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Flashcards in SSTIs and Osteomyelitis Deck (27)
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1

3 pyodermal infections of the epidermis/dermis?

Impetigo
Erysipelas
Ecthyma

2

What is impetigo usually caused by?

S aureus

3

What is erysipelas usually caused by?

Strep pyogenes

4

What is ecthyma usually caused by?

Strep pyogenes

5

How does erysipelas present?

Infection of the superficial skin (down to dermis) often caused by strep pyogenes, distinct leading edge

6

What is ecthyma?

Deep punched ulcer with yellow crusting affecting epidermis and dermis
Often affects lower legs, shins and dorsum of feet

7

3 infectious conditions affecting hair follicles?

Folliculitis
Furuncle
Carbuncle

8

What are folliculitis, furuncles and carbuncles most often caused by?

S aureus

9

Describe the progression from folliculitis -> furuncle -> carbuncle

Folliculitis = pustule formation around hair follicle, when extends down into root of hair = furuncle
Multiple furuncles = draining abscess formation = carbuncle

10

What is cellulitis?

Tender erythematous skin infection that extends right down to the fascia with no distinct leading edge

11

What is paronychia?

Swollen erythematous lesion surrounding the nail bed usually caused by s aureus or strep pyogenes

12

Pathogenesis of nec fasc?

Painful erythematous infection of skin which crosses fascia of underlying muscles causing compartment syndrome and subsequent muscle necrosis
High fever, sepsis

13

Features of SSTI that might make you think nec fasc rather than cellulitis?

Pain disproportionate to clinical signs
Crepitus - gas gangrene
High fever, sepsis
Bullae or ecchymosis
Tender beyond visible poorly demarcated borders

14

What is the emergency management of nec fasc?

Radical debridement

15

What bacteria often cause nec fasc?

Mixture of coliforms e.g. E. coli, anaerobes
Can be strep pyogenes

16

What specific blood test can be done to assess extent of nec fasc?

CK (compartment syndrome leading to rhabdomyelysis)

17

Management of non-complicated cellulitis?

Flucloxacillin
Or erythromycin, clarithromycin

18

What treatment is used for cellulitis with sepsis or facial cellulitis?

IV Co-amoxyclav

19

What is Ludwig's angina?

Nec fasc of submandibular space

20

What is Fournier's gangrene?

Nec fasc of scrotum or vulva

21

What are the 4 aetiological types of nec fasc?

1 = polymicrobial incl coliforms and anaerobes
2 = GAS/staph
3 = gram negative microbes (vibrio, aeromonas hydrophila)
4 = fungal incl candida

22

Who does type 1 nec fasc (polymicrobial anaerobes and coliforms) most commonly affect?

The immunocompromised / chronically diseased

23

Who can type 2 nec fasc (GAS/s aureus) affect?

Anyone of any health

24

Who does type 3 nec fasc (gram negs e.g. Vibrio spp, aeromonas hydrophila) affect?

Marine association so fisherman, swimmers in seawater etc
HIGHLY VIRULENT

25

What bedside test is used for suspected nec fasc?

Bedside finger test - incise 2cm down to deep fascia under local
Lack of bleeding, malodorous dishwater pus, lack of normal tissue resistance
Culture and gram stain this

26

Antibiotic management of nec fasc?

Start IV broad spectrum abx according to local guidelines, ensuring coverage of GAS/MSSA, anaerobes + coliforms and gram negatives
E.g. Meropenem + clindamycin

27

From superficial to deep, what are the 3 main layers of the skin?

Epidermis
Dermis
Subcutis