Chapter 4 MICROBIAL DISEASES OF THE SKIN
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Transcript of Chapter 4 MICROBIAL DISEASES OF THE SKIN
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CHAPTER 4MICROBIAL DISEASES OF THE SKIN
Miss Rashidah Hj Iberahim
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Content
Bacterial skin diseases* Viral skin diseases Fungal skin diseases Wound infection – gas-gangrene*
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Bacterial infections
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Gram positive infections
Folliculitis and other skin lesions
Scalded skin syndrome
Scarlet Fever Erysipelas
Staphylococcus sp Streptococcus sp
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Folliculitis(pimples / pustules)
• S. aureus colonize skin and upper resp. tract of infants within 24 hrs after birth
• Invade thru hair follicle- producing folliculitis (form of pimples and pustules)
• Encapsulated of abcess- x shedding n antibiotic reach the area
• Treatment-surgery
Spread thru hosp personnel, asympt carrier n hosp visitors/catheters and splinters for older patient /nasal droplets and fomites
100 m/org were enough to cause infection in suture
Pathogenesis Transmission
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on base of eye lashes – sty
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A larger and deeper form – abscess
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Exterior abscess – furuncle / boil
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Massive lesion - curbuncle
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Scalded Skin Syndrome
By certain exotoxin-producing strain of S.aureus (2 types exfoliatins)
Common in infant; adult (toxic shock syndrome)
Exotoxin move thru veins to the skin causing outer layer peeling off in leaflike sheets
Can lead to septicemia and very antigenic
Can cause reinfection – antibiotic very important
1. 1st stage – redness of surrounding area
2. 2nd stage – 1-2 days large, soft and easily ruptured vesicles around the body
3. 3rd stage – the lesion getting dry and scale
Pathogenesis Symptoms
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Peeling off skin
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Scarlet Fever
Pathogenesis
Also known as scarlatina By Streptococcus pyogenes Contain 3 types of erythrogenic toxin –
reddening The strain was 1st infected by temperate
phage – erythrogenic toxin that leads to rash Only infecting new exposure pt low- virulent strain – glomerulonephritis /
rheumatic fever Reinfection that already defends by previous
antibiotic – leads to strep throat (but carrier of scarlet fever)
Might also caused by fomites
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Rash
The best medicine is Penicillin – decrease mortality rate
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Erysipelas
Face- small, bright, raised, rubbery lesion.
Beta hemolytic gp A Strept. Always occur after pt
having surgery or wounds Producing hyaluronidase
enzyme and toxin Minor abrasion— sup. Lymph vessels
(causing septicemia, abscess,pneumonia, endocarditis, arthritis, death)
Pathogenesis
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Viral Diseases
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Rubella
Rashes appear on trunk after 16-21 days after infection
Caused by togavirus 2ndary: arthritis and
arthralgia Can caused
congenital rubella syndrome
Mainly through nasal secresion
Direct contact among children age 5 – 14
Infected infants expose to hospital personnel
The disease Transmission
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Rubella
Immunity assessment on pregnant woman
Rubella – specific IgM antibody
Other variety serology test
Currently using rubella vaccine (MMR)
Diagnosis Prevention
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Measles/ Rubeola
Caused by Rubeola virus Koplik’s spots – bluish
specks in upper lips and cheek mucosa
Rubella – pink n flat rash Rubeola – red and raised Other complications : Measles encephalitis Subacute sclerosing
panencephalitis (SSPE)
Diagnose by its symptoms
2nd accompanied by bacterial infection
Using the same vaccine as rubella and mumps (MMR)
Diagnosis and prevention
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Chicken pox and Shingles
1 virus – 2 diseases CP – varicella, S –
zoster (varicella-zoster virus)
2nd inf by S. aureus In children Damages in blood and
lymphatic drainage During latent period,
stay in ganglia of nerve cells
CP = Causing blood clot and hemorrhage, Cause death
S = pain, burning, prickling of the skin when it reactivate
The disease Symptoms
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Disease progression
1. Virus enter upper respiratory tract/ conjuctiva – replicates
2. Carried by blood to various tissues – replicates
3. Release of viruses causes fever and malaise
4. After 14 – 16 days, present of small, irregular, rose-coloured skin lesions
5. Fluid become cloudy, dry and crust over 2-4 days (virus cycle)
6. Rashes start from scalp and trunk, face and limbs, to mouth/throat/ vagina, and may spread to resp tract and GIT
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Chicken pox and shingles
CP – Infect between 5-9 yrs old
V – age >45 yrs old
Spread by respiratory secretion and fluid from moist lesion (not the dry lesion)
Using rapid laboratory test
Treatment – antiviral agent (valtrex and neurontin)
Transmission Diagnosis and treatment
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Gas gangrene
Wound infection
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Gas Gangrene
Caused by more than 1 bacteria = Clostridium sp.
Spores of the bacteria expose during injuries and surgery
The symptoms getting severe because of toxin and enzyme production
Suddent onset = 12-48 hrs after exposure
Foul odour Ferment muscle
carbohydrates “snap, crackle and
pop” High fever, shock,
massive tissue destruction, blackening of tissues
Pathogenesis Symptoms
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Photograph before right leg amputation (hemipelvectomy) of a patient with gas gangrene. The right thigh is swollen, edematous and discoloured with necrotic bullae(large blisters). An impressive crepitation is already palpable. At this juncture, the patient is in shock.
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Others diseases
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1. Wart
Caused by Human Pappiloma Virus (DNA)
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Plane wart Plantar wart Face , back of hands sole
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Genital wart
Condylomata accuminata
Penile, vulvar skin, perianal area
Sexual partner Child---sexual abuse Some: oncogenic:16, 18
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2. Molluscum contagiosum Pox virus Child Face, neck Central punctum Hunderson-patterson bodies
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Superficial mycosisDeep mycosis
Fungal
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Dermatophyte infection
Skin Hair Nails
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Tinea pedisAdult (athlete’s)Toe webs , instepT.rubrum, T.mentagrophytes
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Tinea ungum
T.rubrum, T.mentagrophytes
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Tinea corporis:
TrunkActive edgeT.rubrum
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T.cruris
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T.manun
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Tinea capitis
Well circumscriped pruritic scaling area of hair loss
Black dot (T.tonsurans) Gray patch (M.audouinii), Kerion (T.verrucosum) Favus (T.schoenleinii)