SKIN AND EYES INFECTION

 ANATOMY AND PHYSIOLOGY

 INTEGUMENT – skin, together with the hair, nails, and sweat and, oil glands
 The skin total surface area of 1.5 to 2 square meters. Its thickness varies from 1.5 millimeters at places such as the eyelids to 4 millimeters on the soles of the
feet.
 EPIDERMIS – The outermost portion of the skin; replaced every 25 to 45 days
 LAYERS OF EPIDERMIS
o STRATUM BASALE – the deepest portion of the epidermis; attached to the underlying dermis and is the source for all of the cells that make up the
epidermis
o STRATUM SPINOSUM
o STRATUM GRANULOSUM
o STRATUM LUCIDUM
o STRATUM CORNEUM – thick layer of epithelial cells; most superficial layer; cells in this layer are dead and have migrated from the deeper layers
during the normal course of cell division
 KERATIN – gives the cells their ability to withstand damage and abrasion; the surface of the skin is termed KERATINIZED for this reason
 DERMIS – composed of connective tissues; it is a rich matrix of fibroblast cells and fibers such as collagen, and it contains macrophages and mast cells; also
harbors a dense network of nerves, blood vessels, and lymphatic vessels.
 BLISTER – separation between dermis and epidermis
 FOLLICLES – root of hairs; SEBACEOUS GLANDS AND SCENT GLANDS are associated with hair follicle
 Millions of cells from the stratum corneum slough off every day, and attached microorganisms slough off with them. The skin is also brimming with
antimicrobial substances.
 ANTIMICROBIAL PEPTIDES - are positively charged chemicals that act by disrupting (negatively charged) membranes of bacteria. There are many
different types of these peptides, and they seem to be chiefly responsible for keeping the microbial count on skin relatively low.
 SEBUM – secretion of sebaceous gland that has a low pH; which makes the skin inhospitable to most microorganisms
 LYSOZYME – an enzyme found in sweat (and tears and saliva) that specifically breaks down peptidoglycan, a unique component of bacterial cell walls.

 NORMAL BIOTA OF THE SKIN

 HUMAN MICROBIOME PROJECT (HMP)
 Hundreds of species of microbes were found distributed over many different areas of the body.
 Although five major taxa were represented in the microbiota, the predominance of these groups varied in the different regions of the body sampled.
 There are large differences among people with respect to the types of microbes found on various skin sites.
 An individual’s own skin microbiota seems to be relatively stable over time
 Staphylococcus epidermidis and Propionibacterium acneshave long been thought to be the most numerous normal biota on skin due to their tolerance of high
salt conditions.
 Staphylococcus aureus – a potential pathogen on the skin
 DEFENSES NORMAL BIOTA
SKIN - Keratinized surface Bacteria such as:
- Sloughing - Staphylococcus epidermidis
- Low pH due to sebum secretion - Propionibacterium
- High salt - Corynebacterium
- Lysozyme - Lactobacillus
- Bacteroides
- Prevotella
- Haemophilus
- yeasts such as Malassezia, Candida

 SKIN DISEASES CAUSED BY MICROORGANISM

 MRSA SKIN AND SOFT TISSUE INFECTIONS
 Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of skin lesions in nonhospitalized people; these strains are usually resistant to
multiple antibiotics.
 Staphylococcus aureus is a gram-positive coccus that grows in clusters, like a bunch of grapes. It is nonmotile.
 Considered the sturdiest of all non-endospore forming pathogens, with well-developed capacities to withstand high salt (7.5% to 10%), extremes in pH, and
high temperatures (up to 60°C for 60 minutes). S. aureus also remains viable after months of air drying and resists the effect of many disinfectants and
antibiotics.

MRSA SKIN AND SOFT TISSUE INFECTIONS

Causative Organism(s) Methicillin-resistant Staphylococcus aureus
Most Common Modes of Transmission Direct contact (exposure to person w/ active MRSA), indirect contact (fomites)
Virulence Factors Coagulase (coagulates plasma), Hyaluronidase (digest hyaluronic acid),
staphylokinase (digests blood clots), Nuclease (digest DNA), Lipase (help the
bacteria), superantigens
Culture/Diagnosis PCR, culture and Gram stain, coagulase and catalase tests, multitest systems
Prevention Hygiene practices
Treatment Vancomycin; in Serious Threat category in CDC Antibiotic Resistance Report
Epidemiology Community-associated MRSA infections most common in children and young to
middle-aged adults; Incidence increasing in communities (decreasing in hospitals)