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Y2 infection > skin and soft tissue infections > Flashcards

skin and soft tissue infections Flashcards

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1
Q

what is impetigo

A

epidermis - superficial skin infection

highly infectious

e.g. S. aureus (more common), Strep pyogenes

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2
Q

what is folliculitis

A

circumscribed, pustular infection of a hair follicle

e.g. S. aureus

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3
Q

what is erysipelas

A

infection of the dermis

e.g. Strep pyogenes

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4
Q

what is cellulitis

A

diffuse infection of the deep dermis and subcutaneous fat

e.g. Strep pyogenes (common), S. aures (uncommon)

H. influenzae and other (rare)

role of gram -ve bacteria in diabetics and febrile neuropaths

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5
Q

what is necrotising fasciitis

A

infection of the subcutaneous fat and underlying fascia

e.g. Strep pypgenes or mixed bowel flora

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6
Q

things to consider in skin and soft tissue infections

A

site - possible complications w/ specific sites e.g. abdo, face

organism

host

environment

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7
Q

host factors to consider in skin and soft tissue infections i.e. predisposing factors

A

diabetes leading to neuropathy and vasculopathy

immunosuppression

renal failure

Milroy’s disease

predisposing skin conditions e.g. atopic dermatitis

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8
Q

environmental factors to consider in skin and soft tissue infections

A

drug resistant strains (MRSA)

drus interactions

drug allergies

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9
Q

appearance of impetigo

A

multiple vesicular lesions on an erythematous base

golden crust is highly suggestive of this diagnosis

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10
Q

what is this skin infection

A

impetigo

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11
Q

at what age is impetigo most common

A
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12
Q

where does impetigo usually occur

A

exposed parts of the body including face, extermities and scalp

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13
Q

predisposing factors to impetigo

A

skin abrasions

minor trauma

burns

poor hygiene

inset bites

chicken pox

eczema

atopic dermatitis

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14
Q

treatment of impetigo

A

small areas - topical abx

large areas - topical treatment + oral abx (flucloxacillin)

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15
Q

appearance of erysipelas

A

painful red area

no central clearing

associated

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16
Q

what is this skin infection

A

erysipelas

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17
Q

where does erysipelas tend to occur

A

70-80% - lower limbs

5-20% - face

tends to occur in areas of pre-existing lypmphoedema, venous stasis, obesity, paraparesis, DM

may involve intact skin

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18
Q

recurrence rate of erysipelas

A

high

30% within 3yrs

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19
Q

appearance and presentation of cellulitis

A

spreading erythematous area w/ no distinct borders

fever is common

regional lymphadenopathy and lymphangitis

possible source of bacteraemia

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20
Q

what skin infection is this

A

cellulitis

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21
Q

predisposing factors to cellulitis

A

DM

tinea pedis (athlete’s foot - common cause in otherwise healthy pts)

lymphoedema

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22
Q

what condition is this

A

lymphangitis

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23
Q

treatment of erysipelas and cellulitis

A

combination of anti-staphylococcal and anti-streptococcal abx

extensive disease - admission for IV abx and rest

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24
Q

hair associated infections (3)

A

folliculitis

furunculosis

carbuncles

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25
what infection is this
26
appearance of folliculitis
up to 5mm diameter present as small red papules central area of purulence that may rupture and drain typically found on head, back, buttocks and extremities constitutional symptoms not often seen
27
furunculosis
aka boils single hair follicle-associated inflamamtory nodule extending into dermis and subcutaneous tissue usally affected moist, hairy, friction-brone areas of the body (face, axilla, neck buttocks) systemic symptoms uncommon may spontaneously drain purulent material
28
what infection is this
furunculosis
29
common causative organism for furunculosis
30
risk factors for furunuculosis
obesity DM atopic dermatitis chronic kidney disease corticosteroid use
31
carbuncle
infection extends to involve mutliple furunucles often located in back of neck, posterior trunk or thigh multiseptated abscesses purulent material may be expressed from multiple sites consititutional symptoms common
32
what skin infection is this
carbuncle
33
treatment of hair associated infections
folliculitis - no treatment or topical abx furunuculosis - no treatment or topical abx, oral abx may be necessary if not improving carbuncles - hospital admission, surgery and IV abx
34
necrotising fasciitis
infectious disease emergency any site may be affected
35
predisposing conditions to necrotising fasciitis
DM surgery trauma peripheral vascular disease skin popping
36
type I necrotising fasciitis
mixed aerobic and anaerobic infection - diabetic foot infection, Fournier's gangrene typical organisms: streptococci, staphylococci, enterococci, gram -ve bacilli, clostridium
37
what skin infection is this
Fuornier's gangrene
38
type II necrotising fasciitis
monomicrobial normally associated w/ strep pyogenes
39
what skin infection is this
type II necrotising fasciitis
40
presentation of necrotising fasciitis
rapid onset sequential development of erythema, extensive oedma and severe unremitting pain haemorrhagic bulla, skin necrosis, crepitus may develop systemic features: fever, hypotension, tachycardia, delirium and multi-organ failure anaesthesia at site of infection is highly suggestive of necrotising fasciitis
41
management of necrotising fasciitis
mandatory surgical review imaging may help but coule delay treatment broad spectrum abx - flucoloxacillin, gentamicin, clindamycin 17-40% overall mortality
42
what is pymomyositis
purulent infection deep within striated muscle, often manifesting as an abscess infection is often 2y to seeding into damage muscle
43
sites of pyomyositis
multiple sites involved in 15% common sites: thigh, calf, arms, gluteal region, chest wall, psoas muscle
44
presentation of pyomyositis
fever pain woody induration of affected muscle untreated can lead to septic shock and death
45
predisposing factors to pyomyositis
DM HIV/immunocompromised IV drug use rhematological diseases malignancy liver cirrhosis
46
causative organisms for pyomyositis
S. aureus is commonest gram+ve/-ve, TB, fungi
47
management of pyomyositis
investiagtion w/ CT/MRI treatment: drainage and abx cover depending on gram stain and culture results
48
what does this MRI show
pyomyositis of R thigh muscles
49
septic bursitis
small sac-like cavities that contain fluid and are lined by synovial membrane located subcutaneously between bony prominences or tendons facilitate movement w/ reduced friction most common include patellar and olecranon
50
predisposing factors for septic bursitis
infection is often from adjacent skin infection rheumatoid arthritis alcoholism DM IVDU immunosuppression renal insufficiency
51
what infection is shown here
pre-patellar septic bursitis
52
presentation of septic bursitis
peribursal cellulitis, swelling and warmth fever and pain on movement
53
causative organisms of septic bursitis
diagnosis based on aspiration of fluid most common cause - S. aureus rarer - gram -ve, mycobacteria, brucella
54
what is infectious tenosynovitis
infections of the synovial sheats that surround tendons flexor muscle-associated tendons and tendon sheeth of the hand most commonly involved
55
causes of infectious tenosynovitis
S. aureus and streptococci penetrating trauma is most common inciting event chronic infections due to mycobacteria, fungi possibility of disseminated gonococcal infection
56
presentation of infectious tenosynovitis
erythematous fusiform swelling of finger held in semi-flexed position tenderness over the length of the tendon sheath and pain w/ extension of finger
57
treatment of infectious tenosynovitis
empirial abx hand surgeon to review
58
what causes toxin mediated syndromes
often due to superantigens group of pyrogenic exotoxins associated w/ use of high absorbency tampons can also be due to small skin infections (Staph aureus secreting TSST1)
59
immune response in toxin mediated syndromes
don't activate immune system via normal contact between APC and T cells superantigens bypass this and attach directly to the T cells receptors acivating up to 20% of the total pool of T cells (instead of normal 1/10 000) massive burst in cytokine release leads to endothelial leakage, haemodynamic shock, mutliorgan failure and death
60
causative organsisms of toxin-mediated syndromes
some strains of Staph aureus (TSST1, ETA and ETB) and strep pyogenes (TSST1)
61
diagnostic criteria for staphylococcal TSS
fever hypotension diffuse macular rash 3 of the following involved: liver, blood, renal, 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
62
what condition is shown here
toxic shock syndrome
63
streptococcal TSS
almost always associated w/ presence of streptococci in deep seated infections e.g. erysipelas or necrotising fasciitis mortality rate is much higher than staphylococcal - 50% vs 5% treatment requires urgent surgical debridement of infected tissues
64
treatment of TSS
remove offending agent e.g. tampon IV fluids inotropes abx IV immunoglobulins
65
staphylococcal scalded skin syndrome
infection due to a particular strain of S. aureus producing the exfoliative toxin A or b
66
presentation of staphylococcal scalded skin syndrome
widespread bullae and skin exfoliation usually occurs in children, rarely in adults
67
treatment of staphylococcal scalded skin syndrome
IV fluids and antimicrobials mortality 3% in children, higher in adults who often are immunosuppressed
68
what condition is this
staphylococcal scalded skin syndrome
69
what is panton-valentine leucocidin toxin
gamma haemolysin can be transferred from one strain of S. aureus to another, including MRSA can cause SSTI and haemorrhagic pneumonia
70
presentation of panton-valentine leucocidin toxin and treatment
tends to affect children and young adults pts present w/ recurrent boils that are difficult to treat treat w/ abx that reduce toxin production
71
intravenous catheter associated infections
nosocomial infection normally starts as local SST infection progressing to cellulitis and even tissue necrosis common to have associated bacteraemia
72
risk factors for intravenous catheter associated infections
continuous infusion \>24hrs cannula in situ \>72hrs cannula in lower limb pts w/ neurological/neurosurgical problems
73
causative organisms of intravenous catheter associated infections and how it spreads
staph aureas (MSSA and MRSA) commonly forms a biofilm which then spills into bloodstream can seed into other places (endocarditis, osteomyelitis) diagnosis made clinically or by +ve blood cultures
74
what infection is shown here
intravenous catheter associated infections
75
treatment of intravenous catheter associated infections
remove cannula express any pus from the thrombophlebitis abx for 14 days echocardiogram prevention is more important
76
prevention of intravenous catheter associated infections
don't leave unused cannula don't insert cannula unless it will be used change cannula every 72hrs monitor for thrombophlebitis use aseptic technique when inserting cannula
77
class I surgical site infection
clean wound resp, alimentary, genital or infected urinary systems not entered
78
class II surgical site infection
clean-contaminated wound resp/GI/genital/infected urinary tract entered but no unusual contamination
79
class III surgical site infection
contaminated wound open, fresh accidental wounds or gross spillage from GI tract
80
class IV surgical site infection
infected wound existing clinical infection infection present before the operation
81
what class fo surgical site infection is this
class I
82
what class of surgical site infection is this
class IV wet gangrene diabetic foot amputation
83
causes of surgical site infections
staph aureus (incl MSSA and MRSA) - most common coagulase -ve staphylococci enterococcus E. coli psudomonas aeruginosa enterobacter streptococci fungi anaerobes
84
patient associated risk factors for surgical site infections
diabetes smoking obesity malnutrition concurrent steroid use colonisation w/ staph aureus
85
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 perioperative hypoxia
86
diagnosis of surgical site infections
send pus/infected tissue for cultures esp w/ clean wound infections avoid superficial swabs - aim for deep structures consider an unlikely pathogen as a cause if obtained from a sterile site e.g. bone infection abx to target likely organisms

Y2 infection (15 decks)

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