Podcast
Questions and Answers
Which of the following is a medication used for bacterial infections?
Which of the following is a medication used for bacterial infections?
Which virus is responsible for warts?
Which virus is responsible for warts?
What is the incubation period for Mpox?
What is the incubation period for Mpox?
5-21 days
What are the common clinical features of Mpox?
What are the common clinical features of Mpox?
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Scabies is caused by a mite burrowing into the skin.
Scabies is caused by a mite burrowing into the skin.
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Match the following skin infections with their categories:
Match the following skin infections with their categories:
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What is the recommended treatment for scabies?
What is the recommended treatment for scabies?
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Which of the following is NOT a type of lice?
Which of the following is NOT a type of lice?
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What should a nurse apply for itchy lesions on her fingers?
What should a nurse apply for itchy lesions on her fingers?
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The virus that causes _ is known for outbreaks starting in central Africa.
The virus that causes _ is known for outbreaks starting in central Africa.
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What are the causes of skin and soft tissue infections?
What are the causes of skin and soft tissue infections?
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What are the clinical presentations of cellulitis?
What are the clinical presentations of cellulitis?
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Which pathogen is often associated with cellulitis?
Which pathogen is often associated with cellulitis?
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Which of the following is a life-threatening bacterial skin infection?
Which of the following is a life-threatening bacterial skin infection?
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What is the most appropriate treatment for cellulitis?
What is the most appropriate treatment for cellulitis?
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Which condition is characterized by severe pain and rapid progression, sometimes with normal-looking skin initially?
Which condition is characterized by severe pain and rapid progression, sometimes with normal-looking skin initially?
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The pathogen responsible for gas gangrene is ___
The pathogen responsible for gas gangrene is ___
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What should be included in the management of necrotising fasciitis?
What should be included in the management of necrotising fasciitis?
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What is the primary feature of Fournier's gangrene?
What is the primary feature of Fournier's gangrene?
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Tetanus is caused by Clostridium tetani, which is a spore-forming organism.
Tetanus is caused by Clostridium tetani, which is a spore-forming organism.
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What is the first-line treatment for diabetic foot infections?
What is the first-line treatment for diabetic foot infections?
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What is the most appropriate antimicrobial regimen for a patient with infected deep diabetic foot ulcers?
What is the most appropriate antimicrobial regimen for a patient with infected deep diabetic foot ulcers?
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Study Notes
RCSI Information
- RCSI stands for Royal College of Surgeons in Ireland.
- RCSI is a university of medicine and health sciences.
- RCSI's mission is to lead the world to better health.
Skin & Soft Tissue Infections
- Learning Outcomes
- Describe causes of skin & soft tissue infections (bacterial, viral, fungal, parasitic).
- Recognize clinical presentations of skin and soft tissue infections.
- Choose appropriate specimens for diagnosis of skin and soft tissue infections.
- Identify life-threatening skin and soft tissue infections needing urgent attention.
- Choose appropriate antimicrobials for treating patients with skin and soft tissue infections.
What Lies on Our Skin?
- Resident flora: Staphylococcus epidermidis (>90% of skin flora).
- Others: including Staphylococcus aureus, gut flora
- Colonization vs. infection.
- Site variability (e.g., hand vs. groin).
Life-Threatening Bacterial Skin & Soft Tissue Infections
- Cellulitis: mild, often managed with oral antibiotics, but can lead to severe sepsis.
- Necrotizing fasciitis: severe, destructive, high mortality.
- Gas gangrene: severe, with gas formation in tissues.
Cellulitis
- Acute infection of skin and subcutaneous tissues.
- Often precipitated by a break in the skin.
- Pathogens: Staphylococcus aureus, Streptococcus pyogenes (Group A beta-haemolytic streptococci), less commonly Group C or G beta-haemolytic streptococci.
- Clinical features: erythema, swelling, pain, hot to touch, often well-demarcated, possible evidence of precipitating skin break, patient may be systemically unwell (e.g. febrile, tachycardic).
- Risk factors: previous cellulitis, diabetes mellitus, obesity, peripheral vascular disease, lymphedema, skin breaks (e.g. leg ulcers, IV drug use, trauma, insect bites).
- Management: blood cultures, skin swabs (if indicated), mark boundaries, IV antibiotics (or PO in less severe cases), start smart (empiric) – flucloxacillin (covers Staph. aureus & Strep. pyogenes), then focus (directed) – based on culture & susceptibilities, manage underlying cause.
Necrotizing Fasciitis
- Severe, destructive bacterial infection of skin, subcutaneous, and peri-muscular fat.
- Necrotic liquefaction of fatty tissue.
- Precipitants: minor trauma, stab wounds, surgery.
- Pathogens: Type 1 (polymicrobial), Type 2 (Group A beta hemolytic streptococci), Type 3 (Gas gangrene).
- Clinical features: severe infection, rapidly progressive, pain out of proportion to clinical appearance, initially skin may look normal, shiny skin/blisters, skin color changes due to necrosis, patient is systemically very unwell, high mortality (20-47%).
- Management: prompt diagnosis, urgent surgical assessment & debridement of dead tissue, send tissue for culture & susceptibility, blood cultures, discuss with clinical microbiology/ID, start smart (broad-spectrum empiric therapy e.g., vancomycin + piperacillin-tazobactam + clindamycin), then focus (if group A strep, benzylpenicillin + clindamycin - suppresses toxin production), supportive management in ICU.
Fournier's Gangrene
- A form of necrotizing fasciitis in the perineum.
- Full thickness necrosis of perineal skin.
- May involve scrotum, penis, and abdominal wall.
- Severe and disfiguring.
- Pathogens: Usually polymicrobial, including anaerobes.
- Management: extensive debridement vital, broad-spectrum antibiotics.
Gas Gangrene
- Necrotizing myositis.
- Pathogens: toxin-producing Clostridium spp. (e.g., Clostridium perfringens, C. septicum).
- Precipitated by: direct inoculation of wound (trauma or surgery), hematogenous transmission (e.g., C. septicum from GIT if colon cancer).
- Clinical features: acute onset of severe pain, devitalisation of limb, mottled skin, fluid or gas-filled blisters on skin, systemically unwell, foul odour, crepitus.
- Diagnosis: CT/X-ray: gas in tissues, wound swab/blisters fluid/tissue for culture, blood cultures.
- Treatment: surgical debridement, antibiotic therapy (broad-spectrum empirically, change to benzylpenicillin when Clostridia confirmed), supportive care in ICU, hyperbaric oxygen.
Other Skin and Soft Tissue Infections
- Impetigo: highly infectious, confined to superficial skin layers, caused by Group A, C, or G streptococci or Staphylococcus aureus, typically vesicular/golden crusted lesions, treated with flucloxacillin.
- Folliculitis: superficial infection of hair follicles, mostly Staphylococcus aureus, small pruritic papules with central pustule, often not requiring treatment, or flucloxacillin if persistent/extensive.
- Furuncles: Larger, deeper than a furuncle, extending into subcutaneous fat, located at nape of neck, back, or thighs, patient may be systemically unwell, treatment: spontaneous or surgical drainage.
- Carbuncles: larger and deeper than a furuncle; extends into subcutaneous fat; commonly located at nape of neck, back, or thighs; patient may be systemically unwell; treatment: incision and drainage, usually no role for antibiotics.
- Erysipelas: superficial form of cellulitis with lymphatic involvement; common in children, elderly, diabetics; mostly group A strep; painful erythematous lesion with well-defined border (often face or legs); may be febrile/unwell; treatment: IV benzylpenicillin, PO switch to oral amoxicillin or oral antibiotics from outset.
- Acne: multi-factorial skin disorder with excess sebaceous secretion, blocked sebaceous glands leading to pustules; secondary infection with Cutibacterium spp.; treated with broad-spectrum antibiotics (e.g., doxycycline).
- Tetanus: a life-threatening illness manifested by muscle rigidity & spasms caused by Clostridium tetani; treatment: wound management, toxoid vaccines, and supportive care.
- Animal bites/Human bites: management includes tetanus prophylaxis, antibiotics (usually co-amoxiclav). Investigation for deep infections (e.g. osteomyelitis) should be considered.
- Diabetic foot infections: limb-threatening versus non-limb-threatening; management depends on severity, involving multidisciplinary team, glycemic control, vascular surgeons, radiological imaging for osteomyelitis, and antibiotic regimes.
Viral Skin Infections
- Warts (HPV)
- Cold sores (Herpes simplex)
- Chickenpox (Varicella zoster)
- Mpox
- Hand-foot-and-mouth disease
Fungal Skin Infections
- Candidiasis
- Ringworm
- Pityriasis versicolor
Parasitic Skin Infections
- Scabies
- Lice
Case Studies & Clinical Cases
- Specific clinical case studies are included in the document.
Additional Information
- The slides provide detailed management guidelines, including specific antibiotic regimens and procedures.
- The slides also cover preventive measures for various infections.
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