Chapter 21 Study Guide

Structure/Defenses of Human Skin

 Epidermis and Dermis

 Perspiration and sebum have nutrients
 Salt inhibits nutrients
 Lysozyme hydrolyzes PG
 Fatty Acids inhibit some microbes
 Defensins

Normal Microbiota of the Skin

 Gram positive, salt tolerant bacteria

o Staphylococci
o Micrococci
o Diptheroids
 Aerobes on the Surface
 Oil is nutrient source
 Anaerobe in hair follicle
o Propionibacterium acnes
 Yeast
o Malassezia furfur

Skin Lesions

 4 Kinds
o Vesicle: Tiny; fluid filled; on surface
o Bulla: Large; fluid filled; on surface; normally burst
o Macule: Flat and red rash
o Pustule: Pus filled; Raised

Bacterial Skin Infections

 Staphylococcal Skin Infections

o Staphylococcus Epidermidis
 Gram positive; coagulase negative; AKA Cons
 Normal microbiota in healthy patients
 Opportunistic infections (in immune deficient pts.)
 See a lot of infections in catheters and other medical devices
 o Staphylococcus Aureus
 Gram positive; coagulase positive
 True pathogen; infects healthy people
 It’s a serious infection because…
 Antibiotic resistant
 Leukocidin
 Resists opsonization
 Survives phagolysosome
 Lysozyme resistant
 Exfoliative toxin
 Super antigen

o Staphylococcal Skin Infections cause

 Folliculitis: infections of hair follicle
 Sty: folliculitis of an eyelash
 Furuncle: abscess: pus surrounded by inflamed tissue
 Carbuncle: inflammation of tissue under the skin
 Impetigo: crusting non-bolus sores

o Staph Aureus Skin Infections cause

 Toxic Shock Syndrome: caused by toxic shock syndrome toxin 1; super
antigen
 Scalded Skin Syndrome: AKA bolus impetigo; due to exfoliative toxin

 Streptococcal Skin Infections

o Streptococcus Pyogenes AKA Group A Strep
 True Pathogen
 Beta hemolytic streptococci
 Hemolysins
 Hyaluronidase (break down connections between cells)
 Streptolysins
 M Proteins (exotoxin A)
o Erysipelas: dermal infections
o Necrotizing fasciitis: flesh eating disease
o Streptococcal Toxic Shock Syndrome: cause by streptococcal M proteins; binds
to neutrophils; activates neutrophils

 Pseudomonas Infections
o Pseudomonas Aeruginosa
 Opportunistic
  Environmental microbe
 Cause post burn infections; green pus due to pyocyanin
 Seen in CF patients

o Buruli Ulcer
 Caused by Mycobacterium Ulcerans
 Acid fast
 Deep ulcer
 Tropical disease

 Acne
o Comedonal (mild)
 Blocked sebum gland
o Inflammatory
 Propionibacterium acnes: infection of blocked gland
 Treat with antibiotics
o Nodular Cystic Acne (severe)
 Severe
 Treat with antibiotics
 Treat with Isotretinoin to prevent sebum formation
Viral Infections

 Warts
o Caused by papillomavirus
o Can cause cancer; oncogenic virus
 Specifically HPV16 and HPV18
o Can prevent with vaccination

 Pox Viruses
o Small Pox/Variola
 2 Kinds
 Variola Minor: <1% death rate
 Variola Major: 20% mortality rate
 Eradicated by vaccination
 Transmitted by respiratory route
 Contagious
 Potential bio warfare agent

o Chicken Pox Virus (pustules)

 Caused by varicella-zoster virus (HHV3)
  Transmitted by respiratory route
 Contagious; Easily transmitted
 Prevented by vaccination
 Lays latent in dorsal root; can come back years later as shingles

o Shingles
 Reactivation of HHV3 virus
 Complication of shingles is post herpetic neuralgia (nerve pain)
 Prevented by vaccination
 Treated with Acyclovir (lessens symptoms)

o Herpes Simplex Virus (HSV): Vesicular lesions; Transmitted by contact

 HSV1: Cold sores; latent in trigeminal nerve
 HSV2: genital herpes caused by Herpes encephalitis
 Latent in sacral nerve ganglia
o Encephalitis: can be transmitted through vertical
transmission
o Encephalitis has 70% mortality rate
o Treated with Acyclovir

Childhood Rashes (Transmitted by Respiratory Route)

 Measles
o Get Macular rash (flat) and Koplik’s spots (silvery spots in mouth)
o Complications of Measles: Encephalitis (CNS infection)
o Prevented by vaccination
o Contagious

 Rubella
o Macular Rash
o Congenital infections lead to congenital rubella syndrome
o Prevented by vaccine

 Fifth Disease
o Caused by human parvovirus

 Roseola
o Caused by HHV6 and HHV7
Fungal Infections AKA Mycoses

 Cutaneous Mycoses
o Metabolizes Keratin
o Usually ringworm or tineus
o Usually treated with azoles like miconazole or allylamine
o Fungi Involved:
 Trichophyton: infects hair, skin and nails
 Epidermophyton: Infects skin and nails
 Microsporum: infects hair and skin

 Subcutaneous Mycoses
o More serious than cutaneous mycoses
o Infections usually a puncture wound
o Caused by Sporothrix schenkii

 Candidiasis
o Caused by Candida albicans (yeast)
o Treated with Azoles
o May occur when antibiotics suppress competing bacteria; can cause:
 Thrush: mouth and throat
 Yeast Infection: vulvovaginal candidas
 Fulminating Disease in immunosuppressed people (Rapid systematic
infections)
Arthropods

 Scabies
o Caused by Sarcoptes scabiei
o Burrows in the skin
o Treated with topical insecticides

 Pediculosis (Lice)
o Pathogen: pediculus capitis

Eye Infections

 Conjunctivitis
o Inflammation of the eye
o Pink eye cause by Haemophilus influenza
 3 Kinds of conjunctivitis
o Opthalmia neonatorum
  Caused by Neisseria gonorrhoeae
 Vertical transmission
o Chlamydia Trachomatis
 Called inclusion conjunctivitis
 Vertical transmission
 Can cause Trachoma
 Leading cause of blindness in the world
 Infection causes permanent scarring; scars abrade cornea; leading
to blindness
o Keratitis:
 Caused by bacteria, fungus, HSV, acanthamoeba