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PATHOGENS THAT

INVOLVE THE SKIN


BACTERIAL INFECTIONS OF THE SKIN

A. Staphyloccocus aureus
Characteristics:
- Gram (+) cocci in clusters
- catalase and coagulase positive
- non-motile, non spore forming
- facultative anaerobe
- Toxins and enzymes
TOXINS AND ENZYMES:
1. Coagulase
- coagulates (clot) fibrin
- inhibits phagocytosis
2. Leucocidin
- destroys phagocytic leucocytes
3. Exfoliative toxin (Exfoliatin)
- sloughs off the epidermis
- responsible for the Staphylococcal Scalded
Skin Syndrome (SSS)
TOXINS AND ENZYMES:
4. Enterotoxin
- heat stable
-causes food poisoning  vomiting, diarrhea
5. Toxic Shock Syndrome toxin (TSST-1)
- exotoxin
- responsible for toxic shock syndrome
6. Hyaluronidase
- destroy tissues
- breaks down proteoglycans in connective
tissue
7. Staphylokinase
- dissolves the clot
Diseases:
2. Folliculitis
3. Sty or Hordeolum
4. Furuncle (boil)
5. Carbuncle (coalescence of boils)
6. Staphylococcal Scalded skin Syndrome
7. Toxic Shock Syndrome
7. Staphylococcal Enteritis
8. Staphylococcal Pneumonia - less common
• Reservoir: Humans
• Transmission:
1. Nasal Carriers (20-30%)
- autoinfection
2. Direct Contact with a person having purulent
lesions or a carrier
3. Hands of healthcare workers (hospital)
• Incubation Period:
- Variable but usually between 4 to 10 days
• Diagnosis:
- culture
-Identification of the organism
• Treatment:
1. Penicillinase-resistant Penicillin
2. Cephalosporin
3. Clindamycin
4. Vancomycin
• Prevention and Control
1. Good personal hygiene
- Handwashing
- Antibacterial soap
- Avoid common use of toilet articles
2. Contact Precaution
3. Antibiotic ointment and solution
B. Streptococcus pyogenes
 Group A Strep (GAS) / Strep A
• Characteristics
- Gram (+) cocci in chains
- Group A-Beta hemolytic
- non-motile, non-spore forming
- facultative anaerobe
• Classification of Streptococci
- Lancefield-CHO
- Group A- beta hemolytic streptococci
- Streptococci pyogenes
- Causes: strep throat, impetigo, scarlet fever
• Group B- beta hemolytic streptococci
- Streptococcus agalactiae
- Causes: decubitus ulcer, neonatal infection
• Group D- alpha hemolytic streptococci
- Enterococci
- Causes: SBE, UTI
• Streptococcus viridans
- alpha hemolytic strep
- Causes: dental caries, infectious endocarditis
• Streptococcus pneumoniae
- alpha hemolytic strep
- Causes: pneumonia, meningitis, sinusitis,
otitis media
• Toxins (Produced by Strep. Pyogenes)
1. Erythrogenic Toxin
- cause Scarlet Fever
2. Toxic Shock Syndrome Toxin
• Diseases
1. Scarlet Fever
- widespread, pink red rash in the abdomen,
sides of chest and skinfolds.
2. Erysipelas (St. Anthony’s Fire)
- red hot eruptions
3. Necrotizing Fascitis
4. Impetigo
- reddish spots  vesicles  yellow- brown,
honey-colored crust
• Incubation period: 1 to 3 days
• Reservoir: Human
• Transmission:
-person to person via large respiratory droplets
-direct contact with patients or carriers
• Diagnosis:
- culture
- Identification of the organism
• Treatment:
1. Penicillin 4. Cephalosporin
2. Amoxicillin 5. Clindamycin
3. Erythromycin
• Prevention
- contact and droplet precaution
- isolation until treated
C. Pseudomonas aeruginosa
• Characteristics:
- Gram (-) motile bacillus
- Non-spore forming, obligate aerobe
- produce a blue-green pigment (pyocyanin)
- opportunistic infection
- Toxins: cytotoxin
necrotoxin
neurotoxin
- Diseases:
a. Otitis externa
b. Infection of burn wounds
c. Opportunistic respiratory infection
- Reservoir:
-widespread in nature (soil, plants, animals,
humans)
- Transmission
- Hands of personnel
- Fomites
- Treatment
- Penicillin - Quinolone
- Cephalosphorin - Carbapenems
- Aminoglycoside
- Prevention
-Aseptic treatment of wounds and burns
- Proper disposal of dressings
- Care in sterilization of catheters
D. Leptospira sp.
Characteristics: Spirochete
Highly motile, with hood ends and flagella
Manifestations:
- Mild fever
- Calf tenderness, conjunctival suffusion
- Jaundice, renal failure
Reservoir: Rodents
Transmission:
- Direct contact with urine, blood or tissue from an
infected animal
- Exposure to a contaminated environment like
Flood waters  skin abrasion and mucous
membranes.
• Incubation period: 2 to 26 days
• Diagnosis:
- Isolation from blood, CSF, Urine
- Microscopic Agglutination Test (MAT)
• Treatment
- Penicillin -Ampicillin
-Amoxicillin - Erythromycin
• Prevention and Control
– Chemoprophylaxis: Doxycycline 200mg once a
week
– Avoidance of exposure to urine and tissues from
infected animals
– Rodent control
E. Clostridium tetani
• Characteristics:
- Gram (+), anaerobic, spore-former bacillus
- Produce Tetanospasmin
• Disease: Tetanus
- muscle spasm
- lock jaw
- risus sardonicus
-respiratory muscle paralysis
• Reservoir: Soil
• Transmission: Spore introduced through the wounds
• Incubation Period: 3 to 21 days
• Diagnosis: Clinical findings and isolation of organism
• Treatment:
- Penicillin  to eradicate vegetative cells
- Metronidazole  to eradicate vegetative
cells
- Antitoxin

• Prevention and Control


- proper wound management
- active immunization  tetanus toxoid
with booster every 10 years
F. Mycobacterium leprae
• Characteristics:
- acid fast, aerobic bacillus
• Disease: leprosy (Hansen’s disease)
- 2 forms:
1. Neural, tuberculoid form
- lesions on skin and peripheral nerves
with loss of sensation
2. Cutaneous, Lepromatous form
- progressive disfiguring nodules in skin,
invades throughout the body
• Reservoir: Humans
• Transmission: uncertain
- may gain entrance through respiratory
tract or broken skin
• Incubation Period: 9 months to 20 years
• Diagnosis: AFB in skin smears/biopsies
• Treatment: Dapsone
Clofazimine
Prevention and Control:
- BCG 80% effective
- No isolation needed
G. Borrelia burgdorferi
• Characteristics:
- Gram (-) loosely coiled spirochete
• Disease: LYME DISEASE
- Early distinctive, red skin lesion with
central clearing
- Systemic manifestation
- neurologic and cardiac abnormalities
• Reservoir: ticks, rodents, deer
• Transmission: tick bite
• Incubation period: 3 to 33 days after tick bite
• Diagnosis:
- Observation of characteristic lesions
- Special medium: Barbour-Stoenner-Kelly (BSK)
medium
• Treatment:
– Doxycycline
– Amoxicillin
– Cefuroxime
Prevention and Control:
– Avoid tick-infested areas
– Wear light clothing with long pants, long sleeves
– Use tick repellant (DEET)
H. Bacillus anthrax
• Characteristics:
- Gram (+) spore forming, bacillus
• Reservoirs
- anthrax-infected animals
- present in soil, animal hair, wool, animal skins
and hides
• Mode of Transmission
- Entry of Endospores through:
- breaks in skin
- inhalation of spores
- ingestion of bacteria in contaminated
meat
• Disease:
1. Cutaneous anthrax (95%)
- Depressed, painless blackened lesions (eschars)
- caused by necrotoxin
2. Inhalation or Pulmonary Anthrax (Woolsorter’s
Disease)
- Fever, myalgia, non-productive cough
respiratory distress death
3. Gastrointestinal Anthrax
- Rare, fatal
- Vomiting, abdominal pain, bloody diarrhea
• Diagnosis:
-Isolation of B. anthracis
-Immunodiagnostic procedures
• Treatment: Penicillin
• Prevention: Vaccine
I. Bartonella henselae
 Characteristics:
– Gram (-) motile bacillus
– Present in saliva deposited in cat’s fur and claws

 Disease: Cat Scratch Disease


- small red raised spot crusty sore
- Regional lymphadenopathy, fever, rash, malaise
- Benign, self-limiting (resolves spontaneously in
2-4 months)
 Reservoir: Domestic cats
 Transmission:
• Incubation period: 3-5 days
• Diagnosis:
- positive skin test
- Identification on skin biopsy (Warthin-
Starry silver stain)
• Treatment:
Rifampicin
Cotrimoxazole
Ciprofloxacin
Azithromycin
II. VIRUSES
A. HUMAN PAPILLOMA VIRUS (HPV)
Characteristics: non enveloped, DNA Virus
Disease: Warts
Reservoir: Humans
Transmission: Direct contact
Incubation Period: 1 to 20 years (usually 2 to 3
months)
Diagnosis: Hx and PE
Treatment: may resolve spontaneously
Cryosurgery (liquid nitrogen)
laser therapy, salicylic acid
antiviral therapy
B. VARICELLA ZOSTER VIRUS
Characteristics: herpes virus, DNA virus
Disease: Varicella and Herpes Zoster
- maculopapular vesicle pustules crust = zoster
(shingles)
- painful vesicular lesions in a dermatomal distribution
Reservoir: Humans
Transmission: direct contact, droplet, airborne spread of vesicle
fluids or secretions of the respiratory tract
Incubation Period: 14 to 21 days
- contagious from 1 to 2 days before onset of rash until all
crops of vesicles have crusted.
Treatment: wet compress, varicella zoster Ig (within 96 hrs of
exposure)
Prevention: live attenuated varicella virus vaccine
• C. RUBEOLA VIRUS
Characteristics: Paramyxovirus, RNA virus
Disease: Measles
koplik spots, fever, coryza, cough, conjunctivitis
maculopapular rash from face---arms and legs
Reservoir: Humans
Transmission: airborne by droplet spread
direct contact with nasal or throat secretions
Incubation Period: 7 to 14 days
contagious 2 to 4 days before rash appears until 2
to 5 days after onset of rash
Treatment: supportive
Prevention and Control: live, attenuated measles
vaccine—lasts for 15 years
- airborne precautions
D. RUBELLA VIRUS
Characteristics: Toga virus, RNA virus
Disease: German Measles
- 3 day measles
- mild coryza, conjunctivitis, fever, maculopapular rash
post-auricular lympahadenopathy
Reservoir: Humans
Transmission: droplet spread or direct contact with
nasopharyngeal secretions
Incubation period: 14 to 21 days
- contagious shortly before rash appears and until
symptoms disappear
Treatment: Supportive
Prevention and Control: Live, attenuated rubella vaccine
droplet precautions
E. RABIES VIRUS
Characteristics: Rhabdovirus, RNA virus, bullet shaped
Disease: rabies
- fatal, acute viral encephalitis
- hydrophobia: painful contraction of pharyngeal
muscles when swallowing liquids
- hypersalivation, malaise, convulsion
- death --- within 1 to 2 weeks once symptoms develop
- Pathognomonic: Negri Bodies found in brain cells
Reservoir: dogs, foxes, cats, bats
Transmission: bite of rabid animal
Incubation Period: variable but usually 3 to 8 weeks
Diagnosis: Identify negri bodies
Treatment: prompt and proper treatment of bite wounds
human rabies immunoglobulin
Prevention and Control: vaccinate all pets, avoid sick and
aggressive animals, vaccinate high-risk persons,
standard precautions
F. DENGUE VIRUS
Characteristics: Flavivirus, RNA virus
Disease: Dengue Fever/Break bone fever
myalgia, fever, headache, rash
Transmission: bite of a Aedes aegypti female
mosquito
Incubation period: 2 to 7 days
Diagnosis: Hx and PE
- fever, headache, retroorbital pain, rash,
myalgia
- petecchiae, (+) torniquet test
- viral isolation, serology
Treatment: supportive
Prevention and Control: mosquito control
III. FUNGI
A. DERMATOPHYTES
Characteristics: infects skin, nails and hair
-secrete keratinase-----digest keratin
-Pathogen: Microsporum, Epidermophyton,
Trichophyton
Disease: Dermatophytoses
- S/Sx: irritation, scaling, redness
- tinea capitis --- scalp
- tinea barbae --- beard area
- tinea cruris --- groin (jock’s itch)
- tinea corporis --- body (ringworm)
- tinea pedis --- feet( athlete’s foot)
- tinea ungium --- nails (onychomycosis)
- tinea versicolor --- body
Reservoir: humans, animals, soil
Transmission: direct, indirect contact with lesions
- spore enter the skin breaks, moist areas
Diagnosis: KOH smear
- culture ---- Sabouraud Dextrose Agar
Treatment: keep infected area clean and dry
- antifungal: miconazole, clotrimazole, ketoconazole
Prevention and Control:
- maintain good hygienic practices
- keep susceptible areas of the body clean and dry
B. CANDIDA ALBICANS
Characteristics: common commensals of humans
- found in mouth, stool, vagina
- opportunistic pathogen
Predisposing factors:
-- Intrinsic factors:
a. Cellular defect (immunodeficiency)
b. Malignancies
c. Age (elderly and young)
d. AIDS
-- Extrinsic factors:
a. Wide use of broad spectrum antibiotics
b. Immunosuppressive drugs
c. Cytotoxic drugs, surgery
• Disease: oral thrush -- white plaques in the mouth
cutaneous candidiasis -- redness and maceration
of intertriginous area
Genital candidiasis – pruritus and discharge,
dysuria
Diagnosis: organism in smear (KOH)
Treatment: Antigungal drugs
oral fluconazole (Diflucan)
NORMAL SKIN
QUIZ
1. Rubella
2. HPV
3. TETANUS
4. RABIES
5. VARICELLA ZOSTER
A—DNA B—RNA
C– BOTH D– NONE
6. S. AUREUS
7. S. PYOGENES
8. P. AERUGINOSA
9. C. TETANI
10. M. LEPRAE
A- GRAM (+) B- GRAM (-)
C- BOTH D- NONE

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