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Infection AM > Skin and soft tissue infections > Flashcards

Skin and soft tissue infections Flashcards

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1
Q

What us impetigo?

A

Superficial highly infectious skin infection

Multiple vesicular lesions on an erythematous base

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2
Q

What is highly suggestive of impetigo?

A

Golden crust

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3
Q

What are the causative organisms of impetigo?

A

Most common= staph aureus

Less commonly= strep pyogens

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4
Q

Where does impetigo occur?

A

Exposed areas e.g. face, extremities, scalp

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5
Q

What are the predisposing factors of impetigo?

A

Skin abrasions
Minor trauma or burns
Por hygiene

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6
Q

What is the treatment of impetigo?

A

Small areas= topical antibiotics

Large areas= topical treatment an oral antibiotics

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7
Q

What is erysipelas?

A

Infection of upper dermis

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8
Q

What are the clinical features of erysipelas?

A

Painful red area, no central clearing
Associated fever
Regional lymphadenopathy and lymphangitis
Distinct elevated borders

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9
Q

What is the commonest cause of erysipelas?

A

Strep pyogenes

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10
Q

Where is erysipelas most often seen?

A

Legs

Areas of existing lymphedema, venous stasis, obesity, paraparesis, diabetes mellitus

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11
Q

What is the treatment of erysipelas?

A

Combination of anti-staph and anti-strep antibiotics

IV antibiotics if severe

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12
Q

What is cellulitis?

A

Diffuse skin infection involving deep dermis and subcutaneous fat

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13
Q

What are the clinical features of cellulitis?

A

Spreading erythematous area with no distinct borders
Fever
Regional lymphadenopathy and lymphangitis

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14
Q

What are the most common causative organisms of cellulitis?

A

strep pyogenes

staph aureus

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15
Q

What are the predisposing factors for cellulitis?

A

DM
Tinea pedis
Lymphoedema

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16
Q

What is the treatment of cellulitis?

A

Combination of anti-staph and anti-strep antibiotics

IV antibiotics if severe

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17
Q

What are the hair associated infections?

A

Folliculitis
Furuncles
Carbuncles

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18
Q

What are the clinical features of folliculitis?

A

Circumscribed pustular infection of hair follicle
Up to 5mm in diameter
Small red papule
Central area of purulence that may rupture and drain

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19
Q

Where is folliculitis found?

A

Head
Back
Buttocks and extremities

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20
Q

What is the most common causative organisation of folliculitis?

A

Staph aureus

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21
Q

What is the treatment of folliculitis?

A

None or topical antibiotics

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22
Q

What are furuncles commonly referred to as?

A

Boils

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23
Q

What are the clinical features of furuncles?

A

Single hair follicle associated with inflammatory nodule

Extending to dermis and subcutaneous tissue

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24
Q

Where do furuncles occur?

A

Moist, hairy, friction prone areas

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25
What is the most common causative organism of furuncles?
Staph aureus
26
What are the risk factors for furuncles?
Obesity DM CKD
27
What is the treatment of furuncles?
None Topical antibiotics If not improving, oral antibiotics
28
When do carbuncles occur?
Infection extends to involve multiple follicles
29
Where do carbuncles often occur?
Back of neck, posterior trunk or thigh
30
What are the clinical features of carbuncles?
Multiseptated abscesses | Purulent material may be expressed
31
What is the treatment of carbuncles?
Often require hospital admission, surgery and IV antibiotics
32
What are the predisposing factors for necrotising fasciitis?
DM Surgery, trauma Peripheral vascular disease Skin popping
33
What are the types of necrotising fasciitis?
Type I- missed infection, typically strep, staph or enterococci Type II- mono microbial, associated with strep pyogenes
34
What are the clinical features of necrotising fasciitis?
Rapid onset Sequential development of erythema, extensive oedema and severe pain Haemorrhagic bullae, skin necrosis and crepitus may develop Anaesthesia at site highly suggestive
35
What are the systemic features associated with necrotising fasciitis?
``` Fever Hypotension Tachycardia Delirium Multiorgan failure ```
36
What is the treatment of necrotising fasciitis?
Surgical review mandatory | Broad spectrum antibiotics- flucloxacillin, gentamicin, vancomycin
37
What is pyomyositis?
Purulent infection deep within striated muscle, often manifesting as an abscess
38
What are the common sites for pyomyositis?
``` Thigh, calf Arms Gluteal region Chest wall Psoas muscle ```
39
What are the clinical features of pyomyositis?
Fever Pain Woody induration of affected muscle
40
What can untreated pyomyositis lead to?
Septic shock and death
41
What are the predisposing factors for pyomyositis?
DM Immunocompromised IV drug abuse Malignancy
42
What is the most common causative organism of pyomyositis?
Staph aureus
43
What are the possible causative organisms for pyomyositis?
Gram + and - TB Fungi
44
What investigations are done for pyomyositis?
CT/MRI
45
What is the treatment of pyomyositis?
Grainage | Antibiotics
46
What is septic bursitis?
Small bursae- small sac like cavities containing fluid and lined by synovial membrane Located subcutaneously between bony prominences or tendons
47
Where is septic bursitis most often found?
Patellar or olecranon regions
48
What are the predisposing factors for septic bursitis?
DM IV drug abuse Immunosuppression Alcoholism
49
What are the clinical features of septic bursitis?
Peribursal cellulitis, swelling, warmth Fever Pain on movement
50
How is septic bursitis diagnosed?
Aspirate fluid- not always done
51
What is the most common causative organism of septic bursitis?
Staph aureus
52
What are the possible causative organisms of septic bursitis?
Staph aureus Gram - Mycobacteria Brucella
53
What is the treatment of septic bursitis?
Antibiotics
54
What is infectious tenosynovitis?
Infection of synovial sheets surrounding tendons
55
What are the most common locations for infectious tenosynovitis?
Flexor muscle associated tendons | Tendon sheets of the hand
56
What is the most common inciting event for infectious tenosynovitis?
Trauma
57
What are the causative organisms of infectious tenosynovitis?
Staph aureus and strep most common | Chronic due to mycobacteria or fungi
58
What are the clinical features of infectious tenosynovitis?
Erythematous fusiform swelling of the finger Held in semiflexed position Tenderness over length pf tendon sheet and pain with extension are classic
59
What is the treatment of infectious tenosynovitis?
Empiric antibiotics | Hand surgeon to review
60
What are toxin mediated syndromes often due to and why?
Superantigens- they can bypass normal immune system and attach directly to T cell receptors
61
What are the most common causative organisms of toxin mediated syndromes?
Staph aureus | Strep pyogens
62
What are the causes of toxic shock syndrome?
High absorbency tampons- most common Staph aureus skin infection Strep
63
What are the diagnostic criteria for staph aureus toxic shock syndrome?
``` Fevere Hypotension Diffuse macular rash At least 3 organs involved Isolation of staph aureys ```
64
What is strep in toxic shock syndrome associated with?
Deep seated infections and high mortality
65
What is the treatment of strep causing toxic shock syndrome?
Urgent surgical debridement of infected tissues
66
What is the treatment of toxic shock syndrome?
``` Remove offensive agent IV fluids Inotropes Antibiotics- v high dose IV immunoglobulins ```
67
What causes staphylococcal scalded skin syndrome?
Particular strain of staph aureus producing exfoliative toxin A or B
68
What are the clinical features of staphylococcal scalded skin syndrome?
Widespread bullar and skin exfoliation | Usually in children
69
What is the treatment of staph scalded skin syndrome?
IV fluids and antimicrobials
70
What is Panton-Valentin leucocidin toxin?
Toxin that can be transferred from one strain of staph aureus to another Can cause haemorrhagic pneumonia
71
What are the clinical features of Panton-Valentin leucocidin toxin?
Tends to affect children and young adults | Recurrent boils which are difficult to treat
72
What is the usual progression of IV catheter associated infections?
Local inflammation | Progress to cellulitis and even necrosis
73
What is commonly associated wth IV catheter associated infections?
Bacteraemia
74
What are the risk factors for IV catheter associated infections?
Cannula in situ >72 hours | Cannula in lover limb
75
What is the causative organisms of IV catheter associated infections?
Staph aureus
76
How are IV catheter associated infections diagnosed?
Clinical or positive blood diagnosis | Echo for complications
77
What is the treatment of IV catheter associated infections?
Remove cannula | 14 days antibiotics
78
What are the types of surgical site infection?
Class I= clean wound, systems not entered Class II= clean contaminated wound, no unusual contamination Class III= Contaminated wound Class IV= infected wound
79
What are the possible causative bacteria of a surgical site infection?
``` Staph aureus Staph, strep and enterococci Fungi Anaerobes E. coli Pseudomonas aeruginosa ```
80
What are the personal risk factors for surgical site infection?
``` DM Smoking Obesity or malnutrition Steroid use Staph aureus colonisation ```
81
What are the procedural risk factors for surgical site infection?
Shaving site prior evening Improper pre-op skin prep Improper antimicrobial prophylaxis Break in sterile technique
82
How is surgical site infection diagnosed?
Pus/tissue culture- deep if possible
83
What is the treatment of surgical site infection?
Antibiotics

Infection AM (11 decks)

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