

What are the risk factors and causes for furunculosis?

A

Obesity, DM, atopic dermatitis, chronic kidney disease and corticosteroid use
Staph aureus

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22
Q

Describe carbuncle

A

Occurs when infection spreads to involve multiple furuncles
Multiseptated abscesses and purulent material may be expressed from multiple sites
Constitutional symptoms common
Neck, posterior trunk or thigh

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23
Q

What is the treatment of hair associated infections?

A

Folliculitis - no treatment or topical antibiotics
Furunculosis - no treatment. If not improving then oral antibiotics
Carbuncles - hospital admission, surgery and IV antibiotics

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24
Q

What are predisposing conditions for necrotising fasciitis?

A

DM, surgery, trauma, peripheral vascular disease and skin popping

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25
What is type I necrotising fasciitis?
Refers to mixed aerobic and anaerobic infection Typical organism - strep, staph, enterococci, gram negative bacilli and clostridium
26
What is type II necrotising fasciitis?
Monomicrobial Normally associated with strep pyogenes
27
Describe necrotising fasciitis
Rapid onset Anaesthesia at site of infection is highly suggestive Systemic features - fever, hypotension, tachycardia, delirium and multiorgan failure
28
What does necrotising fasciitis present as?
Sequential development of erythema, extensive oedema and severe and unremitting pain Haemorrhagic bullae, skin necrosis and crepitus
29
What is the treatment for necrotising fasciitis?
Flucloxacillin, gentamicin and clindamycin - broad spectrum antibiotic Mortality between 17-40%
30
Describe pyomyositis
Purulent infection deep within striated muscle, often manifesting as abscess Infection is secondary to seeding into damaged muscle Common sites - thigh, calf, arms, gluteal region, chest wall and psoas muscle
31
How does pyomyositis present?
Fever, pain and woody induration of affected muscle If untreated can lead to septic shock and death
32
What ae predisposing factors for pyomyositis?
DM, HIV/ immunocompromised, IV drug use, rheumatological disease, malignancy and liver cirrhosis
33
What is the commonest cause of pyomyositis?
Staph aureus Others include gram positive/ negative, TB and fungi
34
What is the investigation and treatment for pyomyositis?
CT/ MRI Drainage with antibiotic cover on gram stain and culture results
35
Describe septic bursitis
Small sac like cavities that contain fluid and lined by synovial membrane Located subcutaneously between bony prominences or tendons Facilitate movement with reduced friction Patellar and olecranon
36
What are predisposing factors for septic bursitis?
Rheumatoid arthritis, alcoholism, DM, IV drug abuse, immunosuppression and renal insufficiency Infection is often from adjacent skin infection
37
How does septic bursitis present?
Peri bursal cellulitis, swelling and warmth Fever and pain on movement Diagnosed by aspiration of fluid
38
What is the most common cause of septic bursitis?
Staph aureus Rarer - gram negative, mycobacteria and brucella
39
Describe infectious tenosynovitis
Infection of synovial sheets that surround tendons Flexor associated tendons and tendon sheets of hand most common Penetrating trauma is most common inciting event
40
What is the most common cause for infectious tenosynovitis?
Staph aureus and streptococci Chronic infections may be due to mycobacteria and fungi Possibly disseminated gonococcal infection
41
How does infectious tenosynovitis present?
Erythematous fusiform swelling of finger Held in semi-flexed position Tenderness over length of tendon sheat and pain with extension of finger is classical
42
What is the treatment for infectious tenosynovitis?
Empiric antibiotics Hand surgeon to review ASAP
43
Describe toxin-mediated syndromes
Group of pyrogenic exotoxins Do not activate immune system via normal contact between APC and T cells Super antigens bypass this and attach directly to T cell receptors activating them Massive cytokine release - endothelial leakage, haemodynamic shock and multiple organ failure
44
What is toxin-mediated syndromes mainly caused by?
Staphylococcus aureus and streptococcus pyogenes S. aureus - TSST1, ETA and ETB S. pyogenes - TSST1
45
What can cause toxic shock syndrome?
High absorbency tampons during menses Staph aureus secreting TSST1 small skin infections
46
What is the diagnosis criteria for staphylococcal TSS?
Fever, hypotension, diffuse macular rash, 3 organs involved - liver, blood, renal, GI, CNS and muscular, isolation of S. aureus from mucosal or normal sterile sites, production of TSST1 by isolate and development of antibody to toxin
47
What is the treatment for streptococcal TSS?
Urgent surgical debridement of infected tissues Mortality higher then staph
48
What is streptococcal TSS associated with?
Presence of streptococci in deep seated infections such as erysipelas or necrotising fasciitis
49
What is the treatment for TSS?
Remove offending agent, IV fluids, inotropes, antibiotics and IV immunoglobulins
50
Describe staphylococcal scalded skin syndrome
Infection due to particular strain of S. aureus producing toxin A or B Characterised by widespread bullae and skin exfoliation Usually occurs in children but rarely in adults
51
What is the treatment for staphylococcal scalded skin syndrome?
IV fluids and antimicrobials Mortality is 3% in children but higher in adults who are immunocompromised
52
Describe Panton-Valentine leucocidin toxin
Gamma haemolysin Transferred from one strain of S. aureus to another including MRSA Can cause SSTI and haemorrhagic pneumonia Tends to affect children and young adults Recurrent boils which are difficult to treat
53
What is the treatment for Panton-Valentine leucocidin toxin?
Antibiotics that reduce toxin production
54
Describe IV catheter associated infections
Nosocomial infection Normally starts as local SST inflammation progressing to cellulitis and tissue necrosis Common to have associated bacteraemia
55
What are the risks for IV catheter associated infection?
Continuous infusion over more than 24hrs Cannula in situ for more than 24hrs Cannula in lower limb Patients with neurological/ neurosurgical problems
56
What is the main cause of IV catheter associated infection and how is it diagnosed?
Staph aureus Commonly forms a biofilm which then spills into bloodstream and can seed to other places Diagnosis - clinically or positive blood cultures
57
What is the treatment for IV catheter associated infection?
Remove cannula and express any pus from thrombophlebitis Antibiotics for 14 days Echo Prevention is most important
58
What is the classification of surgical wounds?
Class 1 - clean wound Class 2 - clean contaminated wound Class 3 - contaminated wound Class 4 - infected wound
59
What are some causes for surgical site infections?
Staph. aureus, coagulase negative staphylococci, enterococcus, Escherichia coli, pseudomonas aeruginosa, Enterobacter, streptococci, fungi and anaerobes
60
What are the risk factors for surgical site infection?
Diabetes, smoking, obesity, malnutrition, concurrent steroid use and colonisation with staph. aureus
61
What are procedural factors for surgical site infections?
Shaving of site the night prior Improper preoperative skin prep Improper antimicrobial prophylaxis Break in sterile technique Inadequate theatre ventilation Perioperative hypoxia
62
What is the investigations and treatment for surgical site infections?
Importance of sending pus/ infected tissue for culture Avoid superficial swabs and aim for deep structures Antibiotic to target likely organism
63
What infections need urgent attention?
Necrotising fasciitis, pyomyositis, TSS, PVL infections and Venflon associated infections

Infection (13 decks)

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