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CHAPTER 4 MICROBIAL 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 spStreptococcus 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. 1 st stage – redness of surrounding area 2. 2 nd stage – 1-2 days large, soft and easily ruptured vesicles around the body 3. 3 rd stage – the lesion getting dry and scale PathogenesisSymptoms
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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 1 st 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 diseaseTransmission
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Rubella Immunity assessment on pregnant woman Rubella – specific IgM antibody Other variety serology test Currently using rubella vaccine (MMR) DiagnosisPrevention
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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 2 nd 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) 2 nd 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 diseaseSymptoms
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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) TransmissionDiagnosis 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 PathogenesisSymptoms
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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.hemipelvectomynecroticbullaecrepitationshock
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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 mycosis Deep mycosis Fungal
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Dermatophyte infection Skin Hair Nails
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Tinea pedis Adult (athlete’s) Toe webs, instep T.rubrum, T.mentagrophytes
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Tinea ungum T.rubrum, T.mentagrophytes
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Tinea corporis: Trunk Active edge T.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)
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