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Skin and Soft Tissue Infections Flashcards

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1
Q

What is the cause of impetigo?

A

Staph aureus

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2
Q

What does impetigo look like?

A

Multiple vesicular lesions on an erythematous base

Golden crust highly suggestive

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3
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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4
Q

What is the treatment for impetigo?

A

Small areas topical antibiotics

Larger areas oral antibiotics

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5
Q

What is erysipelas?

A

Infection of the upper dermis

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6
Q

What does erysipelas look like?

A

Distinct elevated borders

Painful red area

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7
Q

What is the cause of erysipelas?

A

Strep pyogenes

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8
Q

What are the clinical signs of erysipelas?

A

Associated fever

Regional lymphadenopathy and lymphangitis

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9
Q

Where is erysipelas likely to occur on the body?

A

Lower limbs

Face

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10
Q

What is cellulitis?

A

Diffuse skin infection involving deep dermis and subcutaneous fat

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11
Q

What does cellulitis look like?

A

Spreading erythematous area with no distinct borders

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12
Q

What is the cause of cellulitis?

A

Strep pyogenes

Staph aureus

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13
Q

What are the predisposing factors for cellulitis?

A

Diabetes
Tinea pedis
Lymphoedema

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14
Q

What is the treatment for cellulitis and erysipelas?

A

Combination of anti-staphylococcal and anti-streptococcal antibiotics

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15
Q

What is folliculitis?

A

Circumscribed, pustular infection of hair follicle

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16
Q

Where is folliculitis typically found?

A

Head
Back
Buttocks
Extremities

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17
Q

What is the cause of folliculitis?

A

Staph aureus

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18
Q

What is furunculosis?

A

Single hair follicle associated inflammatory nodule, extending into the dermis and subcutaneous tissue

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19
Q

What areas are commonly affected by furunculosis?

A

Moist, hairy, friction-prone areas (face, axilla, neck, buttocks)

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20
Q

What is the cause of furunculosis?

A

Staph aureus

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21
Q

What are the risk factors for furunculosis?

A 
Obesity 
Diabetes 
Atopic dermatitis 
Chronic kidney disease 
Corticoidsteroid use
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22
Q

What is a carbuncle?

A

Occurs when infection extends to involve multiple furuncles

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23
Q

Where are carbuncles typically found?

A

Back of neck

Posterior trunk or thigh

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24
Q

What is the treatment for folliculitis?

A

No treatment of topical antibiotics

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25
What is the treatment for furunculosis?
No treatment of topical antibiotics
26
What is the treatment for carbuncles?
Hospital admission, surgery, IV antibiotics
27
What are the predisposing factors for necrotising fasciitis?
``` Diabetes Surgery Trauma Peripheral vascular disease Skin popping ```
28
What is type 1 necrotising fasciitis?
Mixed aerobic and anaerobic infection
29
What organisms could be the cause of necrotising fasciitis?
``` Streptococci Staphylococci Enterococci Gram negative bacilli Clostridium ```
30
What is type 2 necrotising fasciitis?
Monomicrobial
31
What is the organism which causes type 2 necrotising fasciitis?
Strep pyogenes
32
What are the symptoms of necrotising fasciitis?
``` Erythema Extensive oedema Severe, unremitting pain Haemorrhage bullae Skin necrosis Crepitus ```
33
What are the systemic features of necrotising fasciitis?
``` Fever Hypotension Tachycardia Delirium Multiorgan failure ```
34
What is the treatment for necrotising fasciitis?
Surgical review mandatory | Broad spectrum antibiotics (flucloxacillin, gentamicin, clindamycin)
35
What is pyomyositis?
Purulent infection deep within striated muscle, often manifesting as an abscess
36
What are the common sites of pyomyositis?
``` Thigh Calf Arms Gluteal region Chest wall Psoas muscle ```
37
What are the predisposing factors for pyomysitis?
``` Diabetes HIV/immunocompromised IV drug use Rheumatological disease Malignancy Liver cirrhosis ```
38
What is the presentation of pyomyositis?
Fever | Pain and woody induration of affected muscle
39
What is the organism that causes pyomyositis?
Staph aureus | Gram positives/negaitves, TB, fungi
40
What is the treatment for pyomyositis?
Drainage with antibiotic cover depending on gram stain and culture results
41
What is septic bursitis?
Infection of bursar found between bony prominences or tendons
42
What are the predisposing factors for septic bursitis?
``` Rheumatoid arthritis Diabetes Alcoholism IV drug use Immunosuppression Renal insufficiency ```
43
What are the features of septic bursitis?
Peribursal cellulitis Swelling and warmth Fever Pain on movement
44
What is the organism that causes septic bursitis?
Staph aureus | Rarer (gram negatives, mycobacteria, brucella)
45
What is infectious tenosynovitis?
Infection of the synovial sheaths that surround tendons
46
What areas are typically affected by infectious tenosynovitis?
Flexor muscle associated tendons | Tendon sheaths of the hand
47
What is the organism that causes infectious tenosynovitis?
Staph aureus | Streptococci
48
What is the presentation of infectious tenosynovitis?
Erythematous fusiform swelling of finger Held in semiflexed position Tenderness over the length of the tendon sheath and pain with extension of finger
49
What is the treatment for infectious tenosynovitis?
Empiric antibiotics | Hand surgeon review
50
What is the organism that causes toxin-mediated syndromes?
Staph aureus | Strep pyogenes
51
What is a toxin-mediated syndrome?
Superantigens bypass APC and T cell activation and attach directly to T cell receptors causing a massive burst in cytokine release
52
What is the diagnostic criteria for staphylococcal toxic shock syndrome?
Fever Hypotension Diffuse macular rash 3 of the flooring involved (liver, blood, renal, gastrointestinal, CNS, muscular) Isolation of staph aureus from mucosal or normally sterile sites Production of TSST1 by isolate Development of antibody to toxin during convalescence
53
What is the treatment for streptococcal toxic shock syndrome?
``` Urgent surgical debridement of the infected tissues Remove offending agent (tampon) IV fluids Inotropes Antibiotics IV immunoglobulins ```
54
What is staphylococcal scalded skin syndrome?
Infection due to a particular strain of staph aureus producing the exfoliative toxin A or B
55
How is staphylococcal scalded skin syndrome characterised?
Widespread bullae | Skin exfoliation
56
What is the treatment for staphylococcal scalded skin syndrome?
IV fluids and antimicrobials
57
What is Panton-Valentine leucocidin toxin?
Gamma haemolysin which can be transferred from one strain of staph aureus to another including MRSA
58
What is the presentation of Panton-Valentine leucocidin toxin?
Recurrent boils which are difficult to treat
59
What is the treatment for Panton-Valentine leucocidin toxin?
Antibiotics that reduce toxin production
60
What are the risk factors for intravenous-catheter associated infections?
Continuous infusions >24hrs Cannula in situ >72hours Cannula in lower limb Patients with neurological/ neurosurgical problems
61
What is the treatment for intravenous-catheter associated infections?
Remove cannula Express any pus from the thrombophlebitis Antibiotics 14 days Echocardiogram
62
What are the preventative measures for intravenous-catheter associated infections?
``` Don't leave unused cannula Don't insert cannula unless using it Change cannula every 72 hours Monitor for thrombophlebitis Use aseptic technique when inserting cannulae ```
63
What is a class 1 surgical site infection?
Clean wound (respiratory, alimentary, genital or infected urinary systems not entered)
64
What is a class 2 surgical site infection?
Clean-contaminated wound (tracts entered but no unusual contamination)
65
What is a class 3 surgical site infection?
Contaminated wound (open, fresh, accidental wounds or gross spillage from the GI tract)
66
What is a class 4 surgical site infection?
Infected wound (existing clinical infection, infection present before operation)
67
What are the causes of surgical site infections?
``` Staph aureus (incl MRSA and MSSA) Coagulase negative staphylococci Enterococcus Escherichia coli Pseudomonas aeroginosa Enterobacter Streptococci ```
68
What are the patient associated risk factors for surgical site infections?
``` Diabetes Smoking Obesity Malnutrition Concurrent steroid use Colonisation with staph aureus ```
69
What are the procedural risk factors for surgical site infections?
``` Shaving of site the night prior to procedure Improper preoperative skin preparation Improper antimicrobial prophylaxis Break in sterile technique Inadequate theatre ventilation Preoperative hypoxia ```

Infection (12 decks)

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