Id - 4-14 - Skin And Soft Tissue Infections

Front 1

infections affecting epidermis

Back 1

impetigo

Front 2

infections affecting dermis and epi

Back 2

erysipelas

Front 3

infections affecting subcut tissue, dermis and epi

Back 3

cellulitis, folliculitis, furuncle, carbuncle

Front 4

infections affecting fascia

Back 4

fasciitis

Front 5

infections affecting muscle

Back 5

myositis

Front 6

more suscep to skin infection with...

Back 6

breaks in the skin, blunt trauma, immunosupp

Front 7

signs of staph aureus

Back 7

abscess formation - folliculitis, furunculosis, pustules

local necrosis - from hemolysins, cell surf constituents, cellular debris

toxigenic infec - TSS, scalded skin syndrome

spreading infections - cellulitis

Front 8

streptococcal infections - most common one, associations

Back 8

DOES NOT CAUSE ABSCESSES!!!

associated with UResp or GI colonization with group A strep

group a/strep pyogenes is most common - can cause post-strep glomerulonephritis

other beta hemolytic ones aside from group - B and G basically - looks the same as A

B-mainly in immunocomp (elderly, ca, diab, alcoholics)

Front 9

primary infectiosn of skin

Back 9

impetigo, erysipelas, cellulitis

Front 10

things causing ulcers/nodules

Back 10

anthrax, syphilis, fungal and mycobacterial infections.

Front 11

when will you see cutaneous manifestations of systemic infections?

Back 11

toxin-mediated, embolic or systemic

Front 12

impetigo

Back 12

staph aureus or strep pyogenes.

vesicles or pustules on honey-yellow crust in children.

benign

post-infec glomerulonephritis is possible.

looks similar to herpes simpelx

Front 13

txof impetigo

Back 13

if definitely strep - penicillin

otherwise dicloxacillin or cephalexin - assuming methicillin sensitive

Front 14

erysipelas

Back 14

usually group a strep. rarely staph aur or other beta strep (b or g)

sharply demarcated (bc dermal structures confine it), peau d'orange. - raised border and dimpled

systemic toxicity

Front 15

tx of erysipelas

Back 15

penicillin (unless it is actually due to staph - but that is rare)

Front 16

cellulitis

Back 16

acute, spreading, painful erythema. indistinct borders.

systemic toxicity. - may spread through lymph/blood.

can dev foci of necrosis and bullae.

strep pyogenes (grp A) usually (but staph aureus if due to trauma).

can be due to water exposure adn animal bites too.

Front 17

predisp factors for cellulitis

Back 17

trauma is the main one.

obesity, edema, venous insuff, athlete's foot (fissured toe webs)

Front 18

if dog/cat bite with cellulitis...

Back 18

consider P. multocida!!! - and cefelexin is not useful for this

Front 19

dx of cellulitis

Back 19

pretty hard - clinical appearance is the main thing.

rarely get lucky with cultures, aspiration of inflamed skin, punch biopsy or bulla aspiration.

Front 20

recurrent cellulitis

Back 20

strep pyogenes usually.

associated with lymph/venous obstruction.

try chronic penicillin VK

Front 21

paronychia

Back 21

painful inf of nail bed/margin

usually staph aureus.

tx - moist heat,drainage, abx oral

Front 22

strange paronychias

Back 22

pseudomonas if hands are in water a lot

immunosuppressed can get candida

Front 23

folliculitis

Back 23

hair follicle infection --> pustule.

no systemic toxicity.

usually staph aureus

topica antibiotcs

Front 24

furuncles/carbuncles

Back 24

abscess originating in hair follicles.

usually staph aureus.

face, axilla, buttock (shaving places)

pretty painful until drainage.

Front 25

tx o f furuncles

Back 25

moist heat, draining large lesions, oral abx.

Front 26

syphilis

Back 26

priamry - painless indurated ulver. regional lymphadenopathy may be painful though.

Front 27

sporotrichosis

Back 27

gardeners/farmers

painless ulcerating pustule.

secondary lesions along lymphatics.

Front 28

mycobacterium marinum

Back 28

aquariums and fresh water.
small ulcerating papule with lymphangitic spread.

Front 29

anthrax

Back 29

painless papule/ulver with lots of edema and regional lymphadenopathy.

common in world, not in US

has necrotic centers and is painless/doesn't spread.

looks similar to loxocelism spider bite but that is painful and

Front 30

Eczema

Back 30

allergic skin disease.
pts with this have staph aureus on their skin (not normal)

Front 31

lacerations/punctures

Back 31

usually staph and strept

if puncture through sneaker - pseudomonas aeruginosa

Front 32

human bites

Back 32

worse than animal bites bc our mouths have anaerobic bac (so can't tx with cefelexone).

usually from punches to the mouth.

IV tx with ampicillin/sulbactam then amoxicillin/clavulanate (oral) then cefotetan

Front 33

animal bites

Back 33

usually polymicrobial

staph aureus, beta hemolytic strep, and pasteruellla (not susc to cefelexone so you need to use penicillin/amoxicillin for this one)

tx - amoxicillin/clavulanate or ampicillin/sulbactam.

Front 34

decubitus ulcers

Back 34

from pressure. ("bedsore")

sacral - bowel flora causes it. may penetrate bone (important).

heel - staph or strep

Front 35

necrotizing fasciitis

Back 35

necrosis of subcut tissue and overlying skin.

systemic toxicity.

usually group a strept (s. pyogenes) or mixed aerobic/anaer bacteria. NOT STAPH!!

very serious and spreads through fascial layers which have no barriers.

need to do debridement!!

Front 36

how to differentiate btwn cellulitis and deeper infection

Back 36

MRI or exploratory.

Front 37

clues to an anaerobic soft tissue infection

Back 37

gas production
foul odor
tissue necrosis
rapid spread through tissue planes
gram stain shows mixed organisms.

Front 38

lyme disease

Back 38

bull's eye rash

can develop secondary EM (erythema migrans) lesions that are often less distinctive in their appearance.

differs from cellulitis in that erythem amigrans is painless. might have a low grade fever but not systemically ill.

Front 39

bacterial infections of muscle

Back 39

pyomyositis - usually staph aureus. e.g. psoas abscess and tropical pyomyositis

streptococcal infection (S. pyogenes) often complicates necrotizing fasciitis

clostridial myonecrosiss (gas gangrene)