Emergency Soft Tissue Infections Flashcards

1
Q

This covers::

A

Necrotizing Fasciitis
Toxin-Mediated Syndromes (TMS):
- Toxic Shock Syndrome
- Staphlyococcal Scalded Skin Syndrome (SSSS)
- Panton-Valentine Leucocidin Toxin (PVL)

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2
Q

What are the subtypes of Necrotizing Fasciitis?

A

1 is most common
Caused by mixed aerobic/anaerobic infection
Commonly presents in Diabetic Foot Disease or Fournier’s Gangrene (NF of the genitals/perineum mainly in elderly men)

2 is monomicrobial

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3
Q

What organisms cause Necrotizing Fasciitis??

A

Type 1 can be lots of things:

  • Strep
  • Staph
  • Enterococci
  • Gram -ve Bacilli
  • Clostridium

Type 2 can be Strep Pyogenes

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4
Q

Risk factors for Necrotizing Fasciitis?

A
DM
Surgery
Trauma
Peripheral Vascular Disease
Skin popping (Injection drugs under skin, IVDA)
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5
Q

How does NF present?

A

Rapid onset
The tissue becomes red, swells and painful, potentially with anaesthesia.

It will develop haemorrhagic bullae, skin necrosis and crepitus.

Also comes with severe systemic features such as:

  • Fever
  • Hypotension
  • Tachycardia
  • Delirium
  • Multiorgan Failure
  • Septic Shock
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6
Q

NF is a medical emergency, how do we manage it?

A

Broad spectrum Abx:
- Clinidamycin + Gentamicin + Flucloxacillin

Surgery

Supportive Therapy

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7
Q

What are TMSs?

A

Toxins released by bacteria trigger T cells

  • > Excess T cell activation
  • > Massive cytokine release
  • > Endothelial leak, haemodynamic shock & multi-organ failure
  • > Death
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8
Q

What toxin causes TSS?

A

Staph aureus infection that secretes TSST1

Its usually caused by an offending agent e.g. tampon that allows the infection & toxin to build up

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9
Q

How does TSS present?

A

Fever
Hypotension
Diffuse Macular Rash
+ 3 of the Liver, blood, kidneys, GI, CNS or muscular organs involved

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10
Q

How do we confirm and treat TSS?

A

Do a blood culture, requires isolating TSST1

Also remove the offending agent, give IV fluids, Inotropes (for hypotension) and Abx
Potentially IV immunoglobulins

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11
Q

What cases SSSS?

A

Staph Aureus secreting either toxin A or B

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12
Q

How does SSSS present?

A

Its mostly kids and they get widespread bullae along with skin exfoliation

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13
Q

How do we treat SSSS?

A

Abx

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14
Q

What causes Panton-Valentine Leucocidin (PVL)?

A

Staph Aureus

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15
Q

How does PVL present?

A

Recurrent boils

May also cause SSTI or Haemorrhagic Pneumonia

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16
Q

We treat PVL with IV interferons and carbamazepine

A

PSYCH ITS ANTIBIOTICS