AUC: Skin and Soft Tissue Infections 2 – Flashcards
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Unlock answersDracunculus medinesis Found in copepods and humans
IA? CD? |
Tissue nematode or the "Guinea/ Medinia" worm Dracunculiasis - "Guinea worm, fiery serpent"
Name? Reservoir?
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Chronic cutaneous ulcers from which the worm protrudes (1 year after exposure) Hives, GI issues when worm erupts (takes 2-3 mos) Secondary bacterial infections may occur
Name? Risk? |
Dracunculus medinesis Being in tropical Africa
Symptoms? |
Dracunculus medinesis Secondary bacterial infections of ulcer result Later on fibrosis affects many tissues and interferes with locomotion or use of limbs
CD? Dx? |
Dracunculiasis - Fiery serpent Clinical presentation Elevated IgE Eosinophilia
Name? Secondary issues? |
Clinical presentation Elevated IgE Eosinophilia Treated by slowly removing the worm as it emerges from the ulcer over days and weeks
Name? IA? |
Dracunculus medinesis Tissue nematode
Dx? Tx? |
Franisella tularensis Zoonotic - wild animals
IA? CD? |
Facultative intracellular Gram negative rod Requires external source of cysteine Tularemia
Name? Reservoir? |
Ulceraoglandular (70-85%) Papule ulcerates with necrotic center and raised border (Due to cell-mediated immune response) Fever, chills, sweating and coughing Also in the Respiratory and GI tracts
Name? CD? Transmission? Infectious dose? Risk? |
Franisella tularensis Tularemia Direct contact with contaminated animals LOW INFECTIOUS DOSE Hunters at risk
Skin symptoms? Immune response? Other areas affected? |
Tularemia Facultative intracellular Gram negative rod Treated with streptomycin Live attenuated vaccine for high risk
Name? Reservoir? Dx? |
Franisella tularensis Zoonotic Chocolate - Cystine Agar IgM on serology
CD? IA? Tx? |
Spirillum minus Rats or other rodents
IA? CD? |
Gram negative Spiral rod Rate bite fever aka Spirillar Fever aka Sodoku
Name? Reservoir? |
Infected sites ulcerate, lymphadenopathy, rash and relapsing fever Rash lasts 48 hours In untreated patients symptoms subside then reappear in 3 to 9 days Joint manifestations are RARE
Name? CD? Dx? |
Spirillum minus Rat bite fever aka Spirillar fever aka Sodoku Dark-field microscopy CANNOT be grown on artificial media
Symptoms? Joint manifestations?
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Spirillum minus Zoonotic - Asia Bite or scratch Treated with Penicillin G
Symptoms? Dx? IA? |
Ulceration at bite site, regional lymphadenopathy, rash, relapsing fever Dark-field microscopy Gram negative Spiral rod
Name? Risk area? Transmission? Tx? |
Gram negative rod North America, Europe Rat bite No ulceration Arthiritis NO regional lymphadenopathy Rash, Relapsing fever
Name? |
Streptobacillus moniliformis
IA? Geo area? Transmission? Ulceration, arthritis, regional lymphadenopathy, rash, relapsing fever? |
Spirillum minus
IA? Geo area? Transmission? Ulceration, arthritis, regional lymphadenopathy, rash, relapsing fever?
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Gram negative spiral rod Asia Rat bite ULCERATION NO Arthiritis DOES HAVE regional lymphadenopathy Rash, Relapsing fever
Name?
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S. moniliformis has polyarthritis, in S. minus joint manifestations are rare
What is the difference between Spirillum minus and Streptobacillus moniliformis rashes?
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Spirillum minus Radiates from wound site and lasts 48 hours; red-brown macular with plaques or urticarial lesions Streptobacillus moniliformis Nonpuritic rash erupts over palms, soles, extremities; maculopapular, petechial or purpuric
Joint manifestation differences? |
Leishmania spp. Bite of sand fly Anyone exposed is at risk (different spp. all over) IA? CD? |
Flagellated protozoan Intracellular replication Intracytoplasmic growth Cutaneous leishmaniasis Mucocutaneous Leishmaniasis
Name? Transmission? Risk?
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Red papule at bite Ulcerating skin sores (1 or more) which may form granulmomas which progress to nodular lymphangitis Spontaneously heal but leave SCARS
Name? CD? Dx? |
Leishmania spp. Cutaneous Leishmaniasis Hx of exposure, intracellular amstigote speciments DFA, serological tests
Symptoms? Scars? |
Flagellated protozoan Intracellular replication Intracytoplasmic growth Mucocutaneous Leishmaniasis
Name? Symptoms? Tx? |
Leishmania spp. Destruction of mucous membranes Infects tissue at mucosal-dermal junctions Does SERIOUS damage
Pentamidine IA? CD? |
Myobacterium spp. Direct contact with contaminated fresh or salt water or aquariums and soil
IA? Structural features? |
Acid Fast Pleomorphic rod Facultative intracellular Trehalose dimycolate Antigens of outer coat
Name? Transmission?
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Acid fast pleomorphic rod Facultative intracellular bacteria Ranges from self-limiting verrucal lesions to ulcerations to non-caseating granulomas to nodular lymphangitis
Name? Dx? |
Myobacterium spp. Acid fast, fluorescent auramine-rhoadamine dyes Lowenstein Jensen Media Liquid chromatography
IA? CDs?
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Mycobacterium spp. Excision and/or Minocycline, Ethambutol Causes a variable range of clinical expressions
Which do the Antigens of the outer coat do? What is the specific Culture used? |
Ags of outercoat stimulate actively self-destructive host immunity-T cell mediated chronic inflammation --> possible granuloma formation Lowenstein Jensen Media
Name? Tx? What about the CDs? |
Sporothrix schenckii Rose thorns, timber, etc. Exposure to other thorny vegetation
IA? CD? |
Thermally dimorphic fungi Mold at 25 °C Cigar shaped yeast at 35 °C Sporotrichosis
Name? Reservoir? Transmission? |
Sporotrichosis On culture branching, septate and very delicate with pyriform conidia forming a typical arrangement in groups Tissue shows cigar shaped yeast
Name? Symptoms? |
Sporothrix schenckii Fixed ulcerative lesion Sinus tract formation Thickened and cord-like lymphatics Subcutaneous nodules and abscesses Nodular lymphangitis
CD? Dx?
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Sporothrix schenckii Ulcer to granulomatous lesions Sinus tracts Lymphatics become thickened and cord-like Nodules, abscesses, nodular lymphangitis
CD? Risk? Dx?
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Sporotrichosis People working in the woods Branching septate pyriform conidia in groups Cigar shaped yeast in tissue
Name? Symptoms? |
Bacillus anthracis Found in soil; spores viable for decades
IA? Structural features? |
Gram positive spore forming rod Polypeptide capsule - repeating glutamic acid
Name? Reservoir? |
Edema Factor - calmodulin-dependent adenylate cyclase Lethal Factor - Zinc metalloprotease Protective Antigen - cell binding protein (acts as B unit)
Name? CD?
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Bacillus anthracis Cutaneous Anthrax
VFs? |
Bacillus anthracis Cutaneous Anthrax
Symptoms? |
Red, itchy papules Central necrosis going purple to black necrotic eschar Swollen surrounded by purplish vesicles
Name? CD? |
Bacillus anthracis Direct examination of vesicular fluid or aspirates, exposure, history PCR > Culture (because it is a biohazard) Ab titers to EF and LF
Transmission? Risk?
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Spore entry into wounds/ abrasions Ranchers, meat packers, taxidermists, tanners
Name? Dx? |
Gram positive Spore forming Rod Polypeptide capsule Cutaneous Anthrax
Name? Tx? How long? |
Bacillus anthracis Doxycycline/Ciprofloxacin LONG TERM 60 - 90 days!!!
IA? CD? |
Lesion may be confused with bite of Brown recluse spider or Orf Viral infection Vaccine for high risk populations
Name? VFs? |
Bacillus anthracis Edema Factor Lethal Factor Protective Antigen
Can be confused with? Vaccine?
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Bacillus anthracis Cutaneous Anthrax
Transmission? What accompanies the signs? |
Spores entry into wounds/abrasions or contact or consumption of infected animal products Painful lymphadenopathy, massive edema --> may progress to toxemia
Name? CD? |
Poxviridae Orf Virus Zoonotic: Sheep, goats, reindeer, oxen
IA? CD? |
ds DNA virus Malignant Pustule/ Eschar
Name? Reservoir? |
Solitary lesion, red to violet vesiculonodule, maculopapular to pusutlar progresses to weeping nodule to eschar Hands, arms, face May have rash on trunk
Name? CD? What do immunocompromised get?
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Poxviridae Orf Virus Malignant Pustule/ Eschar Erythema multiforme in immunocompromised
Symptoms?
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Poxviridae Orf Virus Malignant Pustule/ Eschar Self limiting in healthy
Transmission? Risk? Confused with?
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Direct contact w/ infected animals/fomites AND skin trauma Farm workers Confused with brown recluse bite or Bacillus anthracis
Name? CD? Tx?
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Malignant Pustule/ Eschar Negative stain electron microscopy ONLY PCR works!
Name? Prevention? |
Poxviridae Orf Virus Vaccinate livestock
CD? Dx?
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Pseudomonas aeruginosa Ecythema gangrenosa
Symptoms? Color change? Upon closer inspection? |
Malignant pustule/eschar Small, painful, reddish, maculopapular, well circumscribed lesion Pink --> Purple --> Black and Necrotic Shows vascular invasion (hemorrhagic vasculitis)
Name? CD?
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Ecythema gangrenosa Malignant pustule/eschar Shows Vascular invasion Small, painful, reddish maculopapular
Name? Tx? |
Pseudomonas aeruginosa For this CD you use arm water/showers to soften "eschar" for removal
CD? Symptoms? |
HPV E6 and E7
IA? CD? |
ds circular DNA non-enveloped Replicates in NUCLEUS Cutaneous and Mucosal warts
Name? VFs? |
Verrucal (rough/scaly) warts Skin colored but can also be dark, flat and smooth Transmitted through Direct contact, often sexual
Name? CD? Dx?
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HPV Cutaneous and Mucosal warts Pap smear KOILOCYTIC CELLS
Symptoms? Transmission? |
ds circular DNA non-enveloped Replicates in Nucleus Guardasil (6,11)- subunit vaccine (also Cevarix for 16,18)
Name? CD? Risk? |
HPV Cutaneous and Mucosal warts Anyone Co-infections often occur
IA? Vaccines? |
Poxviridae: Mulluscipoxvirus: Mulluscum Contagiosum Virus Humans
IA? Transmission? CD?
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ds linear DNA Double envelope Replicates in CYTOPLASM Direct contact or shared clothing/equipment Fomites Mulluscum Contagiosum
Name? |
Benign papular eruption (may be in groups) Replicates in stratum basale Extends down into dermis Skin tone --> white --> yellowish, waxy, smooth, translucent with a central induration
Name? What body areas are they common?
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Mulluscum Contagiosum Virus Adults: lower abdomen, genitals, inner thighs Children: face, trunk, extremities
Symptoms? Color change? Induration? |
Mulluscum Contagiosum Virus Contact sports players and sexual partners of infected
Dx? Tx? |
Clinical expression Oval, eosinophilic cytoplasmic inclusion bodies aka HENDERSON-PATERSON BODIES!!!! Usually resolves itself in a few months
Name? Risk? |
HSV Vesicles due to infection of epithelial cells
Dx? Tx? |
Tzanck smear Multinucleated cells Acyclovir |
Dermatophytes Monomorphic fungi (as molds); septated hyphae Soil, animals, humans
Three Dermatophyte species? Transmission? |
Microsporum, Trichophyton & Epidermophyton Direct contact Introduction of arthrospores which adhere to keratinocytes
Name? IA? Reservoir? |
Tinea corporis - ringworm Tinea pedis - athlete's foot Tinea cruris - jock itch Tinea capitis - scalp hair Tinea manuum - hands Tinea barbae - beard hair Tinea unguium (onychomycosis) - Nail ; Caused by? IA? What happens to nails? |
Dermatophytes Monomorphic fungi (as molds); septated hyphae Nails become discolored and lusterless ; List all the symptoms |
Dermatophytes Monomorphic fungi (as molds); septated hyphae Tinea _______ ; ; Dx? |
Microscopy KOH prep Infected hairs glow under WOODS LAMP |
Malassezia species (furfur) Tinea Versicolor ; IA? VFs? |
Dimorphic fungi (yeast on skin, mold pathogenic), mixed forms appear on skin Mold produces Azaleic acid and Malassezin ; Name? CD? |
Hypo-pigmented maculae on skin "SHIFTING CLOUDS" Sun may be a trigger ; Name? CD? Reservoir? |
Malassezia;species (furfur) Tinea Versicolor Normal flora in some ; Symptoms? What causes it? |
; Malassezia;species (furfur) Mold form produces Azaleic acid and Malassezin Occurs on chest, upper back, arms, abdomen with minimal scaling and inflammation IA? Dx? Tx? ; |
Dimorphic fungi (yeast on skin, mold pathogenic) Mixed forms appear on skin Microscopy - mix of hyphae and yeast Woods Lamp POSITIVE Ketoconazole, topical selenium sulfate products ; Name? VFs? Where on body does it occur? |
Enterococcus faecalis; Gram positive cocci Catalase negative Group D ; Reservoir? Transmission? |
Autoinoculation, nosocomial Endogenous due to perforation of the bowel ; Name? IA? |
Intra-abdominal abscesses Abdominal surgical site infections Risk from hospitalization, catheterization, surgery ; Name? Dx? |
Enterococcus faecalis ;Catalase negative Culture on ENT (Bile Esculin Agar) Lancefield Group D positive Survives in elevated salt (6.5%) ; CDs? |
Enterococcus faecalis; Gram positive cocci; Catalase negative Group D Dual (combo) treatment with high dosage antibiotics ; CDs? Dx?; |
Intra-abdominal abscesses Abdominal surgical site infections Catalase negative Culture on ENT (Bile Esculin Agar) ; Name? IA? Tx? ; |
Bacteroides fragilis; Gram negative Obligate anaerobe Natural flora in urogenital and GI tracts ; VFs? CD? |
Succinic acid; Heparinase LPS has little to NO endotoxic activity Intra-abdominal abscesses, peritonitis, genital infections and PID in females (soft abscesses) ; Name? IA? Reservoir? |
; ; Gram negative Obligate anaerobe Succinic acid Heparinase Endogenous due to perforation of bowel or vagina ; Name? Dx? Risk? ; ; ; |
Bacteroides fragilis; BBE (Bacteroides Bile Esculin agar) Surgical patients, IUDs IA? VFs? Transmission? |
Bacteroides fragilis; Bacteroides Bile Esculin agar Endogenous due to perforation of bowel or vagina for any reason ; CD? Tx? |
Intra-abdominal abscess, peritonitis, genital infections, PID in females (soft abscesses) ; Drainage and debridement Metronidazole Hyperbaric oxygen ; Name? Dx? Transmission? |
Prevotella melaninogenica; Normal flora in mouth, oropharynx; GI tract ; IA? CD? |
Obligate anaerobic Gram negative rod Soft tissue infections, periodontal disease ALSO causes infections in dog and cat bites |
Capsule Heparinase Collagenase Normal flora in mouth, throat, GI tract Soft Tissue infections; Periodontal Disease ; Name? Other infections? Dx? |
Prevotella melaninogenica; Infections in cat and dog bites Multiple tests needed to differentiate from Bacteroides ; Structural features? Reservoir? CD? |
Prevotella melaninogenica; Obligate anaerobe; Gram negative rod Multiple tests needed to differentiate from Bacteroides; Soft Tissue and Skin infections Dog and cat bite infections VFs? Transmission? Risk? |
Capsule Heparinase Collagenase; Endogenous due to overgrowth Introduced via trauma People with poor dental hygiene ; Name? IA? Dx? CD? ; |
Soft Tissue infections Dog and Cat bite infections Ex. Submandibular subcutaneous abcess ; ; Name? Risk? VFs? |
; Prevotella melaninogenica People with poor dental hygiene Capsule Heparinase Collagenase ; CD? Example? ; |
Acinetobacter baumanii; Gram negative rod Facultative anaerobe ; CD? Risk? |
Wound infections Outbreaks tend to occur in ICUs and healthcare settings WOUNDED SOLDIERS ; Name? IA? |
Gram negative rod Facultative anaerobe Biofilm; Phospholipase Multi-drug resistant ; Name? Transmission? Reservoir? |
Acinetobacter baumanii; Direct contact or respiratory Soil and water; skin of healthcare professionals ; IA? VFs? Do antibiotics work? |
Acinetobacter baumanii; ; Risk? Dx? |
Outbreaks occur in ICUs Wounded soldiers Immunocompromised patients Oxidase negative GAMMA hymolysis on BAP Lactose non-fermentor ; Name? CD? |
Oxidase negative Gamma hemolysis on BAP Lactose non-fermentor Wounded soldiers, immunocompromised ; Name? IA? VFs? |
Acinetobacter baumanii; Gram negative rod Facultative anaerobe Biofilm Phospholipase ; Dx? Risk? |
Osteomyelitis From open injury to the bone or a chronic open wound Risk groups are diabetes, hemodialysis, IV drug abuse, poor peripheral perfusion ; Bugs? Transmission? ; |
Staphylococcus aureus (most common) Pseudomonas (trauma/diabetics) Salmonella (sicke cell patients) ; CD? Risk factors/ groups? |
Staphylococcus aureus (most common) Pseudomonas (trauma/diabetics) Salmonella (sicke cell patients) ; CD? Symptoms? |
Osteomyelitis Swelling, pain in infected area Fever, +/- drainage thru skin Sweating, chills, swelling, limping ; Bugs? |
Osteomyelitis Blood tests for WBC, ESR, and CRP Blood culture, needle aspiration or biopsy Bone scan: Technetium-99 pyrophosphate ; Bugs? Tx? |
; Staphylococcus aureus (most common) Pseudomonas (trauma/diabetics) Salmonella (sickle cell patients) ; IV antibiotics for 4-6 weeks, surgery, bone graft ; CD? Dx? |
Salmonella spp. (non-typhoidal) Gram negative rod Non-spore forming Lactose non-fermentor ; Reservoir? CD? |
Animal reservoir (reptiles, chickens, grimy people) Osteomyelitis ; Name? IA? |
Gram negative rod Non-spore forming Lactose non-fermentor Osteomyelitis ; Name? Transmission? Dx? |
Salmonella;spp. (non-typhoidal) Endogenous/Hematogenous Following food borne infection and/or carriage condition Hektoen Agar ; IA? CD? |
Salmonella;spp. (non-typhoidal) Hektoen Agar Animals (reptiles, chickens, grimy people) ; CD? Risk? |
Osteomyelitis Children with sickle-cell anemia ; Name? Dx? Reservoir? |
Swelling, pain, tenderness in infected area Fever Pus drainage thru skin Gram negative rod Lactose non-fermentor ; What two agents could it be? Dx difference? ; ; |
Pseudomonas aeruginosa Salmonella ; Check under UV light or grow on Hektoen Agar Green colonies with black centers --> H2S production by Salmonella
Symptoms? Similar IAs? |
Trichinella spiralis Nematode Helminthic roundworm Consumption of raw or undercooked meats (WILD)
CD? Reservoir? Risk? |
Myositis Zoonotic Swine, other wild animals Man is inadvertent host Anyone who eats undercooked meat Name? IA? Transmission?
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Fever, myositis, periorbital edema First is GI Distress If infection is HEAVY, patients will experience difficulty moving, breathing and heart problems
Name? CD? Dx? Can it be fatal? |
Trichinella spiralis Myositis Blood test for Ab and Eosinophilia Encysted worms in muscle on biopsy Myocarditis can be FATAL!
Symptoms? |
Trichinella spiralis Blood test (IgE & Eosinophilia) Muscle biopsy showing encystment NO EFFECTIVE TREATMENT!
IA? Transmission? What can you do to protect yourself? |
Nematode Helminthic roundworm Eating raw or undercooked wild game meats (Swine!) Freeze pork at least 20 days and COOK WILD GAME MEAT THOROUGHLY!
Name? Dx? Tx? |
