Galderma Chapter 8: Bacterial Infections Of The Skin

Front 1

Actinomycosis is caused by what anaerobic gram-positive rod?

Back 1

Actinomyces Israelii

Front 2

Chronic suppurative nodules and sinus tracts with and exudate containing "sulfur granules" is characteristic of what gram-positive infection?

Back 2

Actinomycosis

Front 3

What bacterial infection causes a "Lumpy Jaw"?

Back 3

Actinomycosis

Front 4

What is the most common source of an Actinomycosis infection?

Back 4

Endogenous oral flora

Front 5

What are the 3 risk factors associated with Actinomycosis?

Back 5

1) Poor oral hygiene
2) Penetrating foreign bodies
3) Dental procedures

Front 6

What are the 4 types of aerobic filamentous bacteria known to cause an Actinomycetoma?

Back 6

1) Nocardia Brasilensis
2) Actinomadura Madurae
3) Actinomadura Pelletieri
4) Streptomyces Somaliensis

Front 7

What causes a chronic, slowly progressive SQ infection characterized by tumefaction, draining sinuses, and an exudate containing grains?

Back 7

Actinomycetoma

Front 8

What body part is most commonly affected with Acintomycetoma?

Back 8

The foot

Front 9

What is the most common source of an Actinomycetoma?

Back 9

Exogenous like soil

Front 10

Anthrax is caused by what gram-positive spore-forming rod?

Back 10

Bacillus Anthracis

Front 11

Cutaneous anthrax is caused by contact with what?

Back 11

Infected wild or domestic animals or their products
(wool, goat, animal hides and bones)

Front 12

B. Anthracis has what 2 exotoxins?

Back 12

1) Edema Toxin
2) Lethal Toxin

Front 13

The edema toxin of B. Anthracis is composed of what 2 parts?

Back 13

Edema Factor (EF) + Protective Antigen (PA)

Front 14

The lethal toxin of B. Anthracis is composed of what 2 parts?

Back 14

Lethal Factor (LF) + Protective antigen (PA)

Front 15

Which exotoxin of anthrax causes gelatinous edema of the skin by inducing an increase in cAMP levels?

Back 15

Edema Toxin

Front 16

The lethal factor portion of the lethal toxin causes shock and death in what form of anthrax?

Back 16

Disseminated Anthrax

Front 17

In disseminated anthrax lethal toxin causes shock and death via the release of what 2 cytokines?

Back 17

1) TNF-alpha
2) IL-1β

Front 18

Protective antigen (PA) is responsible for what in the pathogenesis of anthrax?

Back 18

PA is responsible for the entry of exotoxins into the cell by receptor-mediated endocytosis

Front 19

Having antibodies to what will prevent the actions of Edema factor and lethal factor in the pathogenesis of anthrax?

Back 19

Antibodies to PA

Front 20

What are the 3 clinical forms of anthrax?

Back 20

1) Cutaneous (most common)
2) Inhalation
3) GI

Front 21

What is the treatment for bioterrorism associated anthrax?

Back 21

Cipro or Doxy

Front 22

What is the treatment for conventional anthrax?

Back 22

PCN

Front 23

What is the initial primary skin lesion of anthrax?

Back 23

"Malignant pustule"
Starts as a painless papule

Front 24

The initial painless papule of anthrax evolves into a hemorrhagic blister with surrounding non pitting edema with ultimately forms what characteristic feature of anthrax?

Back 24

Painless black eschar

Front 25

What type of bacteria causes Bartonellosis?

Back 25

Aerobic Gram-negative bacilli of the genus Bartonella

Front 26

Aerobic Gram-negative bacilli of the genus Bartonella cause what 4 diseases?

Back 26

1) Cat-Scratch Disease
2) Bacillary Angiomatosis
3) Trench Fever
4) Oroya Fever

Front 27

Oroya fever is also known by what 2 names?

Back 27

1) Carrion's Disease
2) Verruga Peruana

Front 28

What bacteria causes
Cat-Scratch Disease?

Back 28

Bartonella Henselea

Front 29

What is the vector in Cat-Scratch Disease?

Back 29

The cat flea:
Ctenocephalides Felis

Front 30

TRUE or FALSE?
The vector in Cat-Scratch Fever, cat flea: Ctenocephalides Felis is transmitted from cat to human.

Back 30

FALSE
The cat flea: Ctenocephalides Felis is transmitted from cat to cat only

Front 31

How does a human contract Cat-Scratch disease?

Back 31

By being bitten or scratch by a cat infected via the cat flea Ctenocephalides Felis

Front 32

How is Cat-Scratch disease treated?

Back 32

Most cases spontaneously resolve on their own

Front 33

Bartonella Henslea is the causative agent of what 2 disease?

Back 33

1) Cat-Scratch Disease
2) Bacillary Angiomatosis

Front 34

Bacillary Angiomatosis is caused by what 2 organisms?

Back 34

1) B. Henselae (most common)
2) B. Quintana

Front 35

What 2 abx are used to treat bacillary angiomatosis?

Back 35

Erythromycin and Doxy

Front 36

Bartonella Quintana is the causative organism in what 2 diseases?

Back 36

1) Bacillary angiomatosis
2) Trench fever

Front 37

What bacteria causes Trench Fever?

Back 37

Bartonella Quintana

Front 38

What is the principle vector in Trench Fever?

Back 38

Human body louse:
Pediculus humanus corporis

Front 39

What 2 antibiotics are used to treat trench fever?

Back 39

Erythromycin and Doxy

Front 40

What is the causative organism in Oroya Fever?

Back 40

Bartonella Bacilliformis

Front 41

What is the principal vector in Oroya Fever?

Back 41

The Sandlfy:
Lutzomyia Verrucarum

Front 42

What secondary superinfection do you have to worry about in a patient infected with Carrion's Disease?

Back 42

Salmonella

Front 43

What is the treatment of Oroya fever?

Back 43

Chloramphenicol

Front 44

What 3 diseases are caused by the Borrelia species?

Back 44

1) Lyme Disease
2) Louse-Borne Relapsing Fever
3) Tick-Borne Relapsing Fever

Front 45

What 2 continents do you commonly see Louse-Borne Relapsing fever?

Back 45

South America and Africa

Front 46

Where in the US is Tick-Borne Relapsing fever seen?

Back 46

Western US

Front 47

What Borrelia species causes Lyme Disease?

Back 47

Borrelia Burgdorferi

Front 48

What Borrelia species causes Louse-Borne Relapsing Fever?

Back 48

Borrelia Recurrentis

Front 49

What 2 Borrelia species cause Tick-Borne Relapsing Fever?

Back 49

1) Borrelia Duttonii
2) Borrelia Hermsii

Front 50

What is the treatment for Lyme disease?

Back 50

For Preggers and kids <9yo = Amoxicillin
for everyone else its Doxy

Front 51

What is the vector for Lyme Disease in the Northeast US?

Back 51

Ixodes Dammini
= Ixodes Scapularis

Front 52

What is the vector for Lyme Disease in the Western US?

Back 52

Ixodes Pacificus

Front 53

What is the vector for Lyme Disease in Europe?

Back 53

Ixodes Ricinus
(They eat more rice in europe)

Front 54

What is the vector for Louse-Borne Relapsing fever?

Back 54

Human body Louse
Pediculus Humanus

Front 55

What is the vector for Tick-Borne Relapsing fever?

Back 55

Soft-bodied ticks
Ornithodoros

Front 56

What are the 2 clinical skin features of Lyme disease?

Back 56

1) Erythema Migrans
2) Acrodermatitis Chronic Atrophicans

Front 57

What are the 5 clinical features of both Tick-borne and Louse-borne Relapsing fever?

Back 57

1) Paroxysmal fevers
2) Headache
3) Lymphocytoma
4) Myalgias
5) Erythematous or petechial macules on the trunk & extremities

Front 58

What antibiotic can be used to treat all 3 forms of Borreliosis?

Back 58

Doxycycline

Front 59

Name the 4 causative organisms implicated in Botryomycosis

Back 59

1) Staph Aureus
2) Pseudomonas Aeruginosa
3) E. Coli
4) Proteus species

Front 60

What is the characteristic clinical feature of Botryomycosis?

Back 60

Chronic or subacute suppurative nodules or plaques

Front 61

What will you find on light microscopy with Botryomycosis?

Back 61

Granular bodies

Front 62

What are the 4 risk factors associated with Botryomycosis?

Back 62

1) Immunosuppresion (HIV)
2) DM
3) Trauma
4) ETOHism

Front 63

What is the causative organism of Ecthyma Gangrenosum?

Back 63

Pseudomonas Aeruginosa Septicemia

Front 64

"Gunmetal gray" infarcts with surrounding erythema are the characteristic features of what infection?

Back 64

Ecthyma Gangrenosum

Front 65

What gram-positive rod causes Erysipeloid?

Back 65

Erysipelothrix Rhusiopathiae

Front 66

People who work in what 2 fields are at risk for Erysipeloid?

Back 66

Handlers of contaminated raw fish or meat
Fisherman or Butchers

Front 67

A tender, well-demarcated, violaceous lesion with raised margins and central clearing, typically on the hand or finger is characteristic of what?

Back 67

Erysipeloid

Front 68

What abx is used to treat Erysipeloid?

Back 68

PCN

Front 69

What is the causative organism in Glanders?

Back 69

Burkholderia Mallei
(Glanders likes the bitches in Burkas)

Front 70

Glanders is a disease caused by contact with what animal?

Back 70

Infected Horses

Front 71

Sarah AcMoody is at risk for getting what disease?

Back 71

Glanders

Front 72

An ulcerated nodule with regional lymphadenopathy in a jockey is classic presentation for what disease?

Back 72

Glanders

Front 73

Glanders is treated with what 2 abx?

Back 73

Imipenem or Doxy

Front 74

Meningococcemia is caused by what gram-negative diplococcus?

Back 74

Neisseria Meningitides

Front 75

Young children and patients with type of deficiency are at risk for developing meningococcemia?

Back 75

Patients with Complement deficiencies

Front 76

Petechiae that often progress to large ecchymotic or necrotic areas on the trunk and extremities with fever, chills, meningitis and hypotension most likely are infected with what?

Back 76

Neisseria Meningitides
(meningococcemia)

Front 77

What 2 antibiotics are used to treat meningococcemia?

Back 77

IV PCN or Rocephin

Front 78

What is the causative organism in pitted keratolysis?

Back 78

Micrococcus Sedentarius
(PPK on feet from being sedentary)

Front 79

What infectious disease presents with shallow 1-2mm pits on the plantar surface of the feet?

Back 79

Pitted Keratolysis

Front 80

What 3 topical agents can be used to treat infection with Micrococcus Sedentarius?

Back 80

1) Topical E-mycin
2) Topical clinda
3) BPO

Front 81

Haverhill Fever is another name for what?

Back 81

Rat-bite Fever

Front 82

What is the causative organism in Rat-bite fever?

Back 82

Streptobacillus Moniliformis

Front 83

How does one acquire infection with Haverhill Fever?

Back 83

From rodents or contaminated food

Front 84

What are the 3 characteristic features of Rat-bite fever?

Back 84

1) Fever
2) Arthralgias
3) Rash (nonspecific red macules or papules which can become generalized)

Front 85

What abx treats rat-bite fever?

Back 85

PCN

Front 86

What is the causative organism in Rhinoscleroma?

Back 86

Klebsiella Pneumoniae Rhinoscleromatis

Front 87

What are the characteristic features of Rhinoscleroma?

Back 87

Hypertrophic plaques on the external nares

Front 88

Mikulicz cells on histopathology are pathomnemonic for what?

Back 88

Rhinoscleroma

Front 89

What abx treats Rhinoscleroma?

Back 89

Cipro

Front 90

What phage group of staph aureus produce exotoxins, which can produces bullous or exfoliative skin lesions?

Back 90

Phage group 2

Front 91

What 4 cutaneous eruptions are caused by Staph?

Back 91

1) Toxic Shock Syndrome (TSS)
2) SSSS
3) Bullous Impetigo
4) Staphylococcal Scarlet fever

Front 92

What % of TSS are non-menstral cases?

Back 92

50%

Front 93

What exotoxins are causative in non-menstral cases of TSS?

Back 93

Enterotoxins B and C

Front 94

What toxin causes TSS in menstrual cases?

Back 94

TSST-1 (TSS toxin 1)

Front 95

Along with Fever, and hypotension what skin findings do you see with TSS?

Back 95

Generalized scarlatiniform eruption followed by desquamation

Front 96

The exotoxins that cause SSSS are targeting what human antigen?

Back 96

Desmoglein 1

Front 97

What 2 toxins cause SSSS?

Back 97

Exfoliative toxins/Epidermolytic toxins A and B
(ET-A and ET-B)

Front 98

What antigen do ET-A and ET-B bind to in the pathogenesis of SSSS?

Back 98

Desmoglein 1

Front 99

What 3 patient populations are at risk for developing SSSS?

Back 99

1) Children under 5
2) Adults with Renal failure
3) Adults with immunodeficiency

Front 100

What will culture of a bullous lesion in SSSS reveal?

Back 100

Nothing

Front 101

Where is the site of staphylococcal infection in SSSS?

Back 101

Distant (extra-lesional)
-usually mucous membranes
which is why culture of skin lesions will be negative for staph

Front 102

Is Nikolsky's sign positive or negative in lesional skin in SSSS?

Back 102

Positive

Front 103

Is Nikolsky's sign positive or negative in non-lesional skin in SSSS?

Back 103

Positive

Front 104

What level is the split with SSSS?

Back 104

Sub-granular blister

Front 105

What 3 staphylococcal exotoxins cause Bullous impetigo?

Back 105

1) Exfoliative toxin A
2) Exfoliative toxin B
3) TSST-1

Front 106

Where is the site of staphylococcal infection in bullous impetigo?

Back 106

At the site of the lesion

Front 107

What do you expect to see on cultures of skin lesions in bullous impetigo

Back 107

Staph or strep

Front 108

What level is the split in bullous impetigo?

Back 108

Sub-corneal blister

Front 109

What type of rash do you see with Staphylococcal Scarlet Fever?

Back 109

Generalized scarlatiniform rash

Front 110

What are the 3 distinguishing features of Scarlet fever?

Back 110

1) Pastia's lines
2) Strawberry tongue
3) Pharyngitis

Front 111

TRUE or FALSE?
In Staphylococcal Scarlet Fever the only symptom seen is the generalized scarlatiniform rash, NONE of the other systemic symptoms of classic Scarlet fever are seen.

Back 111

TRUE

Front 112

Impetigo (non-bullous), Folliculitis/Furunculosis, Sycosis barbae, Ecthyma, Cellulitis, Botryomycosis, Acute paronychia, Felon (Staphylococcal Whitlow), Purpura Fulinans and Endocarditis represent what?

Back 112

Diseases that are not usually but CAN BE caused by Staphylococcal Infections

Front 113

Tense blisters filled with purulent fluid and surrounding erythema on the dorsal surface of distal fingers and toes caused by Group A β-hemolytic streptococcus is known as what?

Back 113

Blistering Distal Dactylitis

Front 114

What level is the split with SSSS?

Back 114

Sub-granular blister

Front 115

What 3 staphylococcal exotoxins cause Bullous impetigo?

Back 115

1) Exfoliative toxin A
2) Exfoliative toxin B
3) TSST-1

Front 116

Where is the site of staphylococcal infection in bullous impetigo?

Back 116

At the site of the lesion

Front 117

What do you expect to see on cultures of skin lesions in bullous impetigo

Back 117

Staph or strep

Front 118

What level is the split in bullous impetigo?

Back 118

Sub-corneal blister

Front 119

What type of rash do you see with Staphylococcal Scarlet Fever?

Back 119

Generalized scarlatiniform rash

Front 120

What are the 3 distinguishing features of Scarlet fever?

Back 120

1) Pastia's lines
2) Strawberry tongue
3) Pharyngitis

Front 121

TRUE or FALSE?
In Staphylococcal Scarlet Fever the only symptom seen is the generalized scarlatiniform rash, NONE of the other systemic symptoms of classic Scarlet fever are seen.

Back 121

TRUE

Front 122

Impetigo (non-bullous), Folliculitis/Furunculosis, Sycosis barbae, Ecthyma, Cellulitis, Botryomycosis, Acute paronychia, Felon (Staphylococcal Whitlow), Purpura Fulinans and Endocarditis represent what?

Back 122

Diseases that are not usually but CAN BE caused by Staphylococcal Infections

Front 123

Tense blisters filled with purulent fluid and surrounding erythema on the dorsal surface of distal fingers and toes caused by Group A β-hemolytic streptococcus is known as what?

Back 123

Blistering Distal Dactylitis

Front 124

Ecthyma, Non-bullous impetigo, Erysipelas, Cellulitis, Gangrenous Cellulitis (infectious gangrene, necrotizing fasciitis), Streptococcal toxic-shock-like syndrome, and endocarditis are all examples of what?

Back 124

Other Streptococcal infections
(usually not caused by strep but can be caused by strep)

Front 125

Name the 4 major disease caused by Group A β-hemolytic streptococcus.

Back 125

1) Blistering Distal Dactylitis
2) Perianal Streptococcal "Cellulitis"
3) Scarlet Fever
4) Purpura Fulminans

Front 126

What is the clinical presentation of Perianal streptococcal "cellulitis"

Back 126

Sharply demarcated tender erythematous plaque in the perianal region in children

Front 127

Pyrogenic exotoxin (erythrogenic toxin) types A, B and C mediate what GABHS disease?

Back 127

Scarlet Fever

Front 128

What 2 lab tests will be positive in Scarlet fever?

Back 128

1) Positive strep throat culture
(in early infection)
2) Positive ASO titer

Front 129

What typical systemic finding should you check for when suspecting scarlet fever?

Back 129

Streptococcal pharyngitis

Front 130

A child between 2-10yo with a recent history of strep throat presents to you with a sandpaper rash, what is the dx?

Back 130

Scarlet fever

Front 131

What 2 symptoms compose the enanthem of Scarlet Fever?

Back 131

1) Exudative Pharyngitis
2) Strawberry tongue

Front 132

Name the exanthem: Diffuse erythematous eruption with "sandpaper" texture, beginning on the head and neck, then generalizes, sparing the palms/soles with circumoral pallor.

Back 132

Scarlet Fever

Front 133

Describe Pastia's Lines

Back 133

Linear petechial patches in axillae and antecubital fossa associated with Scarlet Fever

Front 134

What are Pastia's lines associated with?

Back 134

Scarlet Fever

Front 135

When should you expect to see desquamation with Scarlet fever? In the beginning or towards resolution?

Back 135

Desquamation usually starts on the face and ears upon resolution of the exanthem

Front 136

Purpura Fulminans is most commonly associated with what organism?

Back 136

Group A β-hemolytic strep

Front 137

Name the disease that causes hemorrhagic infarction of the skin caused by DIC

Back 137

Purpura Fulminans

Front 138

Name the disease that presents clinically as symmetric, large, ecchymotic areas with irregular ("geographic") borders on the extremities, ears, and most, most commonly

Back 138

Purpura Fulminans

Front 139

What organism causes Trichomycosis Axillaris?

Back 139

Corynebacterium tenuis

Front 140

Yellowish brown concentrations on axillary hair shafts is the characteristic clinical presentation of what?

Back 140

Trichomycosis Axillaris

Front 141

What are 3 tx options for Trichomycosis Axillaris?

Back 141

1) Shaving armpit hair
2) BPO gel
3) Topical E-mycin

Front 142

Tularemia is caused by what organism?

Back 142

Francisella Tularensis

Front 143

What disease is most commonly caused by contact with infected rabbits?

Back 143

Tularemia

Front 144

Dr. Fox and Elmer Fudd are both equally at risk for contracting what disease?

Back 144

Tularemia
(Rabbit Hunters)

Front 145

Ulceroglandular, Glandular, Chancriform, Oculoglandular, Typhoidal, Pulmonary, Oropharyngeal and Meningeal are all possible forms of what disease?

Back 145

Tularemia

Front 146

What is the most common form of Tularemia?

Back 146

Ulceroglandular

Front 147

Describe the clinical presentation of the most common (Ulceroglandular) form of Tularemia.

Back 147

Chancre like ulcer with raised borders and regional lymphadenopathy; typically on the finger or hand

Front 148

Where does Tularemia most commonly present?

Back 148

Finger or hand

Front 149

What abx treats Tularemia?

Back 149

Streptomycin

Front 150

Oroya Fever and Verruga Peruana represent 2 stages of the same infection, which is the acute stage?

Back 150

Oroya Fever (Carrion's Disease) is the acute febrile stage

Front 151

Verruga Peruana is the chronic or acute stage of infection with B. bacilliformis?

Back 151

Chronic

Front 152

After the acute Oroya Fever (Carrion's Disease) stage, the eruptive verruga peruana then occur which clinically are identical to what other infectious disease?

Back 152

The eruptive verruga peruana are clinically and histologically identical to Bacillary Angiomatosis

Front 153

Describe the clinical presentation of verruga peruana

Back 153

Angiomatous, pyogenic-granuloma-like lesions

Front 154

Verruga Peruana can present in 3 different distributions, what are they?

Back 154

1) Mular Form= large and few in number
2) Miliary Form= small and disseminated
3) Nodular and Deep

Front 155

Since 1945, 89% of US cases of the Bubonic Plague have occurred in what region of the US?

Back 155

The Rocky Mountain states

Front 156

How does one catch Rat-Bite Fever (Haverhill Fever)?

Back 156

Direct contact with infected rats or other small rodents

Front 157

Which group of obligate, intracellular, Gram-negative bacteria are transferred to humans through their natural reservoirs, blood-sucking arthropods?

Back 157

Rickettsiae

Front 158

What 3 species of Rckettsia make up the "Typhus Group"?

Back 158

1) Rickettsia Prowazekii
2) Rickettsia Typhi
3) Rickettsia Tsutsugamushi

Front 159

Louse-borne epidermic typhus is caused by what Rickettsia species?

Back 159

Rickettsia Prowazekii

Front 160

Mouse, Cat, or Rat Flea Borne Endemic Typhus is caused by what Rickettsia species?

Back 160

Rickettsia Typhi

Front 161

Scrub typhus, a mite-borne infection is caused by what Rickettsia species?

Back 161

Rickettsia Tsutsugamushi

Front 162

Humans contract Epidemic Typhus from an infestation of what?

Back 162

Body Lice (Pediculus Humanus)

Front 163

Endemic Typhus is a natural infection of rats and mice, transmitted to humans by the same rat flea that transmits the plague known as?

Back 163

Xenopsylla Cheopis

Front 164

Scrub typhus is also known as what?

Back 164

Tsutsugamushi Fever

Front 165

The primary lesion of Scrub Typhus is an erythematous papule at the site of the mite bite, most commonly found on what 3 areas?

Back 165

1) Scrotum
2) Groin
3) Ankle

Front 166

What is the vector for scrub typhus?

Back 166

Trombiculid red mite (Chigger)