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Flashcards in SSTIs Deck (42):
1

Cat bites
-epidemiology (how many get infected)
-etiology
-management

-80% of cat bites get infected
-Pastuerella multocida most common but POLYMICROBIAL
- Treat empirically with amoxil-clav

2

Dog bites
-epidemiology (how many get infected)
-etiology
-management

-5% of dog bites get infected
-Pastuerella canis most common but POLYMICROBIAL
-Treat only if severe or immune-compromised host with amoxil-clav

3

Human bites
-etiology

POLYMICROBIAL
Viridens strep
Staph epidermidis
Corynebacterium
S. aureus
Bacteroides
Peptostreptococcus

4

Clenched fist injury
-epidemiology (how many get infected)
-etiology

-high risk of infection
-patients present late
-POLYMICROBIAL

5

Other animal bites
-general considerations

- Tetanus vaccine booster or IgG if never vaccinated
-Rabies vaccine and IgG

6

Cat scratch disease
-epidemiology (who gets it)
-etiology
-clinical presentation
-diagnosis
-Treatment

-children and young adults
- Bartonella henselae
- local LAD +/- cutaneous lesion but can be atypical
-serology, blood culture
-Azithromycin

7

Disseminated gonococcal infection
-2 classic clinical presentations

-Triad of tenosynovitis, polyarthritis, dermatitis
OR
-purulent arthritis

8

Infectious lymphadenopathy
-etiology

Viral: HIV, CMV, EBV
Bacterial: GAS, S. aureus, Bartonella henselae and many others
Mycobacteria: TB and atypical
Parasite: toxoplasma, histoplasma
Fungal: Sporotrichosis

9

Septic arthritis
-etiology

-disseminated gonoccocal infection
-staph aureus
-strep
-G(-)
-TB
-Fungal

10

Septic arthritis
-risk factors

-Age > 80
-diabetes
-pre-existing joint disease
- recent surgery/injection
-prosthetic joint
-IVDU

11

Septic arthritis
-clinical presentation

Triad: fever, pain (cannot bear weight), decreased range of motion

12

Septic arthritis
-diagnosis

-aspirate synovial fluid and Gram stain and C&S
-blood cultures
-Xray to rule out osteomyelitis

13

Septic arthritis
-management

- antibiotics based on C&S
- aspire fluid/ surgical drainage

14

Septic arthritis
-how does the infective agent get there

hematogenous> trauma >post-surgery > from osteomyelitis

15

Disseminated gonococcal infection
-diagnosis

-cervical/urethral swab usually +
-blood, skin, synovial culture can be -

16

Disseminated gonococcal infection
-management

-Cefotaxime+ Doxyxline
- aspirate fluid
-treat partners

17

Ludwig's angina
-definition

-cellulitis of bilateral sublingual/submandibular spaces

18

Ludwig's angina
-risk factors

- recent dental work
-tooth pain
-immune compromise
- tongue piercing
-mandibular fracture

**almost always the result of an oral infection**

19

Ludwig's angina
-etiology in immunecompetent and immunocompromised

POLYMICROBIAL

Immunecompetent: strep, G+ anaerobes, bacteroides

Immunocompromised: pseudomonas, clostridium, candida

20

Ludwig's angina
-management

- monitor airway (1/3 require intubation)
-Antibiotics IV (e.g penicillin+clindamycin+metronidazole)

21

Non-bullous impetigo
-clinical presentation

-bilateral skin lesions that are painless and pruritic
- bumps-->blisters-->golden crust

22

Non-bullous impetigo
-etiology

-Staph aureus, often preceded by URTI

23

Non-bullous impetigo
-epidemiology (who gets it)

-school-aged children

24

Non-bullous impetigo
-treatment

Topical antibiotic (Mupirocin)

25

Bullous impetigo
-epidemiology (who gets it)
-etiology

-Neonates>> children> adults
- Toxin producing S. aureus

26

Bullous impetigo
-diagnosis in neonate

-blood cultures and septic evaluation

27

Bullous impetigo
-management (treatment and complications)

- cloxacillin or vancomycin (if MRSA)

Complications: dehydration +/- sepsis

28

Diabetic foot infection
-2 factors that contribute to diabetic foot infection

1) peripheral neuropathy
2) decreased blood flow (macro and microvascular)--> decreased immune system

29

Diabetic foot infection
- patient assessment

1) The whole patient: systemic illiness? social support? comorbidities?

2) The affected limb: problems that will impair healing (e.g. charcot joint, vascular disease)?

3) The infection: is it there? how severe?

30

Diabetic foot infection
-how to quantify peripheral vascular disease

- use (ankle/brachial) blood pressure

31

Diabetic foot infection
-risk factors

- previous amputation
-wound extending to the bone
-peripheral vascular disease

Are the top three.

32

Diabetic foot infection
-how to determine presence and severity of infection

-Presence: inflammation +/- purulent discharge

-Severity: IDSA criteria (grade 1-4)

33

Diabetic foot infection
-management

1) imaging if required
2) wound culture if pt has recently received ab
3) Ab for infected wounds: usually can just cover staph and strep (e.g. cloxacillin). This changes if risk of MRSA, or pt has received ab recently or pseudomonas risk factors
4) good wound care: cleaning, elevation

34

Cellulitis
- how it happens
-etiology

- break in skin allows normal flora to invade dermis and subcutaneous tissue
- almost always staph and strep

35

Cellulitis
-clinical presentation

Localized: erythema, LAD, lymphangitis

Systemic: bullae, sever swelling, hemorrhage, systemic symptoms

36

Cellulitis
-management

-empiric Ab based on presentation
-elevate
-analgesic
-draw a line around cellulitis

37

Erisypelas
-what is it?
-what causes it?

-Infection limited to upper dermis and superficial lymphatics (cellulitis is deeper)
-almost always B-hemolytic strep

38

Erisypelas
-clinical presentation
-management

Clinical presentation: well-demarcated, raised erythema, rapid onset, fever

Management: Penicillin V or Amoxil

39

Necrotizing fasciitis
-what is it?
-what types?
-etiology of each type
-which type is more common?

-Deep infection of subcutaneous tissue, sever destruction of fat and fascia
-Type 1: immunocompromised/post-operative (Polymicrobial)
-Type 2: healthy individuals (GAS)

**Type 1 is far more common**

40

Necrotizing fasciitis
-clinical presentation

-bullae
-disproportionate pain
-swelling
-erythema
-systemic signs (fever, tachycardia, hypotension)
-rapidly progressing

41

Necrotizing fasciitis
-management

-IMMEDIATE surgical consult
-Cultures of deep tissue (surgical) and blood
-IMMEDIATE antibiotics: piperacillin-tazo +metronidazole or clindamycin+ carbapenem+cefepime (cover everything)

42

Osteomyelitis
-what is it?
-possible etiology
-management (in Vancouver)

Definition: infection of the bone or bone marrow

Etiology: extrapulmonary TB, staph aureus

Management:
-Imaging
-Blood cultures
-Surgical debridement and bone cultures
-Ab based on bone culture
-Check for endocarditis