1. Agents of skin-manifested infections – I + II
Institute for Microbiology, Medical Faculty of Masaryk University and St. Anna Faculty Hospital in Brno
Miroslav Votava
Agents of skin-manifested infections – I + II
Lecture for 3rd-year students
4th December, 2015

2. Common superficial injuries – revision
Staphylococcus aureus
Streptococcus pyogenes
beta-hemolytic streptococci of other groups (above all G, F, C)
! Attention in case of a foreign body in the wound (splinter, thorn) and in case of deeper stab wounds (fork soiled by horse manure): Clostridium tetani

3. Severe contused wounds – revision
Agents of clostridial myonecrosis (mostly Clostridium perfringens, C. septicum, C. novyi, C. histolyticum)
clostridial myonecrosis = anaerobic traumatosis = gas gangrene or malignant edema
Clostridium tetani
Staph. aureus, Strept. pyogenes & other pyogenic bacteria

4. Wounds sustained in water – revision
In fresh water:
Pseudomonas aeruginosa
Aeromonas hydrophila
other pseudomonads and aeromonads
In salt water:
Vibrio parahaemolyticus, V. vulnificus
Mycobacterium marinum (also in fresh-water swimming pools, tanks and aquaria)

5. Injuries sustained in the tropics – revision
Mainly on feet
soil nocardiae (Dermatophilus congolensis, Rhodococcus equi)
atypical mycobacteria (Mycobacterium ulcerans, Mycobacterium haemophilum)
micromycetes (Sporothrix schenckii, Paracoccidioides brasiliensis)

6. Surgical wounds – revision
Staphylococcus aureus
coagulase-negative staphylococci (mainly Staphylococcus epidermidis)
Enterobacteriaceae (Escherichia coli, Proteus mirabilis)
Streptococcus pyogenes
anaerobes (Peptostreptococcus micros, Peptostreptococcus anaerobius, Bacteroides fragilis)

7. Burns – revision Almost everything, but predominantly:
Pseudomonas aeruginosa
Staphylococcus aureus
Streptococcus pyogenes
other streptococci
enterococci
candidae and aspergilli

8. Man-inflicted bites – revision
members of oral microflora
- „oral streptococci“ (Streptococcus sanguinis, S. oralis, S. anginosus)
- anaerobes (Fusobacterium nucleatum ssp. nucleatum, Porphyromonas gingivalis)
Staphylococcus aureus

9. Animal bites – revision
Most often:
Pasteurella multocida (cats, dogs)
Less often:
Staphylococcus aureus (any animal)
Capnocytophaga canimorsus (dogs)
Streptobacillus moniliformis (rats)
Spirillum minus (mice, rats, cats, dogs)
Francisella tularensis (cats)
& many others

10. Other injuries by animals – revision
Francisella tularensis (rodents, hares – tularemia)
Bartonella henselae (cat scratch disease)
Erysipelothrix rhusiopathiae (pigs, carps – erysipeloid)
Bacillus anthracis (herbivores – skin anthrax, pustula maligna)
Burkholderia mallei (horses, donkeys – glanders, malleus) …

11. Infections with skin symptoms
primary skin infections
secondary infections of already diseased skin
skin symptoms of systemic infections
Etiology: bacterial
viral
fungal
parasitic

12. Primary acute bacterial skin infections I
acne vulgaris – Propionibacterium acnes
carbunculus nuchae – Staph. aureus
ecthyma gangraenosum – Ps. aeruginosa
erysipelas – Streptococcus pyogenes
erysipeloid – Erysipelothrix
erythrasma – Corynebact. Minutissimum
folliculitis – Staph. aureus, P. aeruginosa
furunculosis (boil) – Staph. aureus

13. Primary acute bacterial skin infections II
hidradenitis suppurativa – Staph. aureus
hordeolum (stye) – Staph. aureus
impetigo – Staph. aureus, Str. pyogenes
lymphangoitis – Streptococcus pyogenes
panaritium – Staphylococcus aureus
paronychium – Staphylococcus aureus
sycosis barbae – Staphylococcus aureus

14. Primary chronic bacterial skin infections
actinomycosis – Actinomyces israelii
chronic subcutaneous abscesses – Actin. israelii, Nocardia asteroides, Rhodococcus equi
skin granulomas – Mycobacterium marinum, M. haemophilum, M. chelonae
leprosy – Mycobacterium leprae
lupus vulgaris – Mycob. tuberculosis
scrophuloderma – M. tuberculosis, M. bovis

15. Secondary infections of skin lesions
decubitus (bedsore), trophic ulcer – neighbouring and endogenous flora (staphylococci, streptococci, enterococci, enteric bacteria, pseudomonads and other Gram-negative non-fermenting rods, anaerobes, yeasts)
infected atheroma – S. aureus, Propion. acnes
infected intertrigo (raw) – S. aureus, P. acnes
sec. infected dermatomycoses – S. pyogenes
infected wounds – discussed in previous lecture

16. Skin symptoms of systemic bacterial infections
roseola (rash in typhoid fever) – Salmonella Typhi
disseminated gonorrhoea – Neisseria gonorrhoeae
erythema migrans – Borrelia burgdorferi
infective endocarditis – will be dealt with by sepsis
meningococcemia – Neisseria meningitidis
scarlatina (scarlet fever) – Streptococcus pyogenes
SSSS (staphylococcal scalded skin syndrome) – Staphylococcus aureus
toxic shock syndrome – S. aureus, S. pyogenes
syphilis – Treponema pallidum

17. Etiology of skin fungal infections
Etiology differs in
superficial mycoses, like pityriasis versicolor – Malassezia furfur (prev. Pityrosporum ovale)
mucocutaneous mycoses – Candida albicans and other species of candidae
cutaneous mycoses – typical dermatophytes
subcutaneous mycoses
opportune skin mycoses in immunodeficites

18. Etiology of cutaneous mycoses – I
Three genera of dermatophytes:
Trichophyton
e.g. Trichophyton rubrum
Microsporum
e.g. Microsporum canis
Epidermophyton
only Epidermophyton floccosum

19. Etiology of cutaneous mycoses – II
tinea pedis – Trichophyton rubrum, Trich. mentagrophytes var. interdigitale, Epidermophyton floccosum
onychomycosis – T. rubrum, E. floccosum
tinea corporis – T. rubrum, Microsporum canis, M. gypseum, T. mentagrophytes var. mentagrophytes, E. floccosum
tinea capitis, type ectothrix – M. gypseum, M. canis, M. audouinii, T. mentagrophytes var. mentagrophytes, T. verrucosum
type endothrix – T. tonsurans
favus – Trichophyton schoenleinii

20. Etiology of subcutaneous mycoses
pheohyphomycosis (lesions with pigmented hyphae) – genera Alternaria, Aureobasidium, Cladosporium, Culvularia, Exophiala, Phaeoannelomyces, Phoma, Wangiella & others
chromoblastomycosis (warty nodules with sclerotic bodies) – Cladophialophora, Fonsecaea, Phialophora
mycetoma eumycoticum (swollen lesion with draining tracts containing small grains) – Acremonium, Exophiala, Madurella, Pseudoallescheria (= Scedosporium)
sporotrichosis (dimorphic fungus) – Sporothrix schenckii

21. Etiology of opportune skin mycoses in immunodeficites
Fusarium solani, Fusarium oxysporum, Fusarium verticillioides
Pseudoallescheria boydii (= teleomorf, sexual phase of anamorf Scedosporium apiospermum)
Penicillium marneffei (systemic infection with skin manifestations)
Scopulariopsis brevicaulis

22. Skin symptoms in viral diseases – I
Macular (spotted) exanthem:
morbilli – morbilli virus (Morbillivirus genus)
rubella – rubella virus (Rubivirus genus)
erythema infectiosum (the fifth disease) – parvovirus B19 (Erythrovirus genus)
exanthema subitum (roseola infantum, the sixth disease) – HHV 6 (Roseolovirus genus)
Umbiliform papulae:
molluscum contagiosum – molluscum contagiosum virus (Molluscipoxvirus genus)

23. Skin symptoms in viral diseases – II
Vesicles:
herpes simplex (cold sore) – HSV 1 (Simplexvirus genus)
herpes genitalis – HSV 2 (Simplexvirus genus)
varicella (chicken pox) – varicella-zoster virus (VZV, Varicellovirus genus)
herpes zoster (shingles) – varicella-zoster virus (VZV, Varicellovirus genus)
variola vera (smallpox) – variola virus (Orthopoxvirus genus) (continued)

24. Skin symptoms in viral diseases – III
Vesicles – cont.:
vaccinia – vaccinia virus (Orthopoxvirus genus)
cowpox and monkey pox – cowpox virus and monkey pox virus (Orthopoxvirus genus)
tubera mulgentium (milkers´ nodules) – milker´s nodule virus (Parapoxvirus genus)
aphthae epizooticae (foot and mouth disease) – foot-and-mouth disease virus (FMDV, Aphthovirus genus)
hand, foot and mouth disease – coxsackievirus A16 (Enterovirus genus)

25. Skin symptoms in viral diseases – IV
Petechiae:
Hemorrhagic fevers –
Ebola fever, Ebola virus (Ebolavirus genus)
Marburg disease, Marburg virus (Marburgvirus genus)
Lassa fever, Lassa virus (Arenavirus genus)
Generalized congenital cytomegalic disease –
cytomegalovirus (CMV, Cytomegalovirus genus)

26. Skin symptoms in parasitoses – I
Domestic (native) parasitoses:
scabies – itch mite (Sarcoptes scabiei)
demodicosis – human follicle mites (members of Demodex genus)
pediculosis capitis – head louse (Pediculus capitis)
pediculosis corporis – body louse (Pediculus humanus, syn. Pediculus corporis)
pediculosis pubis (phthiriasis) – pubic (crab) louse (Phthirus pubis)

27. Skin symptoms in parasitoses – II
Infestation by native ectoparasites:
cimicosis, urticaria cimicosa – bites by bedbug Cimex lectularius
pulicosis – bites by human flea Pulex irritans, dog flea Ctenocephalides canis, cat flea Ctenocephalides felis, chicken flea Ceratophyllus gallinae
ixodosis – bite by hard tick Ixodes ricinus
culicosis – bites by common mosquito Culex pipiens
trombiculosis, trombidiosis – bites by Neotrombicula autumnalis larvae

28. Skin symptoms in parasitoses – III
Tropical parasitoses:
ulcus humidum (humid ulcer) – Leishmania major
ulcus siccum (dry ulcer) – Leishmania tropica
espundia – Leishmania braziliensis
tungosis – chigoe flea Tunga penetrans
dermatitis cercariosa – cercariae of Schistosoma, Bilharziella andTrichobilharzia genera
dracunculosis – Dracunculus medinensis
filariosis – filariae Loa loa and Onchocerca volvulus …

29. Homework 10 Jan Havickzoon Steen (1626-1679): The Sick Woman (c. 1665)

30. Homework 10 Another two pictures by Jan Havickzoon Steen ( ) on the similar topic: The Lovesick Woman (1960) The Doctor´s Visit ( )

31. Successful homework 10 solvers:
none

32. Homework 11 Please give the name of the author and of the painting

33. Thank you for your attention
Answer and questions
The solution of the homework and possible questions please mail to the address
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