Staph and Strep infections

Question 1

When does staphylococcal scalded skin syndrome usually occur?

Answer 1

After a history of a sore throat

Question 2

Who does staphylococcal scalded skin syndrome occur in?

Answer 2

Younger people- infants up to about 6 years old

Question 3

How does staphylococcal scalded skin syndrome present

Answer 3

• Widespread erythroderma (>90%)
• Fluid filled blisters lead to desquamation
• Fever and irritable
• Nikolsky sign positive
• ORAL MUCOSA UNAFFECTED

Question 4

What will be positive in someone with staphylococcus scalded skin syndrome?

Answer 4

Nikolsky sign positive

Question 5

What is unaffected in staphylococcal scalded skin syndrome?

Answer 5

Oral mucosa is unaffected

Question 6

How is staphylococcal scalded skin syndrome diagnosed?

Answer 6

Skin biopsy

Question 7

What is the management of staphylococcal scalded skin syndrome?

Answer 7

IV antibiotics

Question 8

What is staphylococcal toxic shock syndrome?

Answer 8

Severe systemic reaction to staphylococcal exotoxins

Question 9

What staphylococcal exotoxin causes toxic shock syndrome?

Answer 9

TSST-1 superantigen toxin.

Question 10

What diagnostic criteria is used for toxic shock syndrome?

Answer 10

Centers for Disease Control and Prevention diagnostic criteria

Question 11

What is the Centers for Disease Control and Prevention diagnostic criteria fort toxic shock syndrome?

Answer 11

• fever: temperature > 38.9ºC
• hypotension: systolic blood pressure < 90 mmHg
• diffuse erythematous rash
• desquamation of rash, especially of the palms and soles

Question 12

Where in particular would you see desquamation of the rash with toic shock syndrome?

Answer 12

Palms and soles of feet

Question 13

How many organ systems need to be involved for the diagnosis of toxic shock syndrome?

Answer 13

3 or more

Question 14

What organ system involvement can there be for the diagnosis of toxic shock syndrome?

Answer 14

• gastrointestinal (diarrhoea and vomiting)
• mucous membrane erythema
• renal failure
• hepatitis
• thrombocytopenia
• CNS involvement (e.g. confusion)

Question 15

What is the initial management of toxic shock syndrome?

Answer 15

Removal of infection focus (e.g. retained tampon)

Question 16

What medical management can you do for toxic shock syndrome?

Answer 16

• IV fluids

* IV antibiotics

Question 17

Which IV antibiotics would you give for toxic shock syndrome?

Answer 17

Flucloxacillin and clindamycin

Question 18

What is the main cause of scarlet fever?

Answer 18

Group A haemolytic streptococci

Question 19

Which group A streptococci is usually responsible for scarlet fever?

Answer 19

Streptococcus pyogenes

Question 20

What is scarlet fever due to?

Answer 20

A reaction to erythrogenic toxins produced by Group A haemolytic streptococci

Question 21

Who is most commonly affected by scarlet fever?

Answer 21

Children aged 2 - 6 years with the peak incidence being at 4 years.

Question 22

How is scarlet fever spread?

Answer 22

Via the respiratory route by inhaling or ingesting respiratory droplets
or
By direct contact with nose and throat discharges

Question 23

How does scarlet fever tend to present?

Answer 23

• fever
• malaise, headache, nausea/vomiting
• sore throat
• ‘strawberry’ tongue
• rash
• fine punctate erythema (‘pinhead’) first on the torso and spares the palms and soles

Question 24

How long does a fever typically last with scarlet fever?

Answer 24

24 to 48 hours

Question 25

What are the 2 characteristic presentations of scarlet fever?

Answer 25

Strawberry tongue | Fine punctate erythema ('pinhead')

Question 26

Where does the fine punctate erythema ('pinhead') first appear with scarlet fever?

Answer 26

On the torso | Spares the palms and soles

Question 27

What is the typical presentation of a child with scarlet fever?

Answer 27

children often have a flushed appearance with circumoral pallor. The rash is often more obvious in the flexures it is often described as having a rough 'sandpaper' texture desquamination occurs later in the course of the illness,

Question 28

How is scarlet fever diagnosed?

Answer 28

Throat swab

Question 29

When should antibiotics for scarlet fever be commenced?

Answer 29

Immediately- before the results of the throat swab come back

Question 30

What is the medical management of scarlet fever?

Answer 30

Penicillin V

Question 31

What is the medical management of scarlet fever in someone with a penicillin allergy?

Answer 31

Azaithromycin

Question 32

When can children return to school after starting antibiotics for scarlet fever?

Answer 32

24 hours after starting antibiotics

Question 33

What can scarlet fever be complicated by?

Answer 33

Otitis media Rheumatic fever Acute glomerulonephritis