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Skin and Soft Tissue Infection Flashcards

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1
Q

Impetigo refers to

A

infection of the epidermis

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2
Q

Erisypelas refers to

A

infection of the epidermis/upper dermis

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3
Q

Cellulitis refers to

A

infection of the subcutaneous layer

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4
Q

Necrotising fasciitis refers to

A

infection of the fascia

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5
Q

What factors should be considered when assessing a soft tissue infection?

A 
Site 
Organism
Host
Predisposing factors 
Environment
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6
Q

Important predisposing factors for soft tissue infections

A 
Diabetes mellitus
Immunosuppression
Renal failure 
Milord's disease 
Predisposing skin conditions
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7
Q

Most common causative organism of impetigo

A

Staph aureus

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8
Q

Presentation of impetigo

A

Multiple vesicular lesions on an erythematous base
Golden crusting characteristic
Tends to occur on exposed areas of body

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9
Q

Second most common causative organism of impetigo

A

Strep pyogenes

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10
Q

Predisposing factors of impetigo

A 
Skin abrasions 
Minor trauma 
Burns
Poor hygiene 
Insect bites
Chickenpox
Eczema 
Atopic dermatitis
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11
Q

Treatment of impetigo

A

Small areas treated with topical antibiotics alone, targeting mainly gram positive
Large areas treated with topical and oral antibiotics e.g. flucloxacillin

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12
Q

Presentation of erysipelas

A 
Raised erythematous areas 
Commonly affect face and limbs 
Painful red area
Associated fever
Regional lymphadenopathy and lymphangitis 
Distinct elevated borders
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13
Q

Most common causative organism of erysipelas

A

Strep pyogenes

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14
Q

Predisposing factors to erysipelas

A 
Pre-exsting lymphoedema 
Venous stasis 
Obesity 
Paraparesis 
Diabetes mellitus
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15
Q

Recurrence rate of erysipelas

A

30% within 3 years

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16
Q

What percentage of erysipelas affects the lower limbs and face?

A

70-80% lower limbs

5-25% face

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17
Q

Presentation of cellulitis

A

Diffuse skin infections involving deep dermis and subcutaneous fat
Spreading erythematous area with no distinct borders
Fever
Systemically unwell

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18
Q

Causative organisms of cellulitis

A

Staph aureus

Strep pyogenes

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19
Q

When should gram negative organisms be considered as a cause of cellulitis?

A

Diabetic patients
Febrile neutropenic patients

Particularly if not improving

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20
Q

Predisposing factors of cellulitis

A 
Diabetes mellitus 
Tinea pedis 
Lymphoedema 
Lymphangitis 
Lymphadenitis
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21
Q

Treatment of erysipelas and cellulitis

A

Combination of anti-staph and anti-strep antibiotics
Usually penicillin or vancomycin and doxycycline

Admission for IV antibiotics and rest if extensive disease

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22
Q

Follicular infections

A

Folliculitis
Furunculosis
Carbuncle

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23
Q

Presentation of folliculitis

A

Well circumscribed pustular infection of a single hair follicle
Small red papules
May occur in clusters, typically on head, back, buttocks and extremities
Central area of purulence

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24
Q

Most common causative organism of folliculitis

A

Staph aureus

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25
What is furunculosis?
Inflammatory infection of a single hair follicle that extends deep into the dermis and subcutaneous tissue
26
Areas affected by furunculosis
Moist, hairy, friction prone areas
27
Most common causative organism of furunculosis
Staph aureus
28
Risk factors of furunculosis
``` Obesity Diabetes mellitus Atopic dermatitis Chronic kidney disease Corticosteroid use ```
29
What is a carbuncle?
Infection which has extended to involve multiple furuncles
30
Presentation of carbuncle
Large abscess involving multiple adjacent hair follicles Multiseptated abscesses Purulent material expressed from multiple sites May drain spontaneously
31
Areas commonly affected by carbuncles
Back of neck Posterior trunk Thighs
32
Major predisposing factor for carbuncles
Diabetes mellitus
33
Treatment of folliculitis
No treatment or topical antibiotics
34
Treatment of furunculosis
No treatment or topical antibiotics | Oral antibiotics if failure to improve with topical
35
Treatment of carbuncle
Admission Surgery IV antibiotics
36
Presentation of necrotising fasciitis
``` Rapid onset Sequential development of erythema, extensive oedema and severe unremitting pain Haemorrhagic bullae Skin necrosis Crepitus Anaesthesia at site of infection ```
37
Systemic features of necrotising fasciitis
``` Fever Hypotension Tachycardia Delirium Multi-organ failure ```
38
Causative organism of type 1 necrotising fasciitis
``` Mixed aerobic and anaerobic infections Strep Staph Enterococci Gram negative bacilli Clostridium ```
39
Treatment of type 1 necrotising fasciitis
``` Broad spectrum Benzapenicillin for strep Flucloxacillin for staph Gentamicin for gram negatives Clindamycin to aid action of benza and fluclox Metronidazole for anaerobes ```
40
Causative organism of type 2 necrotising fasciitis
Monomicrobial | Usually associated with strep pyogenes
41
Predisposing factors of type 2 necrotising fasciitis
``` Diabetes mellitus Surgery Trauma Peripheral vascular disease Skin popping ```
42
Presentation of type 2 necrotising fasciitis
``` Rapid onset Redness followed by oedema and severe pain Hypotension Systemic features Multi-organ failure ```
43
Treatment of type 2 necrotising fasciitis
``` Cannula Fluids to raise BP Antibiotics - flucloxacillin, gentamicin, clindamycin Surgery - removal of dead tissue Surgical review ```
44
Overall mortality of type 2 necrotising fasciitis
17-40%
45
What is pyomyositis?
Purulent infection deep within striated muscles, often manifesting as an abscess
46
Sites affected by pyomyositis
Multiple sites involved in 15% Thigh, calf, arms, gluteal region, chest wall, psoas muscle
47
Presentation of pyomyositis
Pain Fever Woody induration of affected muscle
48
Predisposing factors of pyomyositis
``` Diabetes mellitus HIV Immunocompromised IVDA Rheumatological disease Malignancy Liver cirrhosis ```
49
Commonest cause of pyomyositis
Staph aureus Other organisms may be involved, including gram positive, gram negative, TB bacteria and fungi
50
Treatment of pyomyositis
Drainage and antibiotics depending on gram stain and culture results
51
Presentation of septic bursitis
Commonly affects olecranon and patellar bursae Infection normally spread to bursae from adjacent skin infection Peribursal cellulitis, swelling and warmth Fever and pain on movement
52
Common causative organism of septic bursitis
Staph aureus more rarely caused by mycobacteria and brucella
53
Diagnosis of septic bursitis
Based on aspiration of the fluid
54
Predisposing factors of septic bursitis
``` Rheumatoid arthritis Alcoholism Diabetes mellitus IVDA Immunosuppression Renal insufficiency ```
55
What needs to be excluded in the differential diagnosis of septic bursitis?
Septic arteritis - this requires immediate treatment
56
What is infectious tenosynovitis?
Infection of the synovial sheets that surround tendons
57
Area most commonly affected by infectious tenosynovitis
Flexor synovial sheets around tendons in the hand
58
Most common inciting event of infectious tenosynovitis
Penetrating trauma
59
Most common causative organism of infectious tenosynovitis
Staph aureus | Strep pyogenes
60
Causative organism of chronic infectious tenosynovitis
Mycobacteria or fungi
61
Presentation of infectious tenosynovitis
Erythematous fusiform swelling of the finger Finger held in semi-flexed position Tenderness over length of tendon sheet
62
Treatment of infectious tenosynovitis
Urgent review by hand surgeon Surgery to relieve pressure Empiric antibiotics
63
Toxin-mediated cutaneous infections are often due to
super antigens
64
How do pyogenic exotoxins work?
They don't activate the immune system via normal contact between antigen presenting cells and T cells, they bypass this and attach directly to T cell receptors causing huge cytokine release
65
Most common cause of toxin-mediated cutaneous infections
Staph aureus TSST1, ETA and ETB | Strep pyogenes TSST1
66
What does toxic shock syndrome toxin 1 cause (TSST1) and how does it present?
Toxic shock syndrome | Presents as fever, rash, hypotension and organ failure
67
What do exfoliative toxins A and B cause and how does it present?
Staphylococcal scalded skin syndrome | Widespread bullae and skin exfoliation
68
What does Panton-Valentine leukocidin toxin cause?
Recurrent boils and haemorrhagic pneumonia in children and young adults
69
Diagnostic criteria for staphylococcal toxic shock syndrome
Fever Hypotension Diffuse macular rash Three of the following involved; liver, blood, kidneys, GI, CNS, muscular Isolation of staph aureus from mucosal or normally sterile sites Production of TSST1 by isolate Development of antibody to toxin during convalescence
70
What is streptococcal toxic shock syndrome almost always associated with?
Presence of strep in a deep-seated infection e.g. erysipelas or necrotising fasciitis
71
Mortality rate of staph TSS vs strep TSS
Streptococcal TSS 50% mortality | Staphylococcal TSS 5% mortality
72
Treatment of toxic shock syndrome
``` Remove offending agents IV fluids Inotropes Antibiotics IV immunoglobulins ```
73
Risk factors of venflon-associated infections
Continuous IV infusion > 24 hours Cannula in situ > 72 hours Cannula in lower extremity Neurological and neurosurgical problems
74
Causative organisms of venflon-associated infections
MMSA | MRSA
75
What can bacteraemia associated with venflon-associated infections cause?
Endocarditis | Osteomyelitis
76
Treatment of venflon-associated infections
Prevention Removal of cannula Antibiotics
77
Presentation of IV catheter associated infections
Normally starts as local STT inflammation, progressing to cellulitis and tissue necrosis Associated bacteraemia
78
Treatment of IV catheter associated infections
Remove cannula Express any pus from thrombophlebitis Antibiotics 14 days Echo
79
Prevention of infections in patients with peripheral venous cannulae
``` Do not leave an unused cannula Do not insert a cannula unless it is being used Change cannula every 72 hours Monitor for thrombophlebitis Practice aseptic technique ```
80
Risk factors of surgical site infections
Diabetes Smoking Obesity Malnutrition
81
Procedural risk factors for surgical site infection
``` Shaving site of surgery the night prior to procedure Improper pre-operative skin preparation Improper antimicrobial prophylaxis Break in sterile technique Inadequate theatre ventilation Perioperative hypoxia ```
82
Causative organism of surgical site infection
Can be caused by any organism
83
Description of class 1 surgical site infection
Clean wound infection - Respiratory, alimentary, genital and urinary systems not entered - Infection in a surgical site that is sterile e.g. joint operations - Normally due to invasive organisms e.g. staph aureus
84
Description of class 2 surgical site infection
Clean contaminated wound | - respiratory, alimentary, genital or urinary system entered but no unusual contamination
85
Description of class 3 surgical site infection
Contaminated wound - infections at a surgical site that is either already contaminated at the start of surgery or is contaminated during surgery e.g. due to perforation in abdominal surgery
86
Description of class 4 surgical site infection
Infected wound | - existing clinical infection
87
Diagnosis of surgical site infection
Send pus/infected tissue for culture Avoid superficial swabs Consider unlikely pathogen if obtained from sterile site Target likely organisms

Infection (14 decks)

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