Professional Documents
Culture Documents
D
WHPL
Keratin
Skin sloughing
Sebum: low pH, high lipid
Sweat: low pH, high salt, and
Lysozyme, which digests peptidoglycan
Propionibacterium acnes
Corynebacterium sp.
Staphylococci
◦ Staphylococcus epidermidis
◦ Staphylococcus aureus
Streptococci sp.
Candida albicans (yeast)
Many others
Bacteria are single celled micro-organisms
◦ Spherical, doublets, and spirochetes
Staphylococcus
◦ Gram positive bacteria that appears in clumps in
skin and upper respiratory tract
Streptococcus
◦ Chain bacteria often associated with systemic
disease and skin infections
Bacillus
◦ Spore forming, aerobic, and occasionally mobile
◦ Can cause systemic damage
Impetigo Contagiosa &
Erysipelas
◦ Etiology
Caused by A-beta-hemolytic streptococci, S aureus or
combination of these bacteria
Spread through close contact
Impetigo occurs most in children
Erysipelas can also occur in the elderly
◦ Signs and Symptoms
Mild itching and soreness followed by eruption of small
vesicles and pustules that rupture and crust
Generally develops in body folds that are subject to
friction
◦ Management
Cleansing and topical antibacterial agents
Systemic antibiotics
Furunculosis
(Boils)
◦ Etiology
Infection of
hair follicle
that results in
pustule
formation
Generally the
result of a
staphy.
infection
◦ Signs and Symptoms
Pustule that becomes reddened and
enlarged as well as hard from internal
pressure
Pain and tenderness increase with
pressure
Most will mature and rupture
◦ Management
Care involves protection from
additional irritation
Referral to physician for antibiotics
Keep athlete from contact with other
team members while boil is draining
Carbuncles
◦ Etiology
Similar in terms of early stage development as
furuncles
◦ Signs and Symptoms
Larger and deeper than furuncle and has several
openings in the skin
May produce fever and elevation of WBC count
Starts hard and red and over a few days emerges
into a lesion that discharges yellowish pus
◦ Management
Surgical drainage combined with the
administration of antibiotics
Warm compress is applied to promote circulation
Folliculitis
◦ Etiology
Inflammation of
hair follicle
Caused by non-
infectious or
infectious agents
Moist warm
environment and
mechanical
occlusion
contribute to
condition
Psuedofolliculitis
(PFB)
◦ Signs and Symptoms
Redness around follicle that is followed by
development of papule or pustule at the
hair follicle
Followed by development of crust that
sloughs off with the hair
Deeper infection may cause scarring and
alopecia in that area
◦ Management
Management is much like impetigo
Moist heat is used to increase circulation
Antibiotics can also be used depending
on the condition
Hidradenitis Suppurativa
◦ Etiology
Primary inflammation event of the hair follicle
resulting in secondary blockage of the apocrine
gland
◦ Signs and Symptoms
Begins as small papule that can develop into
deep dermal inflammation
◦ Management
Avoid use of antiperspirants, deodorants and
shaving creams
Use medicated soaps and systemic antibiotics
Acne Vulgaris
◦ Etiology
Inflammatory disease of the hair follicle and the
sebaceous glands
Sex hormones may contribute
◦ Signs and Symptoms
Present with whiteheads, blackheads, flesh or
red colored papules, pustules or cysts
If chronic and deep = may scar
Psychological impact
◦ Management
Topical and systemic agents used to treat acne
Mild soaps are recommended
Paronychia and Onychia
◦ Etiology
Caused by staph, strep and or fungal organisms that
accompany contamination of open wounds or hangnails
Damage to cuticle puts finger at risk
Paronychia – inflamation / infection of the surrounding
tissue
Onychia – infection of the nail.
◦ Signs and Symptoms
Rapid onset; painful with bright red swelling of proximal
and lateral fold of nail
Accumulation of purulent material w/in nail fold
◦ Management
Soak finger or toe in hot solution of Epsom salt 3 times
daily
Topical antibiotics, systemic antibiotics if severe
May require pus removal through skin incision
Streptococcus pyogenes (Group A
Strep)
Tissue digesting enzymes
◦ Hyaluronidase
◦ Streptokinase
◦ Streptolysins
Rapidly spreading cellulitis may lead
to loss of limb
• Disease starts as localized infection
• Pain in area, flu-like symptoms
Invasive and spreading
May lead to toxic shock (drop in
blood pressure)
Incidence 1-20/100,000
30-70% mortality
Surgical removal, antibiotics
Mycobacterium leprae
Disease of skin and nerves
Change of pigmentation, loss of
sensation
Slow progressing
Transmits poorly
Droplet or skin contact?
Mycobacterium
leprae
Acid fast bacterium
Slow growth
Strict parasite
Multiplies in
macrophages
Prefers cool areas
of body
Long course, drug
cocktail
Staphylococcal Scalded Skin
Syndrome
◦ Pathogen and virulence factors
Some Staphylococcus aureus strains
One or two different exfoliative toxins cause SSSS
◦ Pathogenesis
No scarring because dermis is unaffected
Death is rare but may be due to secondary
infections
◦ Epidemiology
Disease occurs primarily in infants
Transmitted by person-to-person spread of
bacteria
Staphylococcal Scalded Skin
Syndrome
◦ Diagnosis, treatment, and prevention
Diagnosed by characteristic sloughing
of skin
Treated by administration of
antimicrobial drugs
Widespread presence of S. aureus
makes prevention difficult
Sacral ganglia
Site of viral latency
Genital
herpes Whitlow
Varied of forms exist
◦ verruca plana (flat wart), verruca plantaris
(plantar wart), and condyloma acuminatum
(venereal wart)
Different types of human papilloma virus
have been identified
◦ Uses epidermal layer of skin to reproduce and
growth
Wart enters through lesion in skin
Common Wart
◦ Signs and Symptoms
Small, round, elevated lesion
with rough dry surfaces
Painful if pressure is applied
May be subject to secondary
bacterial infection
◦ Management
If vulnerable, they should be protected until treated by
a physician
Use of electrocautery, topical salicylic acid or liquid
nitrogen are common means of managing this
condition
Plantar Warts
◦ Etiology
Spread through papilloma virus
◦ Signs and Symptoms
Located on sole of foot, on or adjacent to areas of
abnormal weight bearing
Areas of excessive epidermal thickening
Discomfort, point tenderness
Hemorrhagic puncta (black seeds)
◦ Management
While in competition, protect and prevent spreading
Pair away callus and apply keratolytic
Following season, wart can be removed by freezing it or
by electrodessication (maintain protection until removal)
Molluscum Contagiosum
◦ Etiology
Poxvirus infection which is more contagious than
warts (especially during direct body contact)
◦ Signs and Symptoms
Small, flesh or red colored, smooth-domed papules
with central umbilication
◦ Management
Physician referral is necessary
Cleansing and destructive procedure (counterirritant
such as cantharidin, surgical removal or cryosurgery)
Viral infection through aerosol droplet: One of the
MOST communicable viruses
Initial infection of the oro-pharynx
local infection lymph node(s) (of the neck)
lymphocyte associated viremia
Fever, malaise
Spread throughout the body
Shed in respiratory tract secretions
Koplik’s spots
Skin Rash
Recovery; life long immunity
Effective childhood vaccine (2-3 doses): MMR
(measles, mumps, rubella), but disease still exists
worldwide
Viral infection through aerosol droplet;
systemic infection
A ~Mild~ rash
Serious for a fetus when contracted in the
first trimester of pregnancy
Disrupts fetus development of the CNS
and/or other organs: Congenital Rubella
Syndrome
Small birth weight, blindness, hearing
loss, mental retardation, heart problems
Infection lasts for months-years in the
newborn
Vaccine highly effective (MMR)
Common virus; decreasing disease in
the USA due to effective childhood
vaccine
Benign disease with life long immunity
Life-threatening for
immunocompromised individuals
Recuperation can result in life long
benign Varicella-zoster virus latency
May re-emerge as shingles (skin
lesion): Should we vaccinate adults?
Viral infection through aerosol droplet; systemic
infection
local infection in lymph node(s) (of the neck)
lymphocyte associated viremia
Fever, malaise
Spread throughout the body
Shed in respiratory tract secretions and
Skin Vesicles (small blisters of clear fluid)
Recovery with virus latency in neurons
Life long immunity
May re-emerge as shingles and spread to others
(skin vesicular lesions):
Varicella-zoster virus reemergence as shingles
A disease with an interesting history
Very infectious viral disease (epidemic)
The disease has been eliminated due to
world-wide vaccine program:
Vaccinia: a Jennerian vaccine
Named for Edward Jenner, 1796
The virus has been preserved in
government labs by agreement, at CDC
in Atlanta, and in Russia
Considered a bioterrorism agent