Mss-Deep Tissue Infections

Front 1

What are 4 features of necrotizing fasciitis (NF)?

Back 1

1. extensive tissue destruction
2. thrombosed vessels
3. abundant bacteria spreading through fascial planes
4. in early stages, relatively few acute inflammatory cells

Front 2

What are some ways to differentiate between NF and cellulitis?

Back 2

NF will display pain disproportionate to wound, high fever, and toxic appearance

Front 3

What kinds of people are at increased risk of NF?

Back 3

diabetics, immunocompromised, bad circulation

Front 4

What are the two types of NF?

Back 4

1. type I-DM, abdominal surgery, and perineal infection
2. type II-Group A strep (flesh-eating)

Front 5

What bacteria might be present in type I NF?

Back 5

bacteroides, anaerobic strep, e. coli, staph aureus

Front 6

Which NF produces gas: type I or type II?

Back 6

type I

Front 7

What is a possible finding in type I NF?

Back 7

copious seropurulent exudate occurs 3-4 days after injury; looks like gas gangrene

Front 8

Are NF life-threatening?

Back 8

yes

Front 9

How can NF be differentiated from clostridial myonecrosis?

Back 9

muscle will respond to stimulation in NF

Front 10

Microscopy of type I NF shows:

Back 10

pleomorphic GNR with many neutrophils

Front 11

What are some diagnostic aids in NF?

Back 11

high ESR, left shift in WBC's, leukocytosis, high CPK, hypoalbuminemia

Front 12

What is the most important therapy in NF?

Back 12

early diagnosis

Front 13

Other than early diagnosis, what is the treatment for NF?

Back 13

meticulous debridement, PCN + aminoglycoside + additional broad spectrum antibiotic

Front 14

Type II NF bacterial features:

Back 14

Group A strep; beta-hemolytic; GPC in chains

Front 15

T or F: there is gas formation in type II NF?

Back 15

false

Front 16

Bacteriology in aeromonas hydrophilia myonecrois:

Back 16

motile GNR that live in fresh water and are oxidase positive

Front 17

What is the key feature of aeromonas hydrophilia myonecrois?

Back 17

followa penetrating trauma in a freshwater environment or associated with fish or aquatic animals
(hint: HYDROPHILIA)

Front 18

Gas gangrene is also known as what?

Back 18

clostridial myonecrosis

Front 19

Gas gangrene usually results from what?

Back 19

traumatic injury

Front 20

What is the incubation period for gas gangrene?

Back 20

2-3 days but may be as short as 6-8 hours

Front 21

What are key clinical features of gas gangrene?

Back 21

excruciating pain; patient appears shocky

Front 22

What tactile sign will you find in gas gangrene?

Back 22

crepitus

Front 23

What does gas gangrene look like?

Back 23

yellowish-white with serosanguinous blebs

Front 24

Which clostridium is usually found in gas gangrene?

Back 24

perfringens

Front 25

Microscopy of gas gangrene aspirate will reveal what?

Back 25

large GPR with few neutrophils

Front 26

Treatment for gas gangrene?

Back 26

debridement, antibiotics, possible hyperbaric chamber

Front 27

Spontaneous, non-traumatic gas gangrene is caused by what bacteria?

Back 27

clostridium septicum

Front 28

Clostridium septicum is associated with what other disease?

Back 28

colon cancer

Front 29

What are the symptoms of spontaneous, non-traumatic gas gangrene?

Back 29

bacteremia, pain, and fever

Front 30

What are some prominent features of viral infections?

Back 30

myalgias

Front 31

What is a common finding in sepsis?

Back 31

catabolism of the skeletal muscle → weakness and muscle wasting

Front 32

What immune response occurs as a result of sepsis and results in tissue necrosis?

Back 32

Macrophages→IL-1+TNF→ prostaglandin E2→muscle protease