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SBCP Microbiology > Skin and Soft Tissue Infections > Flashcards

Skin and Soft Tissue Infections Flashcards

(78 cards)

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1
Q

Most common organisms associated with skin and soft tissue infections? (2)

A

Staph aureus

Group A Streptococcus pyogenes

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2
Q

How does the coagulase enzyme produced by staph aureus act as a virulence factor?

A

Activates fibrinogen and is important in abscess formation

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3
Q

What syndrome does the toxin TSST-1 (toxic syndrome one-1) cause?

A

Toxic shock syndrome, systemic illness

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4
Q

How does the enzyme hyaluronidase act as a virulence factor?

A

Produced by staph aureus, lyses fibrin clots and assists in spread of infection

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5
Q

What organism causes scalded skin syndrome in babies?

A

Staph aureus

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6
Q

Well recognised carriage sites of staph aureus on the human body?

A

Anterior nares, skin of axilla and groin

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7
Q

How does a capsule act as a virulence factor for streptococcus pyogenes?

A

Immunological disguise

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8
Q

How does M protein act as virulence factor for streptococcus pyogenes?

A

Adherence, helps to resist phagocytosis

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9
Q

Which organism produces these toxins: Streptolysin O, Streptolysin S, pyrogenic toxin

A

Streptococcus pyogenes

Pyrogenic toxin responsible for some of the severe manifestations of necrotising fasciitis

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10
Q

How can you detect the presence of a previous or recent streptococcal infection?

A

Antibodies to streptolysin O

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11
Q

Where does streptococcus pyogenes normally colonise on the human body?

A

Nasopharynx

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12
Q

Name the two post streptococcal syndromes

A

Rheumatic fever
Glomerulonephritis

Arise a few weeks after an infection. Immunologically related.

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13
Q

Aetiology of impetigo?

A

Staph aureus

Strep pyogenes

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14
Q

Complication of impetigo

A

Post-streptococcal glomerulonephritis

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15
Q

Treatment for impetigo

A

Topical fusidic acid/mupirocin

Flucloxacillin

Exclude from school

Strict hygiene, don’t share towels

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16
Q

What is folliculitis?

A

Superficial infection of hair follicle, caused by staph aureus, pus only in epidermis

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17
Q

What are carbuncles?

A

Infection of multiple adjacent follicles usually on the back of the neck

Inflammatory mass with multiple sinuses

Patient is often diabetic

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18
Q

What are furuncles?

A

Commonly known as boils

Infection of hair follicle that extends into dermis with more inflammation that folliculitis

Inflammatory nodule is present often with a hair seen emerging from this

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19
Q

Treatment of larger furuncles/carbuncles?

A

Incision and drainage

Abx not usually needed

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20
Q

Treatment of recurrent furunculosis

A

Occurs in staph aureus carriers (carried in their anterior nares) therefore topical MUPIROCIN on the anterior nares

Recurrence also occurs in diabetics

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21
Q

What is erysipela?

A

Form of cellulitis affecting most superficial layers of skin

More common in infants and elderly

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22
Q

Symptoms of erysipelas

A

Superficial cellulitis affecting infants and elderly

Abrupt onset with fever, chills, malaise

Raised lesions on red hot area of skin which is well demarcated

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23
Q

What area of the body does erysipelas affect?

A

Lower legs 70-80%

Face 5-10%

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24
Q

Tx of erysipelas

A

Penicillin, oral or IV

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25
Which skin layer is affected by cellulitis?
Dermis and subcutaneous fat
26
Symptoms of cellulitis
Preceded by fever/flu like symptoms Skin red, hot, swollen (peau d'orange) Advancing diffuse edge
27
Risk factors for cellulitis (6)
``` Obesity Venous insufficiency Lymphoedema Trauma Athletes foot Diabetes ```
28
Which organisms cause cellulitis?
MOSTLY will be staph aureus Or strep pyogenes BUT in cases of trauma it may be a more unusual cause (eg dog bite with Pasteurella and mixed anaerobes)
29
Treatment of mild cellulitis?
Oral flucloxacillin (covers both staph and strep)
30
Treatment of moderate to severe cellulitis?
IV flucloxacillin +/- benzylpenicillin
31
Treatment of cellulitis with penicillin allergy?
Clindamycin
32
Investigations for cellulitis?
Skin swab of any breaches Blood cultures if severe CLINICAL DIAGNOSIS
33
Which animals have pasteurella mulocida in their bites?
Cats and dogs
34
Which animals have anaerobes in their bites?
cats, dogs and humans
35
Which animals have eikenella corrodens in their bites?
Humans
36
Management of bites?
Prophylactic abx for high risk wounds and high risk patietns CO-AMOXICLAV covers all relevent pathogens Don't forget tetanus
37
Most common organism in surgical infection?
Staph aureus
38
Surgical infection: organisms in contaminated or dirty wounds?
Coliform streps and anaerobes
39
General management of surgical wound infections
Open and drain Abx not always necessary
40
Abx for surgical wound with staph aureus
Flucloxacillin OR clindamycin
41
Abx for dirty surgical wound infection (eg staph, strep, coliforms, anaerobes)
Second generation cephalosporin such as: CEFUROXIME + METRONIDAZOLE OR Co-amoxiclav
42
4 types of chronic wound
Arterial Venous Pressure sores Diabetic ulcers
43
Symptoms of arterial ulcer
``` Weak or absent pulses Reduced ABPI Intermittent claudication Skin hairless and shiny Ulcer with well defined border ```
44
Tx for arterial ulcer?
Revascularise with bypass grafting or angioplasty
45
Symptoms of venous ulcer
Superior to medial malleolus Haemosiderin deposits Lipodermatosclerosis Oedema
46
Management for venous ulcer
Compression therapy
47
Where do pressure ulcers arise?
Over sites of bony prominence
48
Where do diabetic ulcers occur?
Mostly on plantar surface of foot
49
How many diabetic patients have diabetic ulcers at any time?
4-20%
50
True/false: diabetic ulcers are leading cause of traumatic amputations
FALSE, leading cause of NON-traumatic amputations. 40-60%
51
Investigations for chronic wound infection
Swab wound bed after cleansing and removal of slough but BEFORE antiseptics and antibiotics Tissue biopsies better than swabs ONLY SAMPLE WHEN ?infection Positive swab result is not a directive to treat
52
Debriding options for chronic wounds (3)
Surgical Chemical Larvae
53
Local antiseptics for chronic wounds (2)
Cadexomer iodine | Silver products
54
General management of chronic wounds
Debridement, local antiseptics, and use of complex dressings to keep wound bed moist Reserve antibiotics for systemic infection
55
What is single most important pathogen in diabetic foot infection?
Staph aureus May be polymicrobial in deep or severe infection
56
Describe a mild diabetic foot infection
<2cm radius of cellulitis around wound
57
Describe a moderate diabetic foot infection
>2cm cellulitis radius | Deep infection
58
Describe a severe diabetic foot infection
Deep infection | Systemic sepsis
59
What is necrotising fasciitis?
A RARE, life-threatening, rapidly progressive subcutanous infection which tracks along fascial planes
60
How does necrotising fasciitis spread?
Tracks along the fascial planes
61
3 types of necrotising fasciitis?
Polymicrobial NF Group A strep NF (flesh eating) Clostridial myonecrosis (gas gangrene)
62
When does polymicrobial necrotising fasciitis occur?
After trauma or surgery An example is Fournier's gangrene Involves staph, strep, anaerobes, coliforms, and aerobic gram negatives
63
What is another name for Group A streptococcal NF?
Flesh eating NF Can occur in fit and healthy people Result of minor trauma
64
What is another name for Clostridial myonecrosis?
Gas gangrene, caused by Clostridium perfringens
65
Symptoms and signs of necrotising fasciitis
HAVE HIGH SUSPICION INDEX Overlying cellulitis Pain OUT OF KEEPING with signs Skin necrosis Crepitus Confusion Hypotension
66
How to confirm necrotising fasciitis diagnossi?
Surgical exploration
67
Treatment of necrotising fasciitis
Surgical emergency Aggressive debridement ICU Antibiotics: High doses of benzylpenicillin, clindamycin, ciprofloxacin
68
What 3 abx are used for necrotising fiasciitis?
BCC Benzylpenicillin Clindamycin Ciprofloxacin
69
Causes of ringworm (3)
Trichophyton Microsporum Epidermophyton
70
How is ringworm/tinea spread?
Zoonotic, human to human (shared towels, hairbrushes)
71
How is ringworm diagnosed?
Clinical appearance Direct microscopic exam of scales in potassium hydroxide Culture of scrapings FLUORESCENCE UNDER WOOD'S LIGHT FOR TINEA CAPITIS
72
Tx for tinea/ringworm?
Topical imidazoles 2-4 wks Oral terbinafine for resistant cases
73
Which antibiotics increase risk of MRSA?
Quinolones | Cephalosporins
74
Treatment for mild MRSA infection?
Tetracyclines
75
Treatment for severe MRSA infection?
Glycopeptides: | -IV VACNOMYCIN/ TEICOPLANIN
76
What is CA-MRSA?
Community associated MRSA Affects young, healthy adults and children No associated risk factors
77
What organism produces the toxin Panton-Valentin Leukocid (PVL)
CA-MRSA
78
What is the infection rate of mammal bites?
30-50%

SBCP Microbiology (9 decks)

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