Flashcards in Skin, Soft Tissue Infection Deck (56)
What is the most common infectious agent in cat bites? Dog bites?
Cat: Pastuerella multicoda
Dog: Pasteurella canis
What percentage of cat bites become infected compared to dog bites?
80% vs 5%
What is empiric treatment for dog or cat bites?
What are the most common infectious organisms in a human bite? (7)
-Viridins strep 100%
-Staph epidermidis 53%
-Staph aureus 29%
What are two vaccine-able disease that always need to be considered with animal bites?
What are the conditions when a bite would be treated for tetanus?
-Vaccine: minor wound and no vaccine in last 10 years or major wound and no vaccine in last 5 years
-Tetanus Ig: major wound and has not had at least 3 vaccine doses
What is the treatment plan if an animal bite might have passed on rabies?
-Rabies Ig around the wound
-Rabies vaccine at day 0, 3, 7 and 14
What organism causes Cat Scratch Disease?
What is the typical and atypical presentations of Cat Scratch Disease?
Typical: Local lymphadenitis +/- cutaneous lesions several days after exposure that can last 1-3 weeks
Atypical (10%): liver, spleen, ocular, neurological or MSK involvement, fever of unknown origin
What tests are typically used to diagnose Cat Scratch Disease? What would you treat it with?
-Serology (IFA), blood culture, tissue PCR
What presents as these two classic syndromes:
-triad of tenosynovitis, polyarthritis, dermatitis
Disseminated Gonococcal Infection
What is not common in Disseminated Gonococcal infection?
Urethritis/Cervicitis (but swabs often +ve)
What treatment is used for disseminated gonococcal infection?
Ceftriaxone + Doxycycline x 7 days
(Don't forget to Tx partners!)
What is the most common cause of septic arthritis?
Hematological spread > trauma/bite > post-surgery > direct spread from osteomyelitis
What is the most common organism that causes septic arthritis?
What is the treatment for septic arthritis?
-IV antibiotics based on Gram stain x 4 weeks making sure to cover Staph
-Joint aspiration in all cases, surgical drainage in hip or prosthetic infection
What is Ludwig's Angina?
Cellulitis of the submandibular/sublingual spaces
What does Ludwig's Angina almost always result from?
-Oral infection of 2nd or 3rd molars
-80% of patients report tooth pain or recent dental work
How do you manage Ludwig's Angina?
-Manage and protect airway (1/3 of cases require intubation)
-IV antibiotics based on organism
-CT scan to evaluate abscess and extent of spread
What are the two most common causes of impetigo?
-Group A strep
What are the two types of impetigo and their most obvious clinical feature?
Bullous (vesicles) and non-bullous (golden crust)
What are some risk factors for having a diabetic foot infection? (7)
-Wound extending to bone
-Peripheral vascular disease
-Ulcer duration >30days
-Loss of sensation
-History of recurrent ulcers
-Wound caused by trauma
Would you need to culture a minor infection if the patient has not received antibiotics within the last month?
If you are treating a foot infection in a patient that HAS received antibiotics in the past month, what modifications to antibiotic therapy must you make?
Cover gram negative rods
What is the presentation of a mild infection?
Local infection involving only the skin and subcutaneous tissue. If erythema is present, must be <2 cm around the wound.
What is the presentation of a moderate infection?
Local infection with erythema >2 cm or involving deeper structures than skin and subcutaneous tissues (eg: acbess, osteomyelitis, septic arthritis, faciitis) AND no systemic inflammatory response.
What is the presentation of a severe infection?
Local infection with signs of SIRS, as manifested by 2+ of the following:
-Temperature >38 Celsius or 90 bpm
-RR >20/min or PaCO2 12,000/mcL or 10% immature forms
What is empiric therapy for a severe infection?
Vancomycin and Pipercillin-Tazobactam/4th gen cephalosporin/carbapenem
Rank the most likely places to get cellulitis?
lower extremities > upper extremity > face