INFECTIONS OF THE

SKIN
Microbiology
USLS
Dr. Joan E. Cerrada
SKIN STRUCTURE
EPIDERMIS:
FUNCTIONS OF THE
•SKIN:
absorbs melanin
• •Covers
waterproofing
and keeps via
keratinorgans
internal
•together
dendritic cells
• •Prevents
covered water
with sebum
loss
• Temperature
and salt
•regulation
sloughs off
• Assists formation of
Vitamin D
• Involved in sensory
phenomena
NORMAL SKIN MICROBIOTA

• Compete with potential pathogens for nutrients

and space
• Produce chemicals that interfere with growth of
other microbes

yeasts Staphylococcus Diphtheroids

BACTERIAL DISEASES
OF THE SKIN
BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
FOLLICULITIS
• Infection of the hair follicle
• Base of the follicle becomes
red, swollen, and pus filled
• “Pimple”
• “sty” if at the base of the eyelid
• “furuncle/boil” – large, painful
nodular extension of
follilculitis
• “carbuncle” – coalescence of
several furuncles
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
FOLLICULITIS

STAPHYLOCOCCUS
• most common cause of folliculitis and associated
infections of the skin
• salt tolerant (up to 10% NaCl)
• tolerant of dessication, heat (up to 60 C in 30
minutes and radiation
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
FOLLICULITIS
STAPHYLOCOCCUS Virulence Factors:

ENZYMES ROLE
Coagulase Clots blood, hiding the bacteria from phagocytes

Hyaluronidase Enables bacteria to spread between cells

Staphylokinase Dissolves blood clots, allows the bacteria to spread to new

locations
Lipases Digest lipids including sebum

Β-lactamases Inactivates B-lactam antibiotics

 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
FOLLICULITIS
STAPHYLOCOCCUS Virulence Factors:

STRUCTURAL DEFENSES AGAINST PHAGOCYTOSIS:

• polysaccharide slime layers – inhibits chemotaxis of
and phagocytosis by leukocytes, enables bacteria
to attach to biofilms
• protein A coating – inhibits opsonization, inhibits
complement cascade
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
FOLLICULITIS
STAPHYLOCOCCUS Virulence Factors:

TOXINS:
• production of cytolytic toxins that disrupt the
cytoplasmic membranes of cells (e.g. leukocidin)
• exfoliative toxins – cause SSSS and TSS
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
FOLLICULITIS
STAPHYLOCOCCUS Virulence Factors:

WHY IS Staphylococcus aureus more pathogenic than

Staphylococcus epidermidis?

Answer: absence of most virulence factors other than

lipase and production of slime layer
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
FOLLICULITIS
STAPHYLOCOCCUS Pathogenesis:

1 2 3

Acquisition via Invasion of hair

direct contact or colonization follicles and
from fomites sebaceous glands
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
FOLLICULITIS
STAPHYLOCOCCUS Pathogenesis:

4 5 6

Spread to hypodermis
Hematogenous Seeding to other
(furuncle), and to hair
spread (bacteremia) organ systems
follicles (Carbuncle)
BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
FOLLICULITIS
STAPHYLOCOCCUS Colonization:
BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
FOLLICULITIS
STAPHYLOCOCCUS Diagnosis:

1
• clinical assessment

2
• gram staining of discharges (if any)

3
• culture and sensitivity
BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
FOLLICULITIS
STAPHYLOCOCCUS Treatment:

Clean and
Topical Cloxacillin,
drain
antibiotic Oxacillin
abscesses
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
STAPHYLOCOCCAL SCALDED SKIN SYNDROME

• cells of the outer epidermis

separate from one another
and from the underlying
tissue
• caused by exfoliative toxins
secreted by S. aureus:
dissolution of epidermal
desmosomes
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
STAPHYLOCOCCAL SCALDED SKIN SYNDROME

• primarily affects infants and children

• elderly
• immunocompromised

TRANSMISSION: person to person

 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
STAPHYLOCOCCAL SCALDED SKIN SYNDROME
STAPHYLOCOCCUS Diagnosis:

• clinical: distinctive sloughing off of skin

• fluid in blisters does not contain organisms
because they are caused by toxins released
from sites of infection elsewhere
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
STAPHYLOCOCCAL SCALDED SKIN SYNDROME
STAPHYLOCOCCUS Treatment:

• IV antibiotics: Oxacillin, Methicillin

 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
IMPETIGO (PYODERMA) AND ERYSIPELAS

• IMPETIGO :
characterized by small,
flattened, red patches
that appear most
commonly on the face
and limbs
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
IMPETIGO (PYODERMA) AND ERYSIPELAS

• IMPETIGO :
The patches develop
into oozing, pus-filled
vesicles on a red base,
which will later form
thick, honey colored
crusts
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
IMPETIGO (PYODERMA) AND ERYSIPELAS

• ERYSIPELAS
• reddening of the skin
on the face, arms or
legs, with distinct
margins
• may be fatal
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
IMPETIGO (PYODERMA) AND ERYSIPELAS

• ERYSIPELAS
• swollen local lymph
nodes
• pain
• fever and chills
• leukocytosis
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
IMPETIGO (PYODERMA) AND ERYSIPELAS
PATHOGENS AND VIRULENCE FACTORS

• S. aureus 80%
• S. pyogenes 20%

TRANSMISSION: direct contact; fomites

 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
IMPETIGO (PYODERMA) AND ERYSIPELAS
VIRULENCE FACTORS S. pyogenes

VIRULENCE FACTOR ROLE

M protein Destabilizes complement and interferes with
phagocytosis and lysis of bacterium
Hyaluronic acid “camouflage” the bacterium, hide it from
phagocytes
Pyrogenic toxins (erythrogenic toxins) proteins that stimulate
macrophages and helper T lymphocytes to
release cytokines that produces fever,
widespread rash and shock
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
IMPETIGO (PYODERMA) AND ERYSIPELAS
DIAGNOSIS AND TREATMENT

TREATMENT:
DIAGNOSIS:
Topical Mupirocin
Lesions
Oral cloxacillin
g/s and c/s of blister fluid
Gentle washing with soap
and water
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
NECROTIZING FASCIITIS

Streptococcus pyogenes

• sensationalized as the
“Flesh eating bacteria”
• intense pain and
swelling at the site of
infection
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
NECROTIZING FASCIITIS

Streptococcus pyogenes

• Involves:
• skin
• muscles
• connective tissue
surrounding muscles
• fats
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
NECROTIZING FASCIITIS

Streptococcus pyogenes

• sunburnlike rash
• fever
• malaise, nausea
• sensorial change
• hypotension
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
NECROTIZING FASCIITIS

PATHOGEN AND VIRULENCE

FACTORS:

• Group A strep: most common cause

• S. aureus
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
NECROTIZING FASCIITIS

PATHOGEN AND VIRULENCE

FACTORS:

Streptococcus pyogenes
DEOXY- EXOTOXIN A
HYALURONIDASE
STREPTOKINASES Causes toxemia
RIBONUCLEASES Breaks down
Dissolves blood clot hyaluronic acid STREPTOLYSIN S
Breaks down DNA between cells
Kills human cells
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
NECROTIZING FASCIITIS

PATHOGEN AND VIRULENCE

FACTORS:
S. pyogenes

Entrance through wounds and rapid

spread along muscle fascia
Secretion of enzymes and toxins,
destroying tissues several cms per hour

Organ failures cause MR of >50%

 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
NECROTIZING FASCIITIS

DIAGNOSIS AND TREATMENT

• EXTREME, ACUTE PAIN

• FEVER • AGGRESSIVE SURGICAL
• LEUKOCYTOSIS MANAGEMENT
• INFLAMMATORY SIGNS • IV BROAD SPECTRUM
• RAPID WORSENING OF ANTIBIOTIC
SKIN AND SOFT TISSUE
SIGNS

DIAGNOSIS TREATMENT
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
ACNE

• Propionibacterium acnes:
• most common cause (85%)
• small, gm+ diphtheroids
• propionic acid: by-product of
their fermentation of
carbohydrates
BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
ACNE
BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
ACNE
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
ACNE
DIAGNOSIS AND TREATMENT

TREATMENT:
- for severe cases:
antibiotics (Doxycycline)
- Benzoyl peroxide –
exfoliate dead cells
- Retinoic acid – inhibits
formation of sebum
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
ACNE
DIAGNOSIS AND TREATMENT

WILL EATING
CHOCOLATES CAUSE
ACNE?
BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
CAT SCRATCH DISEASE

• Bartonella henselae
• gram – aerobic bacilli
• can grow and
reproduce inside
RBCs and in cells
lining blood vessel
walls
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
CAT SCRATCH DISEASE
SIGNS AND SYMPTOMS

• Fever
• Prolonged malaise
• Localized swelling at the site of infection and
nearby lymph nodes for several months
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
CAT SCRATCH DISEASE
Cat scratch,
bite; flea bites
introduce the
bacteria into
the skin

Bacteria grows
intracellularly,
releases
endotoxin =
pathogenesis inflammation
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
CAT SCRATCH DISEASE
DIAGNOSIS AND TREATMENT

• IFAT: confirmatory
• TREATMENT: Azithromycin
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
PSEUDOMONAS INFECTION

• Gram negative, aerobic

bacilli
• ubiquitous
• Virulence factors:
• fimbriae and other adhesins
• neuraminidase
• polysaccharide capsules
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
PSEUDOMONAS INFECTION

•Virulence factors:
• fimbriae and other adhesins
• neuraminidase
• polysaccharide capsules
• endotoxin
• exotoxin A and exoenzyme S
• elastase
• pyocyanin
BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
PSEUDOMONAS INFECTION
 BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
PSEUDOMONAS INFECTION
Malignant Otitis Externa

Chronic, non-healing DM foot ulcer

BACTERIAL DISEASES OF THE SKIN AND
WOUNDS:
PSEUDOMONAS INFECTION

• MICROBIOLOGIC • ANTI-PSEUDOMONAL
WORK–UP OF AGENTS
SPECIMENS : GRAM • DRAINAGE OF
STAINING AND C/S ABSCESS

DIAGNOSIS TREATMENT